Hepatitis C: a review of diagnosis, management, and ocular complications from treatment

Chronic hepatitis C is a serious condition that can lead to cirrhosis of the liver, and may progress to life-threatening hepatocellular carcinoma. Timely diagnosis and treatment of patients at risk for severe liver disease from the chronic hepatitis C virus is imperative to prevent life-threatening illness. Current combination therapy of interferon alpha and ribavirin is the most successful treatment. However, patients must be monitored closely, as this therapy may produce serious ocular and systemic side effects.

A 53-year-old white man, who was undergoing treatment for chronic hepatitis C with peginterferon alpha-2b and ribavirin, came to the eye clinic for routine examination. Dilated funduscopy was clear O.D., but revealed flame-shaped hemorrhages and one cotton-wool spot in the superior/temporal arcade O.S. The retinopathy was attributed to peginterferon treatment and resolved completely with no recurrences over the rest of the treatment period.

Patients in need of treatment for chronic hepatitis C should have a baseline fundus examination before initiating treatment to identify any pre-existing retinopathy. Patients with pre-existing retinopathy from diabetes or hypertension should be monitored monthly for progression throughout the course of treatment for chronic hepatitis C. Patients without pre-existing retinopathy in whom mild interferon retinopathy develops should be monitored monthly until the retinopathy resolves. Patients in whom proliferative retinopathy develops must be re-evaluated by their internists to determine whether treatment for chronic hepatitis C should be continued. These patients should also be referred for consultation for pan-retinal photocoagulation.