NEWS
03 November 2023

Are these moths blinding children? Nepalese researchers seek answers

Researchers are carrying out environmental surveys and genomic sequencing to try to learn more about SHAPU, a severe eye condition that mainly affects children — but funding is still scarce.

Saugat Bolakhe

September is typically the end of the monsoon season in Nepal — and the time of year when eye clinicians begin to worry. A mysterious and debilitating eye infection, known as seasonal hyperacute panuveitis1 (SHAPU), starts afflicting people, mainly children, in some parts of the country. Symptoms typically start with a painless reddening and loss of pressure in one eye. If the condition is not treated within 24 to 48 hours, the children are at risk of losing their eyesight.

But in 2023, researchers in Nepal are more committed and better equipped than ever before to determine the cause of this puzzling condition. For the first time, they have environmental surveys, genomic sequencing and a reporting system in place to track down its source. However, they are up against major funding challenges, and this year, reports of the disease have changed. “The cases have come from previously unreported territories and the severity of symptoms has also become quite unpredictable,” says Ranju Kharel (Sitaula), an ophthalmologist at the Institute of Medicine at Tribhuvan University in Kathmandu.

Every two years

The disease itself is not new. Back in 1979, ophthalmologist Madan P. Upadhyay, now chair emeritus at the BP Eye Foundation in Kathmandu, was woken by the sound of his doorbell. Outside was a man clutching his three-year-old daughter, her right eye inflamed. The scene was familiar, matching cases Upadhyay had seen before — first in 1975, and again in 1977. Upadhyay named the mysterious illness SHAPU, and noted that, inexplicably, cases seemed to spike every two years.

The condition turned out to be more serious that doctors had first realized. “Initially, we thought that the condition was just an inflammation but it would shrink the whole eyeball, and treatment options couldn’t save the vision in kids,” says Anu Manandhar, an uveitis specialist at the Tilganga Institute of Ophthalmology in Kathmandu.

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