George Christopher
Michigan, United States

A pivotal moment in the history of Christianity was the conversion of St. Paul while en route to Damascus. “On his journey…a light from the sky suddenly flashed around him…he fell to the ground and heard a voice saying to him, Saul, Saul, why are you persecuting me? …when he opened his eyes, he could see nothing.” After three days of blindness, his sight was restored after the laying on of hands by Ananias. “Immediately things like scales fell from his eyes and he regained his sight.” (Acts 9:3-18).

The etiology of St. Paul’s acute yet transient blindness has been the subject of diagnostic speculation. Temporal lobe epilepsy has been proposed as a unifying diagnosis to explain St. Paul’s ecstatic visions and perceptual experience of hearing voices, followed by post-ictal blindness.¹ However, this formulation has been criticized because he reported multiple visionary experiences during his lifetime yet only one episode of blindness.^1,2 Other proposed etiologies include lightning strike,³ corneal and/or retinal burns caused by intense sunlight,⁴ basilar artery insufficiency,⁵ vitreal hemorrhage,⁵ migraine, occipital trauma sustained during his fall to the ground, and psychogenic blindness cured by suggestion.¹ However, none of these diagnoses address the symptom that “scales fell from his eyes” when his visual function returned. Is this passage a figurative account of the sudden restoration of eyesight, or a literal description of a recovery from pseudomembranous conjunctivitis?

Conjunctival pseudomembranes are yellow-white lesions consisting of cellular debris that may coalesce across the bulbar conjunctivac, thereby covering the pupils and causing near-total blindness and photophobia. Etiologic agents that were likely to be circulating during Biblical times include viruses (adenoviruses, enteroviruses) and bacteria(Corynebacterium diphtheriae, Neisseria gonorrhoeae, Mycoplasma pneumoniae, and Streptococcus pyogenes). An especially interesting etiology in the context of St. Paul’s environmental exposure is ophthalmomyiasis, or conjunctivitis caused by the larvae of the sheep botfly Oestrus ovis, which is endemic in sheep-farming areas including those of the eastern Mediterranean littoral.⁶ Recently emerging etiologies of pseudomembranous conjunctivitis include SARS-CoV-2 (the agent of COVID-19)^7,8 and conjunctival graft-versus-host disease.⁹ Pseudomembranes are easily removed from the underlying epithelium. Cases due to viruses are generally self-limited, while bacterial cases may lead to loca and systemic complications. Ophthalmomyiasis usually responds to physical removal of the larvae.

Miracles are experienced but not understood. They may present as seemingly ordinary events that occur under particular circumstances and lead to otherwise unexplainable effects.¹⁰ Consequently, the circumstance (during travel to lead a persecution) and the effect (as part of the conversion experience) might allow that the cause of St. Paul’s blindness was a miraculously timed case of pseudomembranous conjunctivitis. However, although a diagnosis of pseudomembranous conjunctivitis might explain “things like scales” falling from St. Paul’s eyes and concurrent restoration of vision, it would not explain the instantaneous onset and resolution of symptoms. Furthermore, St. Thomas Aquinas wrote that although God acts through secondary (natural) causes (for example, during cosmogenesis and evolution), miracles are caused directly by God and go beyond nature.¹¹ Consequently, the implication of pseudomembranous conjunctivitis as the cause of St. Paul’s blindness seems neither necessary nor sufficient from theological and medical perspectives, respectively. Whether or not the description of scales falling from his eyes and consequent restoration of sight is a literal account of a highly atypical yet miraculously timed case of pseudomembranous conjunctivitis, the immediate resolution of the scales may serve as a metaphor of the sudden receipt of revealed insight.

References

1. Landsborough D. St Paul and temporal lobe epilepsy. J Neurol Neurosurg Psychiatry. 1987;50(6):659-664. doi:10.1136/jnnp.50.6.659.
2. Stern A. Zum Problem der Epilepsie des Paulus. Psychiat Neurol (Basel). 1957;133:276-284.
3. Bullock JD. Was Saint Paul struck blind and converted by lightning? Surv Ophthalmol. 1994;39(2):151-160. doi:10.1016/0039-6257(94)90161-9.
4. Manchester PT, Manchester PT Jr. The blindness of St. Paul. Arch Ophthalmol. 1972;88:316-321.
5. Bullock JD. The blindness of St. Paul. Ophthalmology. 1978;85:1044-1053.
6. Özyol P, Özyol E, Sankur F. External ophthalmomyiasis: a case series and review of ophthalmomyiasis in Turkey. Int Ophthalmol. 2016;36(6):887-891. doi:10.1007/s10792-016-0204-9.
7. Roshanshad A, Ashraf MA, Roshanshad R, Kharmandar A, Zomorodian SA, Ashraf H. Ocular manifestations of patients with Coronavirus Disease 2019:a comprehensive Review. J Ophthalmic Vis Res. 2021;16(2):234-247.
8. Navel V, Chiambaretta F, Dutheil F. Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. Am J Ophthalmol Case Rep. 2020;19:100735.
9. Liu YC, Gau JP, Lin PY, et al. Conjunctival acute graft-versus-host disease in adult patients receiving allogeneic hematopoietic stem cell transplantation: a cohort study. PLoS One. 2016;11(11):e0167129.
10. McInerny RM. Miracles: A Catholic View. Huntington, IN: Our Sunday Visitor Publishing Division; 1986.
11. Aquinas T. Summa Theologica Part 1, Question 105. Translated by Alfred J. Freddoso. Available at: https://www3.nd.edu/~afreddos/summa-translation/Part%201/st1-ques105.pdf. Accessed July 23, 2024.