Dengue Stings the Eye!

Abstract

A 22-year-old girl with dengue fever and thrombocytopenia (64,000/ cu. mm) was referred for unilateral sudden painless diminution of vision on the fourth day of fever, when she was convalescing from the infection. On examination, best corrected visual acuity in the right eye was 20/20 and in left eye was 20/40. Amsler grid showed a central scotoma in the left eye. Anterior segment and intra ocular pressure were well within normal limits. Fundus examination revealed increased reflexes at the macula in the right eye, whereas there were streak macular haemorrhages with soft exudates, in the left eye [Table/ Fig-1,2]. An Optical Coherence Tomography (OCT) was performed. Right eye macula was normal, however left eye showed cystoid spaces in the outer nuclear layers suggestive of cystoid macular oedema . Other causes of cystoid macular oedema were ruled out, there was no history of trauma, intraocular surgery and Erythrocyte Sedimentation Rate (ESR) and blood sugars were normal. However, other causes of vasculitis were not ruled out. On the basis of this clinical framework, a diagnosis of DAM was made. As there are no proven treatment guidelines, we opted for observation. She recovered remarkably with full anatomic resolution over the next four days, without specific treatment. Visual acuity was 20/20 and central scotoma had disappeared. OCT was within normal limits [Table/ Fig-4], her platelet count being 1,78,000 /cu.mm.The second patient was a 33-year-old lady, referred by her physician for assessment of low visual acuity in the left eye that commenced on the seventh day of fever, when she was convalescing from dengue. Her serial platelet count was at its nadir of 68,000/cu.mm. On examination, best corrected visual acuity in the right eye was 20/20 and in the left eye was 20/80. Amsler grid showed a central scotoma. Anterior segment and intraocular pressure were normal. Fundus examination of the right eye revealed hyperemic disc and a few blot haemorrhages were noted temporal to the disc. Macula had a few discrete subretinal yellow lesions in the right eye. However, fovea was normal in the left eye, disc was mildly elevated and was hyperemic, subretinal discrete yellow lesions in the macula, with interspersed splinter haemorrhages were noted. The fovea was elevated with a yellow well circumscribed lesion at the

Characterization of Retinopathy Among Patients With Yellow Fever During 2 Outbreaks in Southeastern Brazil

“…The most common fundus changes among the 20 eyes were RNFL infarcts (11 [55%]), superficial hemorrhages (7 [35%]), including Roth spots, and grayish deep lesions that appeared to be at the level of the outer retina or choroid (6 [30%]). The observed RNFL infarcts and superficial hemorrhages were nonspecific and similar to those described among individuals infected by other flaviviruses, such as dengue virus . These acute microangiopathic changes are probably associated with occlusion of RNFL precapillary arterioles (Figure 1 and Figure 2) owing to immune-mediated endothelial damage and coagulopathy, peaking at the nadir of thrombocytopenia .…”

Study of Ocular Manifestations in Patients Hospitalized with Dengue Fever

“…The findings of our study were similar to that of Sujatha R et al, [27] albeit with minor differences. While a number of studies in India and globally have noticed Foveolitis as one of the characteristic finding, it was not seen in any of our patients [9,30].…”

Chronic symptoms persisting after travel-related infections

“…Dengue may also cause permanent neurological or ocular damage, including stroke [53,54], parkinsonism [55], myelitis [56], AQP4-antibody-related neuromyelitis optica spectrum disorder [57,58], necrotising scleritis [59], dengue-associated maculopathy [60], outer retinal damage [61], or glaucoma [62].…”