Ocular manifestations in Rickettsial Disease in children admitted in tertiary care center in Northern India

Abstract

Introduction: Rickettsial disease is endemic in many parts in India. Ocular manifestation of the disease in pediatric patients is not known Methodology: This observational study was conducted in children less than eighteen years diagnosed to have Probable rickettsial disease based upon Indian Academy of Pediatrics criteria. These children underwent visual acuity by Snellen's chart and refraction, detailed anterior chamber examination by torch and slit lamp examination, dilated biomicroscopic fundus examination. Fundus fluorescein angiography was done in cases having abnormalities on biomicrocopic fundus examination. Results: A total of 36 children were diagnosed to have probable rickettsial disease. Best corrected visual acuity (BCVA) ranged from 6/6 to 6/60. Posterior Segment changes were seen in 24 (36%) patients. Bilateral changes were seen in 18 children and unilateral in six (total of 42 eyes). Ocular examination showed 0.5-1+ AC reaction in 18/42 eyes, trace vitritis in 19/42 eyes, yellowish white lesions ranging from 1/2 DD to 3 DD along the arcades in all patients, suggestive of retinitis. Five eyes had less than 3 lesion and 14 eyes had more than three. Hemorrhage along with retinitis was seen in 35 eyes. Disc edema was seen in 15 eyes. Retinal vascular sheathing was seen in twelve eyes. Macular edema with star exudates was seen in 33 eyes. Conclusion: Ocular manifestation are common in rickettsial disease. Detailed ocular examination should be done in all cases with Rickettsial disease.