Dengue Eye Disease
Manifestations of dengue in the eye, though rare in the past, are now more recently noted to be common in some outbreaks. The most common manifestation, besides the expected complication of bleeding on macula, seems to be foveolitis or maculopathy (1) Sometimes the maculopathy may resolve spontaneously (2) The prevalence may vary according to the subtype of the virus but it can be as high as 10% in some outbreaks (3) (4). Optical coherence tomography (OCT) patterns may be used to predict the visual outcomes of maculopathy (5) and function may be assessed with Electroretinography (6), and some authors have stressed the need to look at both structure and function (7). Some authors have correlated visual field changes with OCT (8) and others (9) have demonstrated a parafoveal retinal thickness and subfoveal chorioidal thickness. Dengue can have various manifestations in the eye, (10)(11) and more recently a newer terminology of “dengue eye disease” has emerged (12). Dengue may have presenting features of subconjunctival haemorrhage and ecchymosis (13). It may have unusual presentations like frosted branch angitis (14) or papillodema secondary to cerebral veinous thrombosis (15). It may cause a central retinal artery occlusion (16), a branch retinal artery occlusion (17) or subhyaloid haemorrhage (18). In severe, unusual cases it has been found to cause even proptosis and globe rupture, as seen by Nagaraj et al (19).
It can also cause symptomatic inflammatory manifestations like retinochoroiditis (20) vasculitis, choroidal neovascularisation (21) secondary to immune damage, and even panophthalmitis (22).
One needs to be aware that it has been known to cause both eye involvement with potential to make a person irreversibly bilaterally blind by causing bilateral vitreous haemorrhage (23), bilateral stellar neuroretinitis (24), bilateral choroidal effusion (25) and may be a suspect ethology even for bilateral acute angle closure glaucoma (26), oculomotor paralysis (27) and optic neuropathy (28). The " Seet Quek Lim triad" of flashes of light, floaters and blurring of vision (29) may now warrant an ophthalmic consult and if not requested may be construed as negligence if eventually the patient loses vision, because dengue vision loss can be irreversible and may be seen in up to 10 percent of cases and has potential to cause bilateral irreversible visual impairment or blindness as reported.
Besides this the patient may present with an opsoclonus which may point towards an encephalopathy (30) (31) and so the expected retinal and macular haemorrhages (32) (33) are not the only pathologies that dengue can cause in the eye.
One also needs to remember that in endemic areas recurrence of infection may mean recurrence of bilateral eye involvement (34).
If it is uveitis it may recover well with steroids like some reports suggest (35) but bilateral cases like vasculitis and macular oedema (36) one may need to use newer medications and even 66 years after eye manifestations of dengue were first reported (37) ,dengue continues to blind people and greater awareness and timely referral is important even today.
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Competing interests: No competing interests