Ophthalmic complications of dengue

Abstract

We report 13 cases of ophthalmic complications resulting from dengue infection in Singapore. We performed a retrospective analysis of a series of 13 patients with dengue fever who had visual impairment. Investigations included Humphrey automated visual field analyzer, Amsler charting, fundus fluorescein angiography, and optical coherence tomography. Twenty-two eyes of 13 patients were affected. The mean age of patients was 31.7 years. Visual acuity varied from 20/25 to counting fingers only. Twelve patients (92.3%) noted central vision impairment. Onset of visual impairment coincided with the nadir of serum thrombocytopenia. Ophthalmologic findings include macular edema and blot hemorrhages (10), cotton wool spots (1), retinal vasculitis (4), exudative retinal detachment (2), and anterior uveitis (1). All patients recovered visual acuity to 20/30 or better with residual central scotoma by 12 weeks. These new complications suggest a widening spectrum of ophthalmic complications in dengue infection.

Figure 1

Humphrey visual fields of patient 9 at 1 week after onset of visual symptoms. Central scotoma of the right visual field is denoted as black squares (red arrow).

Figure 2

Trend of serial serum platelets after the onset of dengue virus infection.

Figure 3

Fundal photos, fundal fluorescein angiography and optical coherence tomography (OCT) of patient 9. A) areas of blot hemorrhages temporal to the right fovea. B) bilateral dye leakage from the retinal veins, more severe on the right than left. C) OCT gives a 2-dimensional graphic representation of a cross-section of the macular region. The area marked with the red arrow marks the site of exudative retinal detachment. Both sides have marked retinal thickening (edema). Photo: Ken Thian.

Figure A1

Summary of patient demographics, manifestations, clinical findings, management, and outcome. DF, dengue fever; DHF , dengue hemorrhagic fever; NA, not available; BOV, blurring of vision; VA, visual acuity (Snellen); OU, both eyes; OD, right eye; OS, left eye.