Chikungunya and the eye: a review

Abstract

Chikungunya is a self-limited, systemic viral infection that has been a major health problem since the past few years. Ocular manifestations of the disease have become more prevalent in the recent years. Currently, there is neither a specific treatment nor vaccine available for chikungunya fever. This review highlights the current understanding on the pathogenesis, systemic changes with an emphasis on ocular findings, laboratory investigations, and prevention and treatment of this disease.

Figure 1

Slit lamp anterior segment photographs of both eyes. From a 45-year-old woman who presented with complaints of discomfort and photophobia 6 weeks following the resolution of chikungunya fever. The photograph shows pigmented keratic precipitates in the inferior cornea right eye (A) and pigmented and stellate keratic precipitates in the left eye (B), with 1+ cells and 2+ flare in the anterior chamber of both eyes. The patient received topical corticosteroids with cycloplegics and antiglaucoma therapy.

Figure 2

Ocular involvements in chikungunya infection. (A) Fundus photograph of the left eye showing confluent area of retinal whitening suggestive of retinitis. Fundus fluorescein angiography reveals (B) early hypofluorescence in the posterior pole and (C) late hyperfluorescence in the posterior pole. (D) Spectral domain optical coherence tomography (SD OCT) revealed increased reflectivity in the nerve fiber layer zone corresponding to the areas of retinitis with after shadowing and fluid-filled spaces in the outer retina with serous retinal detachment. (E) Fundus photograph showing resolving retinitis lesion 2 weeks after initiation of systemic steroid therapy. (F) SD OCT showing decreased area of hyper reflectivity in the inner retina with resolving retinal detachment. (G) Fundus photograph after 4 months, showing complete resolution of retinitis. (H) SD OCT showing resolution of retinitis with thinning of the inner retinal layers nasal to the fovea.