Dengue Stings the Eye!

Abstract

Dengue is a vector borne viral fever and has varied ocular affections. We report two cases of Dengue Associated Maculopathy (DAM). The first patient was a 22-year-old lady with dengue fever, presented with diminution of vision in the left eye with best corrected visual acuity of 20/40. Fundus revealed soft exudates and streak haemorrhages at the macula in the left eye. Optical Coherence Tomography (OCT) showed cystoid macular oedema. She recovered completely within four days. The second patient was a 33-year-old lady with dengue, with blurred vision in the left eye and with a visual acuity of 20/80. Fundus examination in the left eye revealed elevated fovea with a yellow well circumscribed lesion with surrounding striations. OCT showed features suggestive of foveolitis. She improved spontaneously over the next 21 days to a visual acuity of 20/20p. DAM is usually a self-limiting condition with favourable prognosis. This report highlights the importance of anticipating visual morbidity in patients with dengue and a thorough evaluation and follow-up in spite of its benign behaviour. Also, this report highlights the importance of OCT in differentiating various presentations of DAM.

Keywords: Central scotoma; Cystoid macular oedema; Dengue associated maculopathy; Foveolitis.

[Table/Fig-1]:

Fundus of the right eye, in patient 1: demonstrating increased reflexes at the macula, inferior to fovea, rest of the fundus is unremarkable.

[Table/Fig-2]:

Fundus of the left eye, in patient 1: streak haemorrhages at macula with soft exudates, absence of foveolar reflex, rest of the fundus is unremarkable.

[Table/Fig-3]:

Optical coherence tomography, macular thickness profile (patient 1) showing normal foveal curvature in the right eye (above insert) with a normal central subfield thickness (274μm) and left eye had cystoid space in the inner retinal layers with nasal macular thickening (below insert) and a central subfield thickness of 294 μm.

[Table/Fig-4]:

Optical coherence tomography (patient 1) of left eye demonstrating a macular thickness change analysis from before (above insert) with cystoid space in the inner layer of retina to normal foveal contour after four days of observation. (below insert)

[Table/Fig-5]:

Fundus of the right eye, in patient 2: demonstrating hyperemic disc and a few blot haemorrhages temporal to the disc, rest of the fundus is unremarkable.

[Table/Fig-6]:

Fundus of the left eye, in patient 2: hyperaemic disc, subretinal discrete yellow lesions in the macula, with interspersed splinter haemorrhages. The fovea has a well circumscribed yellow lesion surrounded by striations.

[Table/Fig-7]:

Optical coherence tomography, macular thickness profile (patient 2) showing normal foveal curvature in the right eye (above insert) with a normal central subfield thickness (258μm) whereas left eye has distorted foveal contour, cystoid spaces in the inner retinal layers and an elevated hyper reflective lesion arising from the inner segment-outer segment junction entering the outer nuclear zone consistent with foveolitis. Macular thickening noted at fovea and superonasal to fovea.

[Table/Fig-8]:

Optical coherence tomography (patient 2) of left eye demonstrating a macular thickness change analysis from before (above insert) with foveolitis to a thinned foveola after 20 days of observation. (below insert)