An update on the ocular manifestations of dengue

Abstract

Dengue is the most common arboviral disease. It is typically spread by the bite of an infected female Aedes aegypti or Aedes albopictus mosquitoes. Dengue is endemic in subtropical and tropical regions, but its geographic reach keeps expanding. Ophthalmic manifestations of dengue are common and may present with a wide spectrum of ophthalmic findings. These may range from conjunctival petechiae, retinal hemorrhage, retinal vasculitis to panophthalmitis. Some of these may be vision threatening and may require urgent ophthalmic evaluation. The precise pathophysiologic mechanisms involved in dengue infection involve a complex interplay between host immune responses, virus, and host genes. There is no specific treatment for ocular dengue. Therefore, treatment is supportive. Despite the lack of proven efficacy, corticosteroids have been used in vision-threatening dengue-related ocular complications. Dengue must be considered in endemic areas, and a careful travel history needs to be elicited in nonendemic areas.

Keywords: Dengue maculopathy; dengue ocular; dengue retinopathy; foveolitis; mosquito ocular.

Figure 1

A 27-year-old woman with dengue who developed acute macular neuroretinopathy following dengue infection. (a) Infrared reflectance imaging of the left fundus demonstrating two oval-shaped hyporeflective lesions. (b) Spectral-domain optical coherence tomography horizontal scan across the oval-shaped hyporeflective lesion demonstrating attenuation of the ellipsoid zone

Figure 2

A 27-year-old woman with dengue who developed vitritis in her left eye. (a) Infrared reflectance imaging of the left optic nerve. (b) Spectral-domain optical coherence tomography circular scan of the retinal nerve fiber layer demonstrating hyper-reflective dots (arrow) in the vitreous cavity

Figure 3

A 20-year-old woman with dengue developed flu-like symptoms and central visual loss of her left eye. The patient was treated with 60 mg of prednisone for 2 weeks. (a) Fundus photograph of the left eye demonstrating loss of the foveal reflex suggesting macular edema. (b) Time-domain optical coherence tomography (TD-OCT) demonstrating macular edema. (c) Fluorescein angiogram demonstrating late leakage of macular retinal vessels. (d) Fundus photograph of the left eye 2 weeks postprednisone demonstrating resolution of macular edema. (e) TD-OCT 2 weeks postprednisone demonstrating resolution of macular edema. (f) Fluorescein angiogram 2 weeks postprednisone demonstrating resolution of fluorescein leakage