Ocular Manifestations of West Nile Virus

Abstract

Ocular manifestations are a feature of West Nile virus infection. They mostly occur in association with severe neuroinvasive disease. Linear chorioretinitis is suggestive of the diagnosis and may raise diagnostic suspicion when associated with evocative systemic signs, and in an epidemic context. Various other less specific inflammatory ocular manifestations have been reported, including anterior uveitis, occlusive retinal vasculitis, optic neuritis, and diplopia. The pathophysiology of ocular disease remains unclear, but it reflects the neuroinvasiveness of the disease. Although ocular involvement most often resolves without visual sequelae, some patients may have permanent loss of vision, adding to the need for the development of a specific treatment and/or vaccines.

Emerging Disease of the Desert: Rise of West Nile Virus Chorioretinitis in Arizona

“…The literature has suggested diabetes mellitus (DM) is a risk factor for the development and severity of WNV chorioretinitis. 10 Interestingly, 5 of our 7 cases had a diagnosis of DM and 3 of these cases had lesions involving or abutting the foveal center in 1 eye. This finding further supports DM as a risk factor for the development of a more severe chorioretinitis.…”

“…7 WNV can lead to acute anterior uveitis, occlusive retinal vasculitis, chorioretinitis, optic neuritis, and diplopia. 10 Ophthalmic sequelae may result in permanent vision loss, which further highlights the need to develop a specific treatment and/or vaccine. As the climate changes, outbreaks of WNV are anticipated to worsen in frequency and severity, making it paramount to tackle this disease with improved preventive and treatment strategies.…”

Autochthonous West Nile Virus Infection Outbreak in Humans (Asti, Piedmont, Italy, August–October 2018) and Long-Term Sequelae Follow-Up

“…Neuroradiological exams remained negative but with a reliquated dysmetria. To our knowledge, only one other case of cerebellitis after WNV infection has been reported in a young child [15,16]. The second patient presented with a fever and headache, in addition to malaise, vomiting, diarrhoea, arthralgia and vision disturbance, manifesting as deteriorating visual acuity.…”

“…An ophthalmologic evaluation revealed suspected optic neuritis that resolved over time without sequelae, with concomitant meningitis. To our knowledge, in the literature, optic neuritis complicating WNND has rarely been reported in a case report or case series [16,17].…”

Occlusive retinal vasculitis: novel insights into causes, pathogenesis and treatment

“…In patients presenting with neurological changes consistent with meningitis or encephalitis, West Nile virus should be entertained [24]. Further, diabetes predisposes patients to worse cases of ORV [25 ▪ ]. Like ARN, the involvement of West Nile virus tends to involve arteries.…”