Ophthalmic Complications of Dengue Fever: a Systematic Review

Abstract

IntroductionIn recent years there has been a spurt of peer-reviewed publications on the ophthalmic complications of dengue fever. The authors aim to review the ocular manifestations, utility of relevant diagnostic tests, management, prognosis, and sequelae of dengue-related ocular complications.MethodsA comprehensive literature search was conducted on Medline, PubMed, and Google Scholar databases. Only articles published or translated into the English language were considered, and key data from the full article of each paper was extracted and evaluated.ResultsThe authors’ search yielded 29 articles. A total of 686 patients with a mean age of 33.4 years (range 14–73 years) were included. Blurring of vision was the most common presenting symptom followed by scotoma. Ocular findings were mostly seen in the posterior pole of the fundus, manifesting as retinal hemorrhages, macular edema, foveolitis, vasculitis, and optic neuropathy. Most patients with dengue-related ophthalmic complications recover spontaneously without any treatment. Patients with severe visual loss or bilateral involvement were treated with systemic steroids and occasionally immunoglobulins. Prognosis of dengue-related ophthalmic complications is favorable; almost all patients had normal or showed improvement in visual acuity and complete resolution of dengue ophthalmic complications was noted in almost all cases.ConclusionThe pathological process of dengue ophthalmic complications is complex and clinical manifestations varied. Ophthalmic complications are usually seen in young adults who often present at the nadir of thrombocytopenia. Despite good recovery of vision and resolution of clinical signs in most patients, ophthalmologists and physicians should be aware and vigilant as isolated reports of cases of dengue ophthalmic complications with poor visual acuity refractory to treatment have been reported.

Early treatment of dengue foveolitis resulting in good visual outcome

“…To date, there is no evidence as to which is the more superior mode of administration. However, the outcome of treatment with systemic steroids in vision in both forms has been favourable [6,7]. We commenced treatment with oral prednisolone in our patient due to the extensive involvement of the retina on OCT and also significant reduction in the initial visual acuity.…”

“…There is no specific treatment for systemic dengue fever and usually supportive therapy is revolved. Most of the time, the course of the ocular complications, like systemic dengue fever, is generally self-limiting and resolves spontaneously even without treatment [4][5][6]. The improvement in visual signs and symptoms usually corresponds to improvement of platelet levels [7].…”

“…Because the underlying mechanism is likely to be an immune-mediated response, some researchers advocated the use of systemic steroid therapy, if not contraindicated, to patients with extensive involvement of retina, retinal pigmented epithelium and choroid [3,6,9]. Treatment is especially imperative in patients with poor initial visual acuity [9].…”

“…The reported use of systemic steroids is administered either orally or intravenously [6,7]. The dose suggested for oral prednisolone is 1 mg/kg/day for one week and slowly tapered over two months [7].…”

Vasculitis: An Unusual Ocular Manifestation of Dengue Fever

“…3 Lately, few isolated case reports have shown that the ophthalmic complications of dengue fever are not as rare as used to be thought before. [3][4][5][6][7][8][9] Any dengue fever patient with complaints of blurring of vision, floaters, scotomas or metamorphopsia must be thoroughly examined. Hereby, we present a case of a young girl with post dengue fever vasculitis and macular edema.…”