Ocular manifestations of dengue fever: A cross-sectional study in a teaching hospital in Northwestern Karnataka

• Author Details:   
• Chethana Warad ^*
• Ruben Simon Roy
• Meheeka Agarwal
• Samjna Suresh
• Veerappa Annasaheb Kothiwale

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Background: Dengue is a viral infection transmitted to humans through the bites of infected mosquitoes of aedes family. Dengue fever has appeared as a global public health problem in the recent decades. Though dengue related ocular complications are not uncommon, they are often underreported. Dengue is known to cause wide spectrum of ocular manifestations in the affected patients.

Aim and Objective: The present study aimed to evaluate the prevalence of ophthalmic manifestations among Dengue Sero positive patients.

Materials and Methods: This was a cross-sectional study conducted on 170 dengue Sero positive confirmed patients admitted in medicine wards/ ICU at KLE’S Dr Prabhakar Kore Hospital of either sex of all age groups with no preexisting ocular ailments, willing to take part in the study formed the study sample.

After recording visual acuity using Snellen’s visual acuity test, anterior segment examination was done by focused torch light/hand held slit lamp followed by posterior segment examination after pupillary dilation using IDO. Macular testing was done using Amsler's grid. Patients were assessed on the first day of admission, the third day and at the time of discharge. If required, they were asked to visit the Ophthalmology Outpatient Department. Daily Blood sample collection was done for routine investigations, such as liver and renal function tests, random blood sugar, serum electrolytes and also complete blood count. The relevant findings were documented and subjected to statistical analysis.

Results: The mean age of subjects was 43.10 +16.13 years. The median age was 43 years, ranging from 18 years to 82 years. With respect to gender, 91 (53.52%) subjects were male, while 79 (46.47%) subjects were female. The distribution of subjects based on ocular symptoms reveals that the majority, 134 (78.82%) subjects, did not report any ocular symptoms (NIL). Among those who did, the most common symptom was redness, affecting 19 (11.18%) subjects, followed by blurring of vision (BOV) in 13 (7.65%) subjects. Less frequently reported symptoms included ocular pain in 5 (2.94%) subjects, floaters in 2 (1.18%) subjects, central scotoma in 2 (1.18%) subjects and metamorphopsia in 1 (0.59%) subject. The distribution of subjects based on bilateral ocular involvement shows that 21 (12.35%) subjects had bilateral involvement. Among the 62 eyes with ocular involvement, petechial haemorrhages in the conjunctiva were the most common finding, observed in 15 (24.19%) eyes. Subconjunctival haemorrhage (SCH) was the second most frequent, affecting 9 (14.52%) eyes. Dot blot haemorrhages were noted in 8 (12.90%) eyes, while uveitis was present in 5 (8.06%) eyes. Other findings included Roth’s spots, optic disc haemorrhage, and macular edema, each affecting 4 (6.45%) eyes. Optic disc edema and cotton wool spots were found each in 3 (4.84%) eyes. Less common findings included hard exudates, macular haemorrhage and vascular sheathing, each in 2 (3.23%) eyes and vitreous haemorrhage in 1 (1.61%) eye. Presentation of dengue-related ocular signs and symptoms corresponded to the nadir of thrombocytopenia in our study.

Conclusion: Dengue fever can result in various manifestations in human eye. Regardless of age, a multidisciplinary approach to dengue fever management is crucial. Physicians should promptly refer patients to ophthalmologists and also Ophthalmologists must meticulously evaluate patients with dengue-related ophthalmic manifestations because some patients may have reduced visual acuity and show little or no response to treatment.