Dengue fever is the most common mosquito-borne viral disease in humans. A member of the Flaviviridae family and transmitted by the Aedes aegypti mosquito, dengue is endemic within more than 100 countries in the tropical and subtropical regions of the globe.
Systemic signs and symptoms include fever, headache, myalgia, purpuric rash, and other bleeding manifestations secondary to thrombocytopenia. For many patients, however, this initial infection may be low grade and escape obvious mention unless specifically elicited upon history. The most common ocular manifestation is petechial subconjunctival hemorrhage. A variable degree of anterior chamber and vitreous cells may occur.
Maculopathy or “foveolitis” may develop in approximately 10% of patients 1 month after the onset of systemic disease, causing a sudden decrease in vision and central scotoma. Fluorescein angiography may show early focal arteriolar knobby hyperfluorescence in the macula with late leakage and/or staining; optical coherence tomography (OCT) angiography may show disruption of the foveal avascular zone (Fig 11-18). Despite no apparent lesions on clinical exam, OCT may show macular edema, subretinal fluid, or disruption of the inner segment/outer segment junction.
Figure 11-18 A 46-year-old man presented with decreased vision 1 week after an episode of dengue fever. Small, whitish, retinal opacification patches with few superficial hemorrhages are seen (A). The lesions gradually resolve after a course of oral steroids (B, C). Optical coherence tomography angiogram shows broken foveal avascular zone and loss of capillary density in the superficial retina plexus, which remained unchanged on follow-up (D–F).
(Reprinted with permission from Bajgai P, Singh R, Kapil A. Progression of dengue maculopathy on OCT-angiography and fundus photography. Ophthalmology. 2017;124:1816.)
The diagnosis is based on clinical findings combined with positive serologic testing. While the infection is not endemic to the United States, dengue virus–associated maculopathy should be considered in patients presenting with suggestive findings and a history of recent travel to an endemic area. There is no well-defined treatment algorithm for dengue affecting the posterior segment, but local and systemic steroids may be utilized.
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Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.