Eye Pain In Dengue


Eye Pain In Dengue
Symptoms –

Mild symptoms of dengue can be confused with other illnesses that cause fever, aches and pains, or a rash.

The most common symptom of dengue is fever with any of the following:

Nausea, vomiting Rash Aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain) Any warning sign

Symptoms of dengue typically last 2–7 days. Most people will recover after about a week.

Does dengue affect eyesight?

Discussion – Dengue is the most common mosquitoborne viral disease in humans. In recent years, it has become a major international public health concern. Globally, 2.5 billion people live in areas where dengue viruses can be transmitted ( 4, 14 – 16 ).

  • Over the past 25 years, the geographic spread of both the mosquito vectors and the viruses has led to the global resurgence of epidemic DF and emergence of DHF; with the development of hyperendemicity in many urban centers of the tropics.
  • Though Southeast Asian in origin, this study would be relevant to clinicians across continents where dengue has taken a foothold.

The spectrum of ophthalmologic manifestations would lead one to conclude that several pathophysiologic processes are involved. The first and most obvious pathogenesis would be the thrombocytopenic state, with its resultant bleeding tendency, which gives rise to increased incidence of hemorrhage.

  • These hemorrhages manifest as retinal blot hemorrhages in the macula and retinal periphery.
  • We believe that the preponderance of cases found with complications located at the macula in our series may be due to the higher likelihood of awareness by the patient of visual impairment resulting from poor central vision.

The incidence of dengue-related complications may be higher, given that some patients with changes occurring exclusively in the retinal periphery may not have any perceptible visual impairment. Macular edema and occult vascular changes with minimal functional disturbance may also be unreported by the patient.

  • Clinically, these cases may even be missed on examination alone.
  • Investigations such as fundus FA and OCT can help to detect these occult cases.
  • These signs could also lend insight to the microvascular changes that may be occurring in the rest of the body.
  • However, a hypocoagulable state alone would not account for the entire range of complications seen.

The presence of periphlebitis, anterior uveitis, and macular edema indicate a hyperpermeable and inflammatory process. Parallels can also be drawn from the observation that the visual symptoms tend to occur and manifest at or close to the moment when the serum platelets and leukocytes levels reach their trough, while the disease is at its peak.

  • An hypothesis about the pathogenesis of DHF, though proven true in vivo, involves immune clearance by way of induction of cross-reactive T-cell memory, T-cell proliferation, and recognition of dengue viral antigens on infected monocytes by sensitized CD4+CD8– and CD4–CD8+ cytotoxic T cells.
  • This results in the release of cytokines with vasoactive and procoagulant properties (interleukins, tumor necrosis factor, platelet-activating factor, and urokinase) ( 17, 18 ).

Vasoactive and inflammatory mediators cause capillary leakage, which may form the basis for macular edema and breakdown of the aqueous blood barrier, resulting in anterior uveitis and periphlebitis. In the series reported by Lim et al., ocular complications were mainly confined to the maculae ( 5 ).

  1. However, in our series the extent of involvement includes both the peripheral retina in the posterior segment and the anterior segment (anterior uveitis), which suggests a more widespread inflammatory process in the eye.
  2. The onset of visual symptoms occurs on or close to the day of the lowest serum platelet level.

Visual recovery, in the form of improvement of signs and symptoms, usually corresponds to improving platelet levels but may take several weeks to reach a steady state. Most patients report residual visual impairment in the form of central or paracentral scotoma.

The use of systemic steroids in 2 patients did not appear to aggravate the visual complications or the systemic dengue infection. This finding is supportive of an inflammatory or immune-mediated pathophysiology after acute dengue infections. Visual symptoms and visual acuity recovered in the same manner and speed as in patients with milder, untreated cases.

However, like the other patients, both also described a persistent central scotoma despite normal functional Snellen visual acuities. However, we were not able to draw any statistical conclusions on the efficacy of treatment outcomes. Our findings may have arisen as a result of an increase in incidence and awareness of DF in Singapore ( 19 ).

However, we believe that these complications may constitute a change in the pathoimmunology of the disease. The increase in inflammatory response seen in recent DF patients may be due to a change in pathogenicity of the virus, although any viral mutation would be speculative at best with our current understanding of the disease.

Hence, the identification of serotypes or viral RNA epitopes in future studies might identify particular serotype or combinations of serotypes, as in the case of secondary infections, of heterologous dengue serotypes that might be found to confer a higher risk of ocular and possibly systemic complications.

This case series describes the widest variety of ocular complications of dengue infection to date. Although the ophthalmic community has been reporting more of such cases in recent times, the number of cases in this series is still relatively small and represents a limitation to the results of this report.

No attempt at randomization had been made with regards to treatment. Management was based on clinical judgment on the progress of pathologic features. However, we feel that the consistency of visual outcomes in these patients still reflects the course of dengue-related ophthalmic complications.

In conclusion, DF and DHF can cause ophthalmic symptoms that were not previously well-described in the medical literature. Blurring of vision typically coincides with the nadir of thrombocytopenia and occurs ≈1 week after onset of fever. Clinical features include retinal edema, blot hemorrhages, and vasculitis.

Less common features include exudative retinal detachment, cotton wool spots, and anterior uveitis. Prognosis is generally good as the disease is often self-limiting, resolving spontaneously even without treatment. However, patients may experience mild relative central scotoma that may persist for months.

The use of steroids in treating this inflammatory eye condition is controversial. A randomized controlled trial is under way to evaluate the effect of systemic steroids on dengue retinopathy; results will be reported in due course. With increasing epidemicity and co-circulation of multiple dengue serotypes, the occurrence of DF and DHF is set to rise.

Similarly we expect to see an increase in this newly emergent facet of dengue ophthalmic morbidity. A heightened awareness of dengue-related ophthalmic complications among clinicians involved in the care of patients with dengue would facilitate prompt referral for ophthalmologic assessment and management.

What are the symptoms of dengue in the eye?

Abstract – Dengue fever, a viral disease epidemic in some parts of the world, is of considerable international concern, with a growing incidence owing to developing urbanization, tourism, and trade. Ocular manifestations of dengue fever are uncommon, but of great significance.

  • Proposed mechanisms include direct viral infection as well as immunologic phenomena.
  • Common manifestations include subconjunctival, vitreous, and retinal hemorrhages; posterior uveitis; optic neuritis; and maculopathies such as foveolitis, hemorrhage, and edema.
  • Main symptoms include blurring of vision, scotomata, metamorphopsia, and floaters.

Diagnostic and monitoring investigations described included optical coherence tomography, fundus fluorescein and indocyanine green angiography, visual field analysis, and electrophysiologic tests. Management is based on clinical presentation and includes active surveillance as well as various anti-inflammatory and immunosuppressive therapies.

There have been no prospective, randomized therapeutic trials, and it is unclear if the disease is self-limiting or if treatment is actually beneficial. Prognosis varies, ranging from full resolution to permanent vision loss despite intervention. Keywords: chorioretinitis; complications; dengue; foveolitis; hemorrhage; infection; macular edema; maculopathy; optic neuritis; uveitis; viral.

Copyright © 2015 Elsevier Inc. All rights reserved.

Does eyes swell in dengue?

Dengue fever can affect Your Eyes too | Dr. Agarwals Eye Hospital As monsoons begin; one of the most commonly found patients admitted in the inpatient department are the ones suffering from dengue or malaria. These can prove to be deadly if not treated well in time.

  1. Dengue Fever: Dengue is a disease caused by the Dengue virus that is seen in Aedes mosquito.
  2. The dengue fever is transmitted by the bite this Aedes mosquito.
  3. The mosquito becomes infected when it bites a person with dengue virus in their blood.
  4. It can’t be spread directly from one person to another.
  5. Dengue when left undetected can lead to serious complications and even death in few cases.
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This disease causes multi-systemic problems and one of them being the eye. We shall enumerate few problems caused by this virus to the eye. Case: We treated a case of Dengue related Eye complication at Advanced Eye Hospital and Institute (AEHI) located at Sanpada, Navi Mumbai.

  1. Mr. Seth (name changed) came in with complaints of redness of his eyes that was associated with eye pain and swelling.
  2. On asking history he mentioned that he recently was hospitalised for high fever, cough and cold which was diagnosed as Dengue fever with Thrombocytopenia (Condition with low platelet count).

He was discharged in a week after being kept for observation and receiving treatment for Dengue.2 days later he noticed redness in his eyes and had a discomforting pain in both his eyes. He also mentioned about blurring in vision but attributed it to his physical weakness and had ignored it.

But the pain in his eyes and redness were worsening which is when he decided to visit an eye hospital. He took an appointment at AEHI eye hospital and was examined. His eye examination test revealed a subconjunctival haemorrhage. Dr. Vandana Jain, Specialist advised to monitor the platelet count and prescribed steroid eye drops which took care of the problem.

Today Mr. Seth is relieved and had no complications further. Dengue can be a devastating disease whose complications affect the eyes too. Some of the other complications that one sees in the eye in dengue are mentioned in this article.

What is pain behind the eye?

7 Reasons Why There’s Pain Behind Your Eye | Pain Behind Eye At one time or another, each of us has likely experienced some type of eye pain. It can range from dull to intense and can be sometimes be accompanied by fever, tearing, redness, light sensitivity, sinus pressure, double vision, and numbness.

Dry eye. Dry eye syndrome is a relatively common condition in which your eyes are unable to produce adequate tears to moisten the eye. Dry eyes can bring on sensitivity to light and headaches, both of which can be painful and lead to pain behind your eyes. Problems with vision. If you have a tendency to focus or squint to make up for a vision problem like farsightedness, nearsightedness, or astigmatism, you are more prone to develop eye pain. That’s because your brain and eyes are trying to compensate for your compromised vision. Sinus inflammation. Also referred to as sinusitis, sinus inflammation causes pressure and pain behind your eyes and tenderness in the front of your face. Throbbing pain from a migraine headache almost always includes pain behind the eyes. This condition is caused by the buildup of intraocular pressure. And when pressure increases in your eye, it can lead to pain oftentimes coupled with nausea, swollen eyelids, watery eyes, and loss of peripheral vision. When pain is felt specifically behind the left eye, it could possibly indicate a brain aneurysm. This occurs when blood vessels or an artery wall in the brain are weak, resulting in possible hemorrhaging or stroke. Stabbing pain behind the eye could be caused by inflammation from inside the sclera (the outer coating of your eye ball.) This condition is sometimes combined with other symptoms like redness and light sensitivity.

If you’re experiencing moderate to severe eye pain, or to learn more about any of the services we provide, please North Toronto Eye Specialists today to schedule an appointment with one of our doctors at 416-748-2020.

What is recovery phase in dengue?

Onset of the recovery phase can be identified by the following: Patient improvement. Gradual reabsorption of extravasated fluid (such as from plasma leakage) over 48–72 hours. Increased diuresis (patient might wet bed) Hemodynamic status stabilizes.

What day is critical stage of dengue?

The critical phase typically begins around the time of defervescence but it might begin as early as the third day after fever onset in patients who are still febrile. This is the period when those who develop severe disease will become critically ill.

How many days does severe dengue last?

Symptoms –

Mild symptoms of dengue can be confused with other illnesses that cause fever, aches and pains, or a rash.

The most common symptom of dengue is fever with any of the following:

Nausea, vomiting Rash Aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain) Any warning sign

Symptoms of dengue typically last 2–7 days. Most people will recover after about a week.

What are the peak hours of dengue?

This species is most active for approximately two hours after sunrise and several hours before sunset, but it can bite at night in well lit areas.

Does itching mean healing in dengue?

2. Causes of itchy, red skin in dengue fever – Itching can appear during or even immediately after a dengue infection. The degree of itching also varies widely. Some people have mild itching, but there are people who suffer from itching so much that it is very miserable, sleepless day and night because of the itch.

  • At that time, patients are often extremely worried, whether itching or redness is normal or not.
  • In fact, Dengue fever patients with itching are most likely a symptom caused by a virus.
  • This is a sign that the patient is in the recovery phase after the disease.
  • The body in the process of reabsorption of extracellular fluid into the blood and in the skin tissue is recovering from the wounds caused by the rash, resulting in itching.

Usually, the itching symptoms when recovering from dengue fever will go away after a period of 2 to 3 days, in some cases it can take longer, about 1 week, or even up to several weeks. Some measures can be applied to limit itching caused by dengue fever: Take vitamin C to strengthen resistance Diet: Eat enough nutrients, limit fatty foods, foods that cause allergies Severe reactions such as seafood, wild meat,,

  • Soaking hands and feet in warm water, can add salt or lemon juice will help ease the itching.
  • Aloe vera has anti-fungal, antibacterial, and skin-soothing properties, thereby helping the itchy skin to recover quickly.
  • Rubbing coconut oil all over the skin and then soaking and soaking in warm water is also very effective in reducing itching regardless of the cause.

Some antihistamines such as Loratadin, Desloratadine,, can also be used to reduce itching for patients if allowed by the doctor. Có thể xoa dầu dừa để giảm ngứa Another cause of pruritus may be encountered clinically such as: Acute hepatitis caused by Dengue virus with hepatomegaly or atrophy. Acute liver failure due to drug use (eg, paracetamol overdose). When liver enzymes SGOT (AST) and SGPT (ALT) are elevated, bilirubin levels are high, leading to mucosal jaundice, itching, and clotting factor disorders.

  • This is a case where the patient is experiencing serious complications and needs to be hospitalized immediately for active monitoring and treatment to avoid possible unfortunate complications.
  • Therefore, when having dengue fever, especially if there is itching, in addition to reducing fever, the patient should be checked for blood tests and evaluated for the level of thrombocytopenia, liver enzymes to ensure safety.

and recover soon. Currently, there is no vaccine for dengue fever and no specific treatment, so we rely on routes of transmission to proactively prevent dengue. In particular, those who have not yet contracted the disease but live in epidemic areas must actively prevent dengue fever from spreading into a large outbreak.

  1. When there are signs of suspicion of dengue fever, they must proactively go to medical facilities or hospitals of Vinmec Health System for examination and treatment to avoid serious illness affecting health.
  2. With a system of facilities, modern medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured for examination and treatment at General Hospital.

Vinmec International Faculty. Please dial HOTLINE for more information or register for an appointment HERE, Download MyVinmec app to make appointments faster and to manage your bookings easily. Dấu hiệu sốt xuất huyết nguy hiểm cần nhập viện

Why there is periorbital pain in dengue?

Discussion – The exact mechanism of eye involvement in dengue viral infection is poorly understood. Multiple causes have been suspected and include viral factors, immune mediation, capillary leakage, stress, and hemorrhage. Eye involvement is classically seen at the lowest platelet count and when the count begins to rise.

  1. Though symptoms are nonpathognomonic, blurring of vision is the commonest complaint, but the range of presentation is extensive and variable.
  2. Ophthalmological assessment and funduscopy are very useful in addition to advanced assessments.
  3. There is no clear consensus on management; suggestions range from conservative care to aggressive steroid therapy with immune modulation and even ophthalmological intervention.
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Recovery can be full or partial with a variable time scale.

Does dengue worsen at night?

Severe dengue – When developing into severe dengue, the critical phase takes place around 3-7 days after the first sign of illness. Temperature will decrease; this does NOT mean the person is necessarily recovering. On the other hand, special attention needs to be given to these warning signs as it could lead to severe dengue:

Severe abdominal pain Persistent vomiting Bleeding gums Vomiting blood Rapid breathing Fatigue/ restlessness

When severe dengue is suspected, the person should be rushed to the emergency room or to the closest health care provider as it causes:

Plasma leaking that may lead to shock and/or fluid accumulation with/without respiratory distress; Severe bleeding; Severe organ impairment.

There is no vaccine or specific medication for dengue fever. Patients should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

Patients who are already infected with the dengue virus can transmit the infection via Aedes mosquitoes after the first symptoms appear (during 4-5 days; maximum 12). As a precautionary approach, patients can adopt measures to reduce transmission by sleeping under a treated net especially during the period of illness with fever.

Infection with one strain will provide life-time protection only against that particular strain. However, it is still possible to become infected by other strains and develop into severe dengue. When warning signs of severe dengue are present (listed above), it is imperative to consult a doctor and seek hospitalization to manage the disease.

Evaluate your signs and symptoms; Test your blood for evidence of a dengue virus; Review your medical and travel history.

Persons who had travelled to dengue endemic countries during the past two weeks should inform the doctor about it. Dengue is spread through the bite of the female mosquito ( Aedes aegypti ). The mosquito becomes infected when it takes the blood of a person infected with the virus.

After about one week, the mosquito can then transmit the virus while biting a healthy person. The mosquito can fly up to 400 meters looking for water-filled containers to lay their eggs but usually remains close to the human habitation. Aedes aegypti is a daytime feeder : The peak biting periods are early in the morning and in the evening before dusk.

Dengue cannot be spread directly from person to person. However, a person infected and suffering from dengue fever can infect other mosquitoes. Humans are known to carry the infection from one country to another or from one area to another during the stage when the virus circulates and reproduces in the blood system.

Aedes aegypti has evolved into an intermittent biter and prefers to bite more than one person during the feeding period. This mechanism has made Aedes aegypti a very highly efficient epidemic vector mosquito. The mosquitoes thrive in areas close to human population (urban areas). The dengue mosquito lays its eggs in water-filled containers inside the house and surrounding areas of dwellings (this includes non-used bottles, containers, discarded waste, tyres etc which hold water).

The eggs hatch when in contact with water. Eggs can withstand very dry conditions and survive for months. Female mosquitoes lay dozens of eggs up to 5 times during their lifetime. Adult mosquitoes “usually” rest indoors in dark areas (closets, under beds, behind curtains).

Here it is protected from wind, rain and most predators, which increases its life expectancy and the probability that it will live long enough to pick up a virus from one person and pass it on to the next. The best preventive measure for areas infested with Aedes mosquito is to eliminate the mosquitoes’ egg laying sites – called source reduction.

Lowering the number of eggs, larvae and pupae will reduce the number of emerging adult mosquitoes and the transmission of the disease. Examples of the following habitats are listed:


Ant traps Flower vases and saucers Water storage tank (domestic drinking water, bathroom, etc) Plastic containers Bottles


Discarded bottles and tins Discarded tyres Artificial containers Tree holes, potholes, construction sites Drums for collecting rainwater Shells, husks, pods from trees Leaf axils of various plants Boats, equipment

Items that collect rainwater or are used to store water should be covered or properly discarded. The remaining essential containers should be emptied and cleaned and scrubbed (to remove eggs) at least once a week. This will avoid the adult mosquitoes to emerge from the egg/ larva/ pupa stage.

In fact, the community participation is the key to dengue prevention. As every household aims to reduce vector density, the transmission rate will decrease or maybe even stop. Protecting yourself from mosquito bites is most effective by reducing exposed skin to mosquitoes to bite on. Long-sleeved clothing and mosquito repellents (containing DEET, IR3535 or Icaridin) are the most viable options.

Window and door screens, air conditioning reduces the risk of mosquitoes coming into contact with the household members. Mosquito nets (and/or insecticide-treated nets) will also provide additional protection to people sleeping during the day, or protect against other mosquitoes which can bite at night (such as malaria).

Does dengue blur the vision?

Case Report: Acute Vision Loss in a Young Returning Traveler with Dengue Fever Dengue is the most common arboviral disease worldwide, with an estimated global disease burden of 390 million infections annually, of which 100 million are symptomatic. The disease burden has increased greatly over the past decades, with Southeast Asia having the highest dengue incidence and mortality. Dengue is transmitted by Aedes mosquitos and has an incubation period of 5–10 days. Although most infections are asymptomatic, about 5% of patients develop severe, life-threating complications. Typical symptoms of dengue virus infection include fever, headache, retro-orbital pain, arthralgia, myalgia, nausea, vomiting, and rash. Despite the fact that ocular involvement is relatively uncommon, it is an increasingly recognized complication as it may lead to permanent visual impairment., Here, we present a case of severe vision loss due to acute dengue infection. A 29-year-old Caucasian female patient presented at our outpatient clinic for tropical medicine, 4 days after returning from a 20-day vacation in Vietnam and Cambodia. She reported fever with body temperatures up to 39.1°C, headache, myalgia, sweating, and chills since 2 days. Furthermore, she suffered from diarrhea and vomiting, which started 7 days prior. Although the vomiting had disappeared, the patient still suffered from diarrhea at the time of presentation. She reported no previous comorbidities, except for mild bilateral myopia, and no medication intake. At admission, her white blood cell count was 2.6 × 10 9 /L (reference 4.4–11.3 × 10 9 /L), hematocrit 0.465 L/L (reference 0.35–0.45 L/L), platelets 158 × 10 9 /L (reference 150–400 × 10 9 /L), alanine transaminase 31 U/L (reference 10–35 U/L), and aspartate transaminase 39 U/L (reference 10–35 U/L). The diagnosis of dengue fever was confirmed by a positive nonstructural protein 1 antigen test and positive polymerase chain reaction. Serum anti-dengue virus IgM and IgG were initially negative, but seroconversion with detectable IgM and IgG in immunofluorescence test was observed after 1 month. Thick blood smear did not show any parasites, and the serology and polymerase chain reaction were negative for chikungunya virus. Because the patient did not show warning signs according to the 2009 WHO classification system, she was seen daily at our outpatient department. However, on the sixth day of fever, she experienced sudden onset of blurred vision as well as paresthesia on hands and feet, and she immediately presented at the emergency department of our hospital. This coincided with the nadir of her platelet count at 88 × 10 9 /L. The physical examination was normal, except for petechia at the hard palate. At this time, the patient was hardly able to read because of vision impairment. Initially, the vision was finger counting on the left (oculus sinister) and 0.4 on the right eye (oculus dexter). Pupils were of equal size and reactive to light, with no relative afferent pupillary defect. Cerebral magnetic resonance imaging was normal. The anterior segment examination was unremarkable. The macula showed no reflex, the eyes showed no sign of vitritis, and the papilla was physiological (). The intraocular pressure was 15 mmHg in oculus dexter and 13 mmHg in oculus sinister (reference 10–21 mmHg). The fluorescence angiography presented no sign of leakage (). The optical coherence tomography (OCT) showed a maculopathy with a detachment of the retinal pigment epithelium, a central shift in the retinal pigmentation and fine intraretinal cysts in oculus dexter (). Oculus sinister showed similar pathologies with more intraretinal fluid (). The visual evoked potentials showed right/left similar patterns with prolonged latencies, oculus sinister > oculus dexter. The vision field testing showed unspecific changes, oculus sinister > oculus dexter. Figure 1. Multimodal imaging at the onset of visual loss. Normal fundus photography of the ( A ) right and ( B ) left eyes and normal fluorescein angiogram with no leakage on the ( C ) right and ( D ) left eyes. Optical coherence tomography showing detachment of the retinal pigment epithelium and subretinal fluid (arrow), central shift in the retinal pigmentation on the ( E ) right and ( F ) left eyes; intraretinal cysts (arrowheads) are more pronounced on the left eye. Figure 1. Multimodal imaging at the onset of visual loss. Normal fundus photography of the ( A ) right and ( B ) left eyes and normal fluorescein angiogram with no leakage on the ( C ) right and ( D ) left eyes. Optical coherence tomography showing detachment of the retinal pigment epithelium and subretinal fluid (arrow), central shift in the retinal pigmentation on the ( E ) right and ( F ) left eyes; intraretinal cysts (arrowheads) are more pronounced on the left eye. The patient was hospitalized, and treatment with a short course of high-dose intravenous prednisolone of 250 mg/day was initiated. Reported steroid treatment duration varies from 2 weeks to 5 months. – In the present case, prednisolone treatment was discontinued already after 2 days because of subjective improvement of vision as well as improvement in ophthalmological follow-up examination.

Ten days later, the vision had improved to 0.1 in oculus sinister and 0.5 in oculus dexter. The OCT showed a discontinuation of the ellipsoid zone. More than 9 months after the onset, the patient had a full recovery, with a vision of 1.0 in both eyes and also a recovery of the visual field testing. The OCT showed a regular morphology ().

Figure 2. Optical coherence tomography of the ( A ) right and ( B ) left eyes showing regular neuroretinal layer without intraretinal fluid after more than 9 months. Citation: The American Journal of Tropical Medicine and Hygiene 103, 5; Dengue-associated ocular inflammation is an increasingly recognized and reported ophthalmic disease often involving the posterior segment, with maculopathy being reported more often than other ocular manifestations., Maculopathy is defined as any pathological condition of the macula, which is the center of the retina and crucial for highly sensitive, accurate vision.

Optical coherence tomography is an important diagnostic tool for characterization, monitoring, and prognostication of the visual defect in dengue maculopathy., Other useful diagnostic tools are visual field testing, fundus fluorescein, and indocyanine green angiography., The prevalence of dengue maculopathy was as high as 10% among seropositive patients in a study including 197 participants hospitalized for dengue fever in Singapore.

However, there are only very few cases of dengue maculopathy reported in travelers. In the present case, other reasons for maculopathy cannot be excluded, but are very unlikely considering the results of the conducted investigations. Ocular symptoms of dengue maculopathy can manifest unilaterally or bilaterally.

The mean interval between onset of fever and onset of symptoms is 7 (range 0–30) days., Dengue-related ocular symptoms often present at the nadir of thrombocytopenia,, as in the present case. Blurred vision is the most common visual complaint in dengue maculopathy, and was the main visual defect described here.

However, scotoma, micropsia, near vision disturbance, and floaters also occur in patients with dengue maculopathy., In patients with thrombocytopenia associated with dengue, venous occlusion with scattered blots and flame hemorrhages associated with perifoveal telangiectasia and Roth spots is common.

  1. Optic disc or diffuse retinal edema, retinal vasculitis, intermediate uveitis, anterior uveitis, vitreous cells, subconjunctival hemorrhages, or inflammatory optic neuropathy may also occur in patients with dengue fever.
  2. In severe cases, cotton wool spots can be present as a sign of occlusive vascular involvement.
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In a study including 41 patients with dengue maculopathy from Singapore, three patterns were proposed based on the predominant appearance on OCT imaging: type 1 with diffuse retinal thickening around the fovea, type 2 with cystoid macular edema characterized by intraretinal cysts disrupting the photoreceptor layers, and type 3 with foveolitis characterized by thickening and reflectivity at the subfoveal outer retina.

Whereas type 1 was most common and had the best prognosis, type 3 had the worst prognosis with all patients noticing scotoma after 2 years of follow-up, even after clinical and anatomic structural resolution. According to this classification, in the present case, type 1 was observed in oculus dexter and type 2 was observed in oculus sinister associated with a more severe visual impairment at initial presentation.

However, the vision was normalized in both eyes at the last follow-up. The pathogenesis of dengue maculopathy is still unknown. An immune-mediated mechanism has been postulated., In patients with more severe ocular impairment, topical or systemic steroid treatment may benefit prognosis, with most patients achieving reasonable improvement of vision.

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J Travel Med 26 : taz062, 4. Singh S, Kumar A, 2018, Ocular manifestations of emerging flaviviruses and the blood-retinal barrier, Viruses 10 : 530, 5. Yip VC, Sanjay S, Koh YT, 2012, Ophthalmic complications of dengue fever: a systematic review, Ophthalmol Ther 1 : 2, 6. World Health Organization, 2009,

Dengue Guidelines for Diagnosis, Treatment, Prevention and Control, Geneva, Switzerland : WHO,

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7. Loh BK, Bacsal K, Chee SP, Cheng BC, Wong D, 2008, Foveolitis associated with dengue fever: a case series, Ophthalmologica 222 : 317 – 320, 8. Bacsal KE, Chee SP, Cheng CL, Flores JV, 2007, Dengue-associated maculopathy, Arch Ophthalmol 125 : 501 – 510,

9. Kan KW, Sylves P, Nik-Ahmad-Zuky NL, Shatriah I, 2017, Dengue maculopathy with foveolitis in a postpartum female, Cureus 9 : e1942, 10. Teoh SC, Chee CK, Laude A, Goh KY, Barkham T, Ang BS ; Eye Institute Dengue-related Ophthalmic Complications Workgroup, 2010, Optical coherence tomography patterns as predictors of visual outcome in dengue-related maculopathy,

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: Case Report: Acute Vision Loss in a Young Returning Traveler with Dengue Fever

What are the long term side effects of dengue?

Dengue leaves some long term ill effects including hair fall, alopecia, joint pain and muscle pain. As per a study which was published in April 2013 edition of Nature, around 390 million people are infected with dengue virus every year, globally.

Does dengue fever cause eye pain behind the eyes?

Symptoms –

Mild symptoms of dengue can be confused with other illnesses that cause fever, aches and pains, or a rash.

The most common symptom of dengue is fever with any of the following:

Nausea, vomiting Rash Aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain) Any warning sign

Symptoms of dengue typically last 2–7 days. Most people will recover after about a week.