INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue X October 2025
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Dengue without Warning Sign Associated with Unilateral
Maculopathy :AnUnusual case
Dr Vinitkumar Mahajani1*, Dr Anas Khan2, Optom Prathmesh Yadav3
1Ophthalmologist, Shahu Maharaj Lions Pride Eye Hospital, Ichalkaranji, Maharashtra, India
2 MS (Shalakya tantra), Lions Eye Hospital, Kurundwad, Maharashtra, India
3 BSc Optometry, Bharti Vidhyaapeeth College of Optometry , Miraj, India
*Corresponding author
DOI: https://doi.org/10.51584/IJRIAS.2025.1010000024
Received: 09 Oct 2025; Accepted: 18 Oct 2025; Published: 29 October 2025
ABSTRACT
As we all know dengue is viral infection caused by RNA virus of genus flavivirus which is transmitted by
Aedes aegypti mosquito. Dengue maculopathy is a rare cause of visual morbidity. We have a 30 years old male
presented with gradual painless diminution of vision in his left eye for 20 days. At the time of presentation his
vision was hand movement close to face. He was diagnosed case of dengue fever for which he was treated
outside one month back. Fundoscopy of left eye shows multiple yellowish deposits at the fovea. Optical
coherence tomography and optical coherence tomography angiography was done to rule out Dengue
maculopathy. The diagnosis is unusual and most cases will recover without treatment however to prevent from
permanent visual damage frequent follow ups would be recommended.
Keywords: Dengue, flavivirus, foveolitis, maculopathy, optical coherence tomography angiography
INTRODUCTION
Dengue fever is common viral infections caused by flavivirus and transmitted to humans by the bite of an
infected female Aedes aegypti mosquito.1The first case of ophthalmic findings secondary to dengue fever was
reported in 1980. The complications following dengue fever which consist blurring of vision to severe visual
morbidity.2 Retinal hemorrhage, cotton wool spot, retinal edema, retinal, vasculitis/sheathing, optic neuritis and
uveitis are some of the ophthalmic manifestations of dengue fever.3,4 Other ophthalmic symptoms are blurring
of vision, followed by positive scotoma, eyeache, micropsia and metamorphopsia. The prevalence rate of
dengue maculopathy was 10% among hospitalized patients.2
An ocular involvement in dengue fever is self-limiting but management with corticosteroids may improve
prompt vision and prevent from severe permanent visual damage.
Case report: A 30 years old male presented with chief complaints of gradual painless blurring of vision in his
left eye for 20 days which was preceded by fever, malaise, arthralgia and was diagnosed as a case of dengue
fever based on clinical and laboratory finding (positive serological test and low platelets count) one month
back. The diminution of vision was not accompanying by metamorphopsia or micropsia. He didn’t give history
of redness or discharge. There was no history of ocular pain associated with eye movement. Anterior segment
finding was normal in both eyes. Fundus of the left eye showed multiple yellowish deposits at fovea whereas it
was unremarkable in the right eye. (Fig 1) Optical coherence tomography (OCT) revealed intraretinal cystoid
spaces along with disruption of external limiting membrane and photoreceptors zone (Fig 2). Similarly, OCT
angiography (OCTA) of the left eye showed disruption of normal flow pattern both in superficial and deep
plexus leading to enlargement of foveal avascular zone.(Fig 3) On the basis of above finding, diagnosis of
dengue maculopathy (foveolitis) was made. Patient was treated with oral corticosteroids in tapering dose along
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue X October 2025
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with proton pump inhibitors and asked him to follow up after 3 weeks.
DISCUSSION
Dengue fever, an arthropod borne disease is one of the most common viral infections caused by
flavivirus.5Systemic involvements including eye had also been affected by dengue fever.2,6Ocular
involvements following dengue fever are unusual. Previous literatures found that blurring of vision being the
common symptom in dengue fever.4Posterior segment is the commonest site where ocular changes secondary
to dengue fever occur. The posterior segment ophthalmic features include retinal hemorrhage, cotton wool
spot, retinal edema, retinal, vasculitis/sheathing and optic neuritis.4 6The pathophysiology of ophthalmic
manifestations following dengue infection would be immune mediated rather than direct viral infection.4In our
case there was few yellows to orange deposits at the fovea suggestive of dengue associated foveolitis which
was confirmed by OCT and OCTA. Ophthalmic involvement due to dengue fever resolves without treated. Till
now there is no updated treatment for dengue maculopathy. Depending upon status of visual acuity, modality
of treatment varies from conservative to immunosuppression therapy.7Bascal KE et al found improvement in
visual acuity in those patients treated with oral corticosteroids having dengue associated
maculopathy.6Improvement in visual acuity in patients with foveolitis treated with immunosuppression was
found in a retrospective study done by Lim WK et al.4Our patient was also treated with oral steroids in
tapering dose and asked him to review after 3 weeks.
CONCLUSION
Dengue maculopathy is an unusual ocular manifestation which varies from moderate blurring of vision to
severe visual impairment. It is recommended to do complete ophthalmic examination in all dengue patients.
Till now there is no approved therapy for dengue fever and its complications but immunosuppression drugs
have some role.
REFERENCES
1. Kuhn, R.J, Zhang, W et al. Structure of Dengue Virus: Implications for Flavivirus Organization,
Maturation, and Fusion. Cell. 2002;108(5):717-25.[DOI]
2. Su DHW, Bascal K, et al. Prevalence of dengue maculopathy in patients hospitalized for dengue
fever. Ophthalmol. 2007; 114(9): 1743-7.[PMID]
3. Teoh, S.C.B, Chana, D.P.L et al. A Re-Look at Ocular Complications in Dengue Fever and Dengue
Haemorrhagic Fever. Dengue Bulletin.2006; 30: 183-193.
4. Lim WK, Mathur R et al. Ocular manifestations of dengue fever. Ophthalmolol. 2004 ;11(11):
2057–64.[PMID]
5. Gubler DJ: The changing epidemiology of yellow fever and dengue, 1900 to 2003: full circle?
Comp Immunol Microbiol Infect Dis. 2004;27(5):319–30.[PMID]
6. Bascal KE et al. Dengue-associated maculopathy. Arch Ophthalmol. 2007; 125(4): 501-10.[PMID]
7. Loh BK et al. Foveolitis associated with dengue fever: A case series. Ophthalmologica. 2008;
222(5): 317-320. [PMID]
Figures:
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
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Fig 1: Fundus of the left eye showed multiple yellowish deposits at fovea
Fig 2: OCT of the left eye revealed intraretinal cystoid spaces along with distruption of external limiting
membrane and photoreceptors zone
Fig 3: OCT angiography (OCTA) of the left eye showed disturption of normal flow pattern both in
superficial and deep plexus leading to enlargement of foveal avascular zone.