Central retinal artery occlusion secondary to dengue fever.

Dengue fever is endemic in the tropics and subtropics and has become a worldwide health threat in recent years. Dengue-related ocular complications are increasingly being reported from countries in South-East Asia. The authors report the first documented case of a patient with dengue fever who developed central retinal artery occlusion in addition to many other eye complications such as severe ptosis and complete internal and external ophthalmoplegia during her convalescent phase. The disease was confirmed by specific serological tests. Despite treatment, severe visual impairment occurred in this case.

Subhyaloid haemorrhage in dengue fever.

In India, the dengue disease has attained an unprecedented proportion with a sharp increase in the size of human population at risk recently. Presentation of the disease varies from asymptomatic illness to haemorrhagic manifestations and shock. Previously ocular findings were considered rare in dengue fever; but due to increased number of cases various types of ocular complications are described in present day case series. Here, is presented a case of a girl with serologically proven dengue fever who developed a subhyaloid premacular haemorrhage in one eye with superficial retinal haemorrhages and cotton wool spots in both eyes.

Ocular problems in HIV and AIDS patients in Nigeria.

PURPOSE: To investigate ocular disease and visual acuity defects in patients with HIV/AIDS according to CD4T-cells counts. METHODS: The CD4T lymphocyte counts of all the volunteers were obtained. Visual acuity, refraction, ophthalmoscope, and slitlamp examinations were performed on each patient after the CD4T-cell count result was obtained. RESULTS: Young adults aged between 21 and 30 years were mostly affected, 39 (97.5%) of the HIV patients had refractive errors, and 10 (25%) had reduced vision. Seven (17.5%) moderate and one (2.5%) severe low vision patients were found between 499 to 0 and 299 to 200 CD4T-cell counts, respectively. Ocular diseases found in various CD4T-cells counts were proptosis (2.5%), orbital cellulitis (2.5%), and cytomegalovirus retinitis (2.5%) in 99 to 0, keratoconjunctivitis sicca (2.5%) and corneal keratitis (2.5%) in 499 to 400, molluscum contagiosum (2.5%) in 299 to 200, iridocyclitis (2.5%) in 199 to 100, cloudy media (22.5%), red eyes (30%), poor pupillary reflexes (17.5%), and painful eye (30%) in 499 to 0, retinal exudates (15%), disc edema (30%), and choroidoretinitis (15%) in 399 to 0, ocular toxoplasmosis (5%) and herpes zoster (7.5%) in 299 to 100, Kaposi sarcoma (12.5%) in 199 to 0, conjunctivitis (7.5%) in 499 to 300, and uveitis (7.5%) in 399 to 200. There were significant differences between visual acuity of the control and the HIV/AIDS patients, p < 0.05. CONCLUSIONS: Ocular impairments increased with decrease in CD4T-cells counts. Additional studies are required in predicting the CD4T-cells counts that will serve as a marker for specific ocular disease manifestation in HIV/AIDS.

Factors affecting visual outcome in herpes zoster ophthalmicus: a prospective study.

PURPOSE: To evaluate visual outcome and factors affecting visual outcome in herpes zoster ophthalmicus (HZO). METHODS: A prospective, longitudinal, observational study was undertaken in 64 consecutive patients with HZO presenting within 72 h of rash onset. Patients underwent detailed ophthalmological and dermatological examinations at presentation, with follow up at first, second and fourth weeks and third and sixth months. All patients received both systemic and topical acyclovir. The main outcome measure was best-corrected visual acuity at 6 months' follow up. Local and systemic factors were correlated with visual outcome using univariate and multivariate analyses. RESULTS: Overall visual outcome was good, with 36/64 (56.3%) patients having a visual acuity of 6/6 or better. Mild visual loss occurred in 22/64 (34.3%), moderate loss in 3/64 (4.7%) and severe loss in 3/64 (4.7%); moderate to severe visual loss was due to severe uveitis (2), neurotrophic keratitis (1) and cataract (3). Increasing age (P = 0.04), positive Hutchinson sign (P = 0.001), absent corneal sensation (P = 0.01), corneal epithelial lesions (P = 0.03) and uveitis (P < 0.001) were significantly associated with visual loss. Uveitis was found to be the best predictor of visual loss in HZO on multivariate analysis. CONCLUSION: The overall visual outcome is good in HZO patients receiving antiviral therapy. Hutchinson's sign and anterior uveitis were found to be strong predictors of visual loss in HZO. Presence of these predictors calls for close monitoring.

Cytomegalovirus infection with MRI signal abnormalities affecting the optic nerves, optic chiasm, and optic tracts.

A 49-year-old woman who had been immunosuppressed after a renal transplant developed bilateral severe visual loss. Visual acuities were finger counting and hand movements in the two eyes. Both optic nerves were pale. There were no other ophthalmic abnormalities. Brain MRI disclosed marked signal abnormalities involving the optic nerves, optic chiasm, and optic tracts. Cerebrospinal fluid polymerase chain reaction (PCR) was positive for cytomegalovirus. Treatment did not restore vision. Such extensive clinical and imaging involvement of the anterior visual pathway, which has been previously reported with other herpes viruses, illustrates the propensity for this family of viruses to track along axons.

Juxtapapillary cytomegalovirus retinitis with optic neuritis.

A 49-year-old man with AIDS developed acute monocular visual loss and an ipsilateral swollen optic disc with a large right relative afferent pupillary defect, a nerve fiber bundle visual field defect, and a peripapillary retinal infiltrate. Lumbar puncture disclosed cytomegalovirus (CMV) DNA on polymerase chain reaction (PCR). Treatment with oral valganciclovir produced complete resolution of the visual deficits and the fundus abnormality. This case differs from previously reported cases of CMV optic neuritis in which visual function has been irreversibly lost.