Anterior uveitis often associated with Zika virus infection
Anterior uveitis may be present in a high percentage of patients infected by Zika virus and is often associated with increased IOP, according to a study.
Zika virus (ZIKV) infection is transmitted by Aedes mosquitoes. The first cases were reported in Uganda and Tanzania in the late 1940s, and in subsequent years, outbreaks were identified in several other African and Asian nations, Pacific islands and, later, several countries within Latin America and the Caribbean. Ocular manifestations reported in the literature were limited to conjunctivitis until 2016, when an outbreak affecting 1.3 million people occurred in Brazil. Since then, with the expanded understanding of the clinical manifestation of ZIKV, several cases of uveitis were reported.
At an island referral center in the French West Indies, the Pointe-à-Pitre University Hospital in Guadeloupe, the medical records of patients with confirmed ZIKV infection were reviewed. Patients who were referred for a red eye were included in the study. All patients underwent further virologic and serologic testing for ZIKV, best corrected visual acuity and IOP measurement, and slit lamp and fundoscopy examination. Uveitis was defined as active or inactive based on the standardization of uveitis nomenclature criteria.
Out of 62 patients with red eye, 30 (48.4%) had anterior nongranulomatous uveitis without synechiae, which was bilateral in all cases. Ocular hypertension, defined as IOP greater than 21 mm Hg, was reported in 50 of 60 eyes (83.3%).
“Ocular hypertension is thought to occur when the cells of the ZIKV-infected trabecular meshwork trigger an inflammatory cascade, which in turn causes trabeculitis,” the authors wrote.
Ocular pain was reported by 60% of patients. Visual acuity was rarely and only mildly affected. No case of posterior uveitis or retinal lesions was observed.
All eyes were treated with dexamethasone eye drops from diagnosis, leading to complete recovery after 1 year of treatment. However, despite the use of glaucoma medications, IOP was still high at 1 year in 50% of eyes. This led the authors to recommend thorough clinical examination in any patient positive for ZIKV presenting with a red eye.
“Although the findings of this study suggest that anterior uveitis responds well to corticosteroid eye drops, it is often associated with raised IOP that, if left untreated, could be sight threatening. Therefore, clinicians attending to those with acute ZIKV infection should have a low threshold for considering ZIKV-associated uveitis and arrange slit lamp biomicroscopy and IOP measurement for any of their patients presenting with a red eye,” they wrote.
Agrawal R, et al. JAMA Ophthalmol. 2021;doi:10.1001/jamaophthalmol.2020.5138.