Systemic and Ophthalmic Manifestations of West Nile Virus Infection

Yos Priestley; Marcia Thiel; Steven B. Koevary

Disclosures

Expert Rev Ophthalmol. 2008;3(3):279-292. 

In This Article

Optic Neuritis

Another rare, but notable, symptom of WNV is optic neuritis. Most patients that develop optic neuritis have WNM and present with ocular pain, blurred vision, and visual clouding or 'black fog' in both eyes. In many of the reported cases of optic neuritis, patients described onset of ocular symptoms concomitantly with other systemic symptoms and had associated chorioretinitis. Fundus examination of patients with optic neuritis revealed bilateral pale, swollen optic nerves and in many cases a few vitreous cells.[29,64,74] An associated relative afferent papillary defect was noted, in addition to remarkable loss of peripheral vision in many cases where the bilateral optic neuropathy had an asymmetric presentation between the two eyes. Follow-up examinations revealed optic atrophy, visual acuity loss and visual field loss.[64,74]

Optic nerve involvement is seen in many conditions, highlighting the importance of considering epidemiologic events as part of the differential diagnosis, especially in cases where patients present with acute neurologic symptoms. It is worth noting that in some cases of reported optic neuritis, patients had previously received lumbar punctures but opening pressures were not reported. Thus, increased intracranial pressure, or papilledema, may have played a role in their optic nerve swelling.[29] Optic neuropathies are thought to develop secondarily to primary occlusion of the posterior ciliary or retinal vessels.[60]

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