Boon Kwang Loh, MBBS, Bob Ching Li Cheng, FRCS(Ed), MMed, Doric Wong, FRCS(Ed), MMed, Soon-Phaik Chee, FRCOphth, FRCS(G)


To report a case of bilateral macula foveolar inflammation in a patient with dengue fever.


A case report.


A 27 year old gentleman presented with bilateral sudden decrease in vision 6 days after initial manifestations of dengue fever which was confirmed with detection of denguespecific IgM antibodies. The presenting Snellen visual acuity for the right and left eyes were 6/120 and 6/60 respectively. Fundus findings included an orange reflex at each fovea associated with macular edema, intraretinal hemorrhages, subretinal yellow precipitates and vascular sheathing. Fluorescein angiography showed transmission window defect type hyperfluorescence at the fovea that corresponded to the orange reflex. Multifocal  electroretinography (MfERG) showed decreased foveal and parafoveal responses. Optical coherence tomography (OCT) showed foveal pigment epithelial disturbance. The pathophysiology of the orange reflex was likely due to foveolitis or inflammation with swelling of the retinal pigment epithelium (RPE) of the fovea. The patient was treated with both intravenous, oral steroids and intravenous immunoglobulin. Visual acuity improved to 6/6 bilaterally 2 months later with resolution of the orange reflex. There was RPE mottling of the macula with improvement in OCT and MfERG.


Foveolitis with severe visual loss may be a presenting feature of dengue maculopathy.

Take-home message:

Dengue fever foveolitis may respond to immunosuppressive therapy with good visual outcome.