Nearly a Third of Zika Patients Have Ocular Conditions

Disease vector which carries zika, chikungunya, dengue and yellow fever, known locally as “mosquito da dengue” and internationally as the “yellow fever mosquito”. Close-up showing it’s white spots.
Ocular abnormalities were even seen in children who did not develop microcephaly.

When investigating ophthalmologic conditions in children with congenital Zika syndrome (CZS) in Brazil, researchers found that roughly 30% of the children had ocular manifestations of the disease. Further, ocular abnormalities were found in 7.5% of children without microcephaly. The findings were published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

Researchers have been describing the ocular manifestations of CZS since 2016, according to investigators. The most typical ocular manifestations of the CZS include retinal (e.g., chorioretinal atrophy, pigment mottling) and optic nerve abnormalities (e.g., increased cup:disk ratio, optic nerve pallor, optic nerve hypoplasia). Retinal vascular findings have included retinal hemorrhages, vascular tortuosity, and abnormal termination of the retinal vessels. Structural ocular abnormalities, such as microphthalmia, iris coloboma, lens subluxation, congenital cataracts, and congenital glaucoma, also have been noted.

To analyze manifestations in children in Brazil, investigators reviewed the medical records of infants born in the states of Pernambuco, Bahia, and Rio de Janeiro, Brazil, between December 2015 and December 2016. The records of children with clinical manifestations of CZS and positive reverse transcription polymerase-chain-reaction or serology for the Zika virus, or both, were reviewed retrospectively. Data were collected from the record of the first ophthalmological assessment performed on admission. Children with other congenital infectious diseases, genetic conditions, and incomplete medical records were excluded from the study.

A total of 469 infants (242 girls [51.6%]) were included. The mean age at examination was 5.0±7.1 months (range, 0.0-36.0 months). Microcephaly at birth was detected in 214 (45.6%) children; 62 cases (29.0%) were severe. Of the 252 of 466 children without microcephaly (54.1%), 19 children (7.5%) had funduscopic findings.

Ocular manifestations were found in 269 of 938 eyes (28.7%; 148/469 children [31.6%]). The main ocular alterations were optic nerve pallor in 122 of 938 eyes (13.0%), focal pigment mottling in 112 eyes (11.9%), and chorioretinal scars in 101 eyes (10.8%).

More granularly, of the 469 infants, 197 (42.0%) were from Rio de Janeiro, 144 (30.7%) from Pernambuco, and 128 (27.3%) from Bahia state. Pernambuco had significantly more children born with microcephaly compared with Bahia and Rio de Janeiro (P <.001). A higher prevalence of ocular manifestations was seen in Pernambuco (P <.001). 

The research team acknowledged several limitations of their work, including the varied descriptions of the ocular findings in patients’ medical records, which had to be standardized for this study. Additionally, there the data regarding the gestational histories of all of the mothers was incomplete. Further, children’s ages at examination in Bahia State were older than those for Pernambuco and Rio de Janeiro states. Lastly, there may be a selection bias in the Pernambuco State sample, where more severe cases may have been referred for ophthalmologic screening and early intervention.


Ventura CV, Zin A, de Paula Freitas B, et al. Ophthalmological manifestations in congenital Zika syndrome in 469 Brazilian children. J AAPOS. Published online May 31, 2021. doi:10.1016/j.jaapos.2021.01.009