Case Studies: Can Zika-Related Uveitis Be Hypertensive?

Elevated IOP is uncommon in uveitis, but showed up in a pair of Zika patients.

The link between Zika virus and uveitis is well-established, with new studies and case reports emerging frequently. In addition to recent reports detailing the presence of posterior uveitis, the least common manifestation of the disease according to the National Eye Institute, in the eyes of Zika patients, a new observation discusses anterior uveitis in a pair of patients.

Both patients were African-Caribbean, one in her 50s and the other in her 60s. Both complained of painless vision loss or blurred vision in their right eyes and tested positive for the mosquito-borne illness in urine samples. Neither had redness of the eyes, but upon testing revealed hypertensive-levels of intraocular pressure (IOP). 36mm Hg OD in the younger of the two, with 16mm Hg OS; and markedly elevated IOP in both eyes of the older patient, with 58mmHg OS and 32mm OD.

“Elevated intraocular pressure in uveitis is uncommon and results from an impairment of the [aqueous humor] outflow,” the authors write. Still, they state that “The link between [Zika virus] and uveitis is likely given the positive-reverse transcription polymerase chain reaction findings and the rarity of the presentation.” In the two women studied, they were able to rule out toxoplasmosis, syphilis, streptococcus, leptospirosis, cytomegalovirus, varicella-zona, HIV, herpes, human T-lymphotropic virus, and tuberculosis as possible associations.

The two women responded well to treatment. The patient in her 50s had a lowered IOP of 12mm Hg OU after two weeks of β-blockers and carbonic anhydrase inhibitor eyedrops, with no anterior chamber inflammation occurring in the 16 weeks following discontinuation of treatment. The patient in her 60s saw her IOP return to 16mm Hg OU at one week follow-up and remained symptom-free two months later.

The case report, titled “Zika-Related Bilateral Hypertensive Anterior Acute Uveitis,” appeared online first in JAMA Ophthalmology. The authors practice in the Department of Ophthalmology of the University Hospital of Martinique in the French West Indies.

Related Coverage:

Zika May Lead to Bilateral Posterior Uveitis in Infected Adults

Cytomegalovirus Implicated in Some Anterior Uveitis

Syphilis of the Eye Making a Comeback, CDC Warns