Unilateral orbital compartment syndrome unmasking dengue haemorrhagic fever: An unusual presentation

Abstract

Dengue fever may be a potentially life-threatening condition owing to massive capillary leakage and severe bleeding, causing dengue shock syndrome. The earlier literature did not classically describe ophthalmic manifestations in dengue fever. We report a case of a 43-year-old male who presented with sudden onset swelling and pain in the left eye for 2 days along with a history of fever with myalgia for 5 days, for which he did not take any treatment. After a clinical evaluation, a provisional diagnosis of orbital compartment syndrome was made, which required urgent decompression. On investigation, the patient had thrombocytopenia (platelet count of 10,000/mL). A positive dengue non-structural protein-1 (NS-1) antigen, along with thrombocytopenia, confirmed the diagnosis of dengue haemorrhagic fever. Dengue IgM antibodies were also found to be positive. The patient was given supportive therapy and urgent platelet transfusions. Lateral canthotomy for orbital decompression, performed after platelet transfusion. However, retropulsion was not possible despite the surgical intervention. During the follow-up period, the left eye chemosis was slightly reduced. However, the visual acuity did not show improvement in the left eye throughout the follow-up. It is recommended that ophthalmologists be aware of such ocular manifestations as the likely initial presentation of dengue fever. Prompt and appropriate treatment through a multidisciplinary approach should prevent sight-threatening complications.