Chikungunya virus infection has recently been reported to cause different ocular manifestations like non-granulomatous anterior uveitis, episcleritis, panuveitis, granulomatous anterior uveitis, optic neuritis, sixth nerve palsy, retrobulbar neuritis, retinitis with vitritis, neuroretinitis, keratitis, central retinal artery occlusion, multifocal choroiditis, exudative retinal detachment and secondary glaucoma.[4
] Bilateral neuroretinitis is described in viral infections caused by measles, influenza, Epstein-Barr virus, dengue virus[9
] and Rift valley fever virus. This typically occurs subsequent to an acute viral systemic illness. In our case a typical picture of bilateral neuroretinitis was seen after two weeks of serology-proven chikungunya infection. It is not clear whether the neuroretinitis is immunologically mediated or due to the virus itself. Systemic acyclovir has been given in some patients with ocular manifestations in chikungunya fever without evidence.[7
] As there was optic disc involvement in our case we feel systemic steroids were indicated. Delayed onset of the eye problem after the fever subsided and prompt response to steroids in our case points towards an immune-mediated underlying cause. Optic neuritis following CHIKV infection has been treated successfully with parenteral steroids.[4
] There are recent reports which show the need to institute early treatment after the onset of optic disc involvement. Delay in the treatment could result in poor visual outcome.[4
] In our case visual recovery had been very satisfactory probably because there was no delay in starting systemic steroids. Being a single case report this result cannot be generalized to draw a conclusion regarding the prognosis of chikungunya neuroretinitis. We may be able to get a better picture once larger case series are published. To conclude, chikungunya neuroretinitis should be kept as a differential diagnosis of any bilateral neuroretinitis. We feel that to better understand and manage the full spectrum of ocular disease caused by chikungunya infection, all patients who have suffered from chikungunya fever and have eye problem should be referred for detailed ophthalmologic evaluation.