[Ocular changes in hemorrhagic fever with renal syndrome]

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-originating zoonotic disease caused by Puumala and Dobrava viruses, which belong to the genus Hantavirus. The most prominent ocular change in HFRS is transient myopia, which lasts for up to one week and is due to a forward movement of the ocular anterior diaphragm and thickening of the lens. Other ophthalmic manifestations of HFRS are eyelid edema, conjunctival injection with or without hemorrhages, chemosis, anterior uveitis, retinal edema with or without hemorrhages, and photophobia. Acute glaucoma attacks, which are rare, could be explained by the increased intraocular pressure (IOP) due to edema and hemorrhage in the ciliary body, causing anterolateral rotation, relaxation of the zonules, and anterior movement of the lens. They are treated with mydriatic-cycloplegic and corticosteroid eye drops and with furosemide. However, there are also controversial reports on decreased IOP during the acute phase of HFRS. Despite the fact that ocular symptoms in HFRS are common generally they do not require any medical therapy and the recovery of the patients is complete.