Retinal manifestations of neglected tropical diseases

Neglected tropical diseases (NTDs) are increasingly encountered outside endemic regions due to global migration, international travel, and climate change. This review addresses the timely need for ophthalmologists to recognize the retinal manifestations of NTDs, as these conditions now appear in developed nations where clinicians may have limited prior exposure.

Modern multimodal imaging has revealed distinct retinal patterns that are frequently seen in NTDs. Dengue and chikungunya present with maculopathy, foveolitis, and retinal hemorrhages. Onchocerciasis causes progressive chorioretinal atrophy and optic nerve involvement leading to vision loss. Neurocysticercosis manifests as subretinal or intravitreal cysts with visible scolices. Schistosomiasis produces chorioretinal granulomas and neuroretinitis. Leishmaniasis presents with posterior uveitis and chorioretinal lesions. African trypanosomiasis demonstrates choroidal infiltrates and retinal vasculitis. Chagas disease shows microvasculopathy with retinal hemorrhages, while leprosy causes chronic uveitis with iris pearls and chorioretinal scarring.

Recognition of retinal manifestations is crucial for NTD diagnosis and management. Ophthalmologists must maintain high clinical suspicion based on travel history and systemic symptoms. Collaborative care with infectious disease specialists and utilization of appropriate diagnostic modalities facilitate optimal outcomes and prevent vision loss while addressing broader public health implications.