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Congenital Zika virus infection may cause eye abnormalities in addition to the widely reported microcephaly and neurological findings. Criteria for ophthalmologic screening in infants exposed to Zika virus are still emerging.
Researchers in Brazil reported eye exam findings for 112 infants of mothers with polymerase chain reaction–proven Zika infection during pregnancy, noting trimester of infection and presence of microcephaly or central nervous system abnormalities.
Twenty-four infants (21%) had eye findings, the majority affecting the optic nerve or the retina. Although eye findings were associated with microcephaly (odds ratio, 19.1), other central nervous system abnormalities (OR, 4.3), and arthrogryposis (OR, 29.0), eight infants with eye findings (33%) had none of these. Eye findings were associated with first trimester maternal infection (OR, 5.1) but were also found after second and third trimester infections.
Zin AA et al. Screening criteria for ophthalmic manifestations of congenital Zika virus infection. JAMA Pediatr 2017 Jul 17; [e-pub]. (http://dx.doi.org/10.1001/jamapediatrics.2017.1474)
Comment
Current congenital Zika infection guidelines recommend eye screening only in the presence of microcephaly (Brazilian Ministry of Health) or lab-confirmed maternal Zika infection (Centers for Disease Control and Prevention). Based on the findings from this case series, we should strongly consider following the authors' recommendation that all infants with possible in utero exposure to Zika virus be referred for an eye exam, regardless of central nervous system findings or maternal trimester of infection.