Ophthalmic manifestations in Chagas disease: From infection entry to chronic complication

Abstract

Chagas disease (CD) is a systemic condition in which ocular involvement remains underrecognized. This narrative review synthesizes evidence on ophthalmic manifestations of CD, from acute entry-related findings to chronic and immunosuppression-associated complications. A comprehensive literature search was conducted in reference databases, including classical and contemporary studies without restrictions on publication date, language, or study design. In the acute phase, manifestations are classically represented by Romaña’s sign, including conjunctivitis and keratitis, and experimental data support ocular tissues as parasite reservoirs. In the chronic phase, subtle retinal pigment epithelium alterations, rod dysfunction, autonomic changes in intraocular pressure, and optic nerve involvement have been reported. Advanced imaging techniques, such as optical coherence tomography (OCT) and OCT-angiography, reveal structural and vascular changes, although findings remain inconsistent. In immunosuppressed patients, parasite reactivation may lead to severe retinitis. Overall, ocular involvement in CD appears multifactorial and underestimated, highlighting the need for further prospective studies.