Title : The underestimated threat: A review of ocular leptospirosis
Abstract:
Background: Ocular leptospirosis, a severe yet underrecognized complication of systemic leptospirosis, is an emerging global health concern. Primarily affecting tropical and subtropical regions, this neglected zoonotic disease contributes to significant morbidity and vision loss, disproportionately impacting resource-limited settings where surveillance and healthcare access are often inadequate.
Objective: This review aims to provide a comprehensive overview of ocular leptospirosis, focusing on its diverse clinical manifestations, diagnostic challenges, and global public health implications. It also highlights opportunities for advancing diagnosis, treatment, and prevention strategies to address this underestimated threat.
Methods: An extensive review of the literature was conducted, synthesizing data on the epidemiology, ocular presentations, diagnostic modalities, and public health challenges associated with leptospirosis. Emerging diagnostic technologies and integrated health approaches were evaluated for their potential to improve outcomes.
Findings: Ocular leptospirosis encompasses a spectrum of clinical manifestations, from acute conjunctival congestion to sight-threatening complications such as uveitis, hypopyon, vitreous membranes, and rapid cataract maturation. Diagnostic delays are common, driven by the non-specificity of ocular symptoms and limitations of traditional methods like serology and PCR. Recent advancements, including electrochemical biosensors and metagenomic sequencing, offer promising avenues for improving diagnostic accuracy and accessibility. Public health impacts are profound, with vision impairment affecting quality of life, productivity, and economic stability, particularly in vulnerable populations.
Conclusions: Ocular leptospirosis is a critical yet underestimated cause of preventable vision loss worldwide. Urgent action is needed to enhance surveillance systems, raise awareness, and develop accessible, accurate diagnostic tools. A One Health approach, integrating human, animal, and environmental health efforts, is vital to addressing transmission dynamics and reducing disease burden. Early diagnosis and intervention are essential to preserving vision and improving outcomes. Through coordinated global efforts, the impact of this neglected disease can be substantially mitigated, protecting individuals and strengthening public health systems worldwide.
