West Nile virus has been described in Africa, Europe, the Middle East, west and central Asia, Oceania, and has emerged in recent years in temperate regions of Europe and North America.¹ West Nile virus was first isolated from a febrile adult woman in the West Nile District of Uganda in 1937 and became recognised as a cause of severe human meningoencephalitis in elderly patients during an outbreak in Israel in 1957.² In 1999, the plight of city birds and a collection of human encephalitis cases in New York heralded the arrival of West Nile virus on this side of the Atlantic. From 1999 through 2001, there were 149 cases of human West Nile virus infection in the United States, including 18 deaths, but in 2002 alone more than 3500 cases and 200 deaths were reported.³ In 2003, over 9000 cases were reported with more than 300 cases of neuroinvasive disease.³

The Centers for Disease Control notes that neuroinvasive disease includes those cases resulting in meningitis, encephalitis, or meningoencephalitis.³ Cases with ocular involvement should probably be included in this …