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TOPIC: Ocular manifestations in dengue fever remain underrecognized despite reports of vision-threatening complications. This systematic review and meta-analysis aimed to determine the pooled prevalence of ocular manifestations in dengue patients, characterizing their spectrum, frequency, and clinical significance. CLINICAL RELEVANCE: Dengue fever affects millions globally, predominantly in tropical regions. While systemic complications are well documented, ophthalmic involvement remains poorly defined, with variable prevalence estimates and unclear risk factors. Early recognition is crucial for timely intervention, particularly in endemic areas where clinical suspicion is low. METHODS: A comprehensive search was conducted in PubMed, CINAHL, and LILACS. Eligible studies included observational studies reporting the prevalence of ocular manifestations in dengue patients. Risk of bias was assessed using Hoy et al.'s tool for prevalence studies. Pooled prevalence estimates were calculated using a random-effects model, and heterogeneity was assessed using I2 statistics. RESULTS: A total of 32 studies, including 11,426 patients, were included. The pooled prevalence of ocular manifestations, calculated from 16 studies, was 0.32 (95% CI: 0.22-0.45, I2 = 91.8%). Retro-ocular pain had a pooled prevalence of 0.20 (95% CI: 0.10-0.37, I2 = 99.6%), while blurred vision was reported in 0.11 (95% CI: 0.05-0.23, I2 = 92.8%). Among structural manifestations, subconjunctival hemorrhage had a prevalence of 0.18 (95% CI: 0.10-0.30, I2 = 94.1%), retinal hemorrhage 0.08 (95% CI: 0.05-0.12, I2 = 77.8%), maculopathy 0.04 (95% CI: 0.02-0.08, I2 = 91.6%), and uveitis 0.05 (95% CI: 0.01-0.24, I2 = 97.4%). Significant heterogeneity was observed across studies, likely due to differences in diagnostic criteria, study populations, and disease severity. CONCLUSION: This study highlights a substantial prevalence of ocular manifestations in dengue patients, emphasizing the need for increased clinical awareness, particularly in endemic regions. Given the heterogeneity in reported prevalence, future research should focus on prospective, standardized ophthalmologic assessments to improve early diagnosis and management.