Afferent and Efferent Neuro-Ophthalmic Complications of Coronavirus Disease 19

Abstract

Purpose: To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 documented in the literature thus far. Methods: The PubMed and Google Scholar databases were searched using the keywords: Neuro-Ophthalmology, COVID-19, SARS-CoV-2, and coronavirus. A manual search through reference lists of relevant articles was also performed. Results/Conclusions: The literature on COVID-associated neuro-ophthalmic disease continues to grow. Afferent neuro-ophthalmic complications associated with COVID-19 include optic neuritis, papillophlebitis, papilledema, visual disturbance associated with posterior reversible encephalopathy syndrome, and vision loss caused by stroke. Efferent neuro-ophthalmic complications associated with COVID-19 include cranial neuropathies, Miller Fisher syndrome, Adie's pupils, ocular myasthenia gravis, nystagmus and eye movement disorders. Proposed mechanisms of neurologic disease include immunologic upregulation, vasodilation and vascular permeability, endothelial dysfunction, coagulopathy, and direct viral neurotropism. When patients present to medical centers with new onset neuro-ophthalmic conditions during the pandemic, COVID-19 infection should be kept on the differential.

Spike in Rhino-Orbital-Cerebral Mucormycosis Cases Presenting to a Tertiary Care Center During the COVID-19 Pandemic

“…Reports on ocular manifestations in patients with the novel coronavirus disease 2019 (COVID-19) describe self-limiting conjunctivitis (8) and rare neuro-ophthalmic manifestations that include optic neuritis and ocular motor cranial neuropathies (9). We are still learning about the overreaching health implications and long-term sequalae associated with the viral pandemic.…”

Multiprofessional Neurorehabilitation After COVID-19 Infection Should Include Assessment of Visual Function

“… 4 , 5 Due to the heterogeneity of the manifestations, different possible pathogenic pathways have been suggested, e.g., direct neural invasion, immune-mediated processes, endothelial dysfunction, and hypercoagulability. 6 , 7 , 8 The increasing number of studies reporting on a variety of symptoms persisting after Covid-19, particularly cognitive impairments, underscore the need for multi-professional rehabilitation. 3 , 4 , 5 , 9 , 10 , 11 …”

“… 23 , 25 , 26 In addition, inner parts of the eye may be involved, e.g., retinal disease. 8 , 22 Neuro-ophthalmic symptoms include headache, ocular pain, visual impairment, and double vision, 24 and the signs may involve optic neuritis, visual disturbances due to encephalopathy or stroke, cranial nerve palsies, and eye movement disorders. 8 …”

Unilateral Optic Neuritis as the First and Only Manifestation of SARS-CoV-2 Infection

“…We wonder if the unilateral optic neuritis was the sole manifestation of the SARS-CoV-2 infection. Cases of COVID-related optic neuritis have been previously described 3 , 4 , 5 , but these have occurred in symptomatic patients infected with SARS-CoV-2.…”