An eye to the future: Acute and long‐term neuro‐ophthalmological and neurological complications of COVID‐19

Abstract

COVID‐19 has had a significant impact on the global population and has produced compelling evidence of non‐pulmonary organ dysfunction, including the nervous system. It is vital that specialists in ophthalmology and neurology are informed of the potential complications of COVID‐19 and gain a deeper understanding of how COVID‐19 can cause diseases of the nervous system. In this review we detail four possible mechanisms by which COVID‐19 infection may result in neurological or neuro‐ophthalmological complications: (1) Toxic and metabolic effects of severe pulmonary COVID‐19 disease on the neural axis including hypoxia and the systemic hyper‐inflammatory state, (2) endothelial dysfunction, (3) dysimmune responses directed again the neuroaxis, and (4) direct neuro‐invasion and injury by the virus itself. We explore the pathological evidence for each of these and how they may link to neuro‐ophthalmological disorders. Finally, we explore the evidence for long‐term neurological and neuro‐ophthalmological complications of COVID‐19, with a focus on neurodegeneration.

A review of neuro-ophthalmic sequelae following COVID-19 infection and vaccination

“…However, it has also been pointed out that despite auto-antibodies targeting MOG, molecular mimicry is unlikely the cause due to lack of homology between the COVID-19 viral protein and the MOG protein ( Johnsson et al., 2022 ). Instead, loss of self-tolerance in the context of an activated adaptive immune system is suggested to be culprit ( Wesselingh and Wesselingh, 2023 ).…”

“…SARS-CoV-2 took the world by storm at the dawn of 2020. The novel single-stranded RNA beta coronavirus affected the health and livelihoods of millions across the globe on a scale only encountered once approximately every 100 years ( Wesselingh and Wesselingh, 2023 ). There is currently a plethora of case reports and case series of neuro-ophthalmic manifestations of COVID-19 and its vaccine counterparts ( Luís et al., 2020 ; Betsch and Freund, 2021 ; Tisdale et al., 2021 ).…”

Fighting infection

“…4 A large cohort study involving 228 patients and 109 healthy controls conducted in general hospitals in Hong Kong provided an assessment of the ocular surface disturbances that prove to be common after recovery from COVID-19. 5 Clinical and Experimental Ophthalmology also recently featured a comprehensive review by Wesselingh and Wesselingh 6 of the neuro-ophthalmological and neurological complications of COVID-19, including longterm sequelae that occur as part of 'long COVID'. As a group, reviews are our most popular articles, whether one measures this by citation or by reader feedback.…”

“…Clinical and Experimental Ophthalmology also recently featured a comprehensive review by Wesselingh and Wesselingh 6 of the neuro‐ophthalmological and neurological complications of COVID‐19, including long‐term sequelae that occur as part of ‘long COVID’. As a group, reviews are our most popular articles, whether one measures this by citation or by reader feedback.…”

Persisting Shadows: Unraveling the Impact of Long COVID-19 on Respiratory, Cardiovascular, and Nervous Systems

“…Several studies, including cohort studies, have also linked COVID-19 to the development of peripheral nervous system (PNS) diseases, indicating that SARS-CoV-2 infection leads to immune dysregulation affecting the PNS as well [105,106]. Manifestations like nerve pain, skeletal muscle injury, Guillain-Barré syndrome (GBS), cranial polyneuritis, neuromuscular junction disorders, neuro-ophthalmological disorders, neurosensory hearing loss, and dysautonomia have been reported in COVID-19 patients [107].…”