Anterior Ischemic Optic Neuropathy as a Rare Manifestation of COVID-19: A Case Report

Abstract

Aim: A variety of manifestations in different organs could be associated with severe COVID-19; for example, ocular manifestations. Case report: A 52-year-old male complaining of sudden onset unilateral painless vision loss in the right eye for 1 month (started just 1 week after COVID-19 remission) came to the ophthalmology clinic. On further evaluations, he was diagnosed with anterior ischemic optic neuropathy (AION). Considering his past history and the result of evaluations, the hypothesis of association between AION and COVID-19 was proposed. Results & discussion: Ocular and neurologic manifestations of COVID-19 are more likely to happen in patients with more severe conditions. Complications occur secondary to two basic mechanisms including severe inflammatory response and hypercoagulable state. Conclusion: Our findings indicated that non-arteritic AION is another manifestation of microangiopathic/thrombotic events which may occur in the course of COVID-19.

Optic neuropathies post-Covid 19 - review

“…In the articles in literature, an accurate diagnosis of postcovid optic neuropathy was carried out through an ophthalmological examination, in some cases associated with a neurological examination [7][8][9]. Imaging studies such as optical coherence tomography (OCT) [5,7,9,10,12,13,15,17], computer tomography (CT) [15], angiofluorography (AFG) [2,11], magnetic resonance imaging (MRI) [3-5,7-10,16-18], ultrasonography of the retrobulbar arteries [2], as well as laboratory, immunological and serological analyses were used. In order to clarify the etiological diagnosis and establish differential diagnoses with other infectious or autoimmune diseases, the following inflammatory tests were performed: erythrocyte sedimentation rate (ESR), ferritin, LDH, fibrinogen, CRP [2,4,6,7,8,13], D-dimers [2,6,12,14,16,17] immunological tests: rheumatoid factor (RF) [2,4,6,7,8,11,13,14,15], antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA) [6,7], anti-aquaporin 4 antibodies (AQP4) [6], anti MOG IgG, antibodies IgG and IgM SARS-CoV-2; anti neuromyelitis optica antibodies (NMO), serology for syphilis, tuberculosis, cytomegalovirus, Lyme disease, Ebstein Barr virus, Herpes Simplex, human immunodeficiency virus, Borellia, hepa...…”

“…The tropism of the Corona virus on the cranial nerves manifests itself on the sensory function, while the motor function is rarely affected [21]. In Sars-Cov-2 infection, complications generally occur within the second week after the onset of the symptoms [13]. There are two main mechanisms: a severe inflammatory response and a state of hypercoagulability, by activating the coagulation cascade [22].…”

“…There are two main mechanisms: a severe inflammatory response and a state of hypercoagulability, by activating the coagulation cascade [22]. In the first mechanism, proinflammatory factors such as C-reactive Protein (CRP), ferritin, cytokines (CK) and interleukins (IL) 2,6,7,10, and tumor necrosis factor (TNFɑ) are activated [13,22]. Regarding the neuroophthalmological manifestations associated with Covid-19, the physiopathogenic mechanisms involved are related to hypoxia, severe HT, toxic metabolic processes, ischemic stroke, hemorrhages associated with certain parainfectious and postinfectious inflammatory processes [23].…”

Non-arteritic anterior ischaemic optic neuropathy (NA-AION) and COVID-19 vaccination

“…COVID-19 has been implicated as a possible cause of NA-AION 25–27. The postulated mechanisms include hypercoagulable and hyperinflammatory state post-COVID-19, which lead to microangiopathic and thrombotic events in the body including the eye 27…”

Hearing Loss and Sixth Cranial Nerve Paresis after COVID-19

“…In the case presented, symptoms started 3 weeks after infection. Other authors have reported anterior ischaemic optic neuropathy 1 week after COVID-19 resolution [ 5 ] . The temporal relationship, the absence of other pathologies after exhaustive work-up, and the clinical evolution led us to suspect that the neurological symptoms in our patient were related to SARS-CoV-2 infection.…”