Anterior Scleritis Manifesting After Coronavirus Disease 2019: A Report of Two Cases

Abstract

Purpose: The purpose of this study was to report 2 patients with anterior scleritis manifesting after coronavirus disease 2019 (COVID-19). Methods: The patients with confirmed COVID-19 developed anterior scleritis after their systemic symptoms were markedly improved. A thorough systemic workup identified no underlying autoimmune diseases. Ocular characteristics and safety and efficacy of systemic immunosuppressive therapy were evaluated. Results: Case 1 was a 67-year-old woman who presented with necrotizing anterior scleritis in both eyes 3 weeks after the onset of COVID-19. One-week treatment with topical betamethasone and oral prednisolone (65 mg daily) did not result in improvement, so she was started on intravenous cyclophosphamide and subcutaneous adalimumab in addition to oral prednisolone. Necrotizing scleritis was gradually improved over 3 months. Case 2 was a 33-year-old man who presented with sectoral anterior scleritis in his right eye 2 weeks after the onset of COVID-19. He was started on topical betamethasone and oral prednisolone (85 mg daily). One week later, all signs and symptoms disappeared, and topical and oral corticosteroids were gradually tapered off over 2 weeks. There was no recurrence of respiratory symptoms or active scleritis in any cases after discontinuation of treatment. Conclusions: These cases suggest that COVID-19 can be associated with anterior scleritis, which responds to immunosuppressive and biologic agents. Ophthalmologists should consider anterior scleritis in patients with COVID-19 who present with ocular pain and redness during the convalescent phase of the illness.

Orbital myositis and scleritis after anti-SARS-CoV-2 mRNA vaccines: A report of three cases

“…Cases of episcleritis and scleritis occurring during COVID-19 infection have already been reported in literature. 8 – 10 Likewise, other cases have been reported recently by Pichi et al occurring after inactivated COVID-19 vaccination. The timing of onset of clinical manifestations in the cases described by us is in agreement with the timing (1 to 10 days after vaccination) reported by the authors.…”

Case Report: Associated Ocular Adverse Reactions With Inactivated COVID-19 Vaccine in China

“…The symptoms of the case were mild and responsive to glucocorticoids. Noteworthily, there were two reports of scleritis (one case of episcleritis and two cases of anterior scleritis) after the outbreak of coronavirus in 2019 ( 19 , 20 ).…”

Nodular scleritis-a rare presentation of COVID-19& variation with testing

“…There has been a report of 2 cases with confirmed COVID-19 developing anterior scleritis after their systemic symptoms improved and in these cases a thorough systemic workup did not identify any underlying autoimmune diseases. 6 One patient presented with necrotizing anterior scleritis and required intravenous cyclophosphamide, subcutaneous adalimumab in addition to oral prednisolone and the other patient had only sectoral anterior scleritis and responded to topical betamethasone and oral prednisolone. 6 There have also been reports of patients with COVID-19 developing acute follicular conjunctivitis, conjunctival hyperaemia, chemosis, epiphora, and increased ocular secretions.…”

“… 6 One patient presented with necrotizing anterior scleritis and required intravenous cyclophosphamide, subcutaneous adalimumab in addition to oral prednisolone and the other patient had only sectoral anterior scleritis and responded to topical betamethasone and oral prednisolone. 6 There have also been reports of patients with COVID-19 developing acute follicular conjunctivitis, conjunctival hyperaemia, chemosis, epiphora, and increased ocular secretions. 7 , 8 These manifestations however have been observed more frequently in patients with severe pneumonia and during the middle phase of illness.…”