Corneal Complications after COVID-19 Vaccination: A Systemic Review

Abstract

Multiple vaccines are now being used across the world, and several studies have described cases of corneal graft rejection following the administration of the COVID-19 vaccine. The purpose of this article is to review the corneal adverse event that occurred following COVID-19 vaccine administration. The literature search was conducted in March 2022 using MEDLINE, PubMed, and the Cochrane Database of Systematic Reviews. A total of 27 articles, including 37 cases, have documented corneal adverse events that occurred following COVID-19 vaccination. The mean age was 60 ± 14.9 years (range, 27–83 years). The most common events were acute corneal graft rejection (n = 21, 56.8%), followed by herpes zoster ophthalmicus (n = 11, 29.7%) and herpes simplex keratitis (n = 2, 5.4%). The mean time from vaccination to the event was 10 ± 8.5 days (range, 1–42 days) after the first or second dose of vaccine. All patients with corneal graft rejection, immune-mediated keratolysis, and peripheral ulcerative keratitis (PUK) (n = 24, 64.9%) were managed topically with or without oral corticosteroids. Patients with herpes zoster ophthalmicus and herpes simplex keratitis were managed with oral antiviral agents. Two patients received penetrating keratoplasty due to keratolysis after invalid topical treatment. Disease resolution was noted in 29 patients (78.3%), whereas 3 (8.1%) had persistent corneal edema after graft rejection, 1 (2.7%) had corneal infiltration after HZO, and 4 (10.8%) were not mentioned in the articles. Corneal adverse events could occur after COVID-19 vaccination. After timely treatment with steroids or antiviral agents, most of the events were mild and had a good visual outcome. Administrating or increasing steroids before vaccination may be useful for the prevention of corneal graft rejection. However, the prophylactic use of antiviral treatments in patients with a herpes viral infection history is not recommend.

Rare Case of Thygeson Superficial Punctate Keratitis After COVID-19 Vaccination

“…These include herpes simplex virus (HSV) and varicella zoster virus keratouveitis, subepithelial infiltrates in the context of previous epidemic keratoconjunctivitis, corneal graft rejection, corneal epithelial rejection after limbal stem cell transplantation, peripheral ulcerative keratitis, marginal keratitis, and immune-mediated keratolysis. [5][6][7] Onset of symptoms for these immune-related adverse events seems to begin 10 days after vaccination, on average. 7 The most commonly reported corneal events are corneal graft rejections, followed by herpes zoster ophthalmicus.…”

“…[5][6][7] Onset of symptoms for these immune-related adverse events seems to begin 10 days after vaccination, on average. 7 The most commonly reported corneal events are corneal graft rejections, followed by herpes zoster ophthalmicus. 7 We present the case of a 25-year-old patient who developed Thygeson superficial punctate keratitis (TSPK) after vaccination against the SARS-CoV-2.…”

“…7 The most commonly reported corneal events are corneal graft rejections, followed by herpes zoster ophthalmicus. 7 We present the case of a 25-year-old patient who developed Thygeson superficial punctate keratitis (TSPK) after vaccination against the SARS-CoV-2. To the best of our knowledge, ours is the first case report describing the temporal association between COVID-19 vaccination and findings consistent with TSPK.…”

“…5–7 Onset of symptoms for these immune-related adverse events seems to begin 10 days after vaccination, on average. 7 The most commonly reported corneal events are corneal graft rejections, followed by herpes zoster ophthalmicus. 7…”

“…7 The most commonly reported corneal events are corneal graft rejections, followed by herpes zoster ophthalmicus. 7…”