Embolic Abducens Palsy and Central Retinal Artery Occlusion in a Patient With COVID-19

Larochelle, Ryan; Koduri, Vivek A.; Chen, Rachel; Subramanian, Prem S.

doi:10.1097/wno.0000000000001291

Cited by 9 publications

(20 citation statements)

References 4 publications

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“…The age ranged from 29 to 68 years, and 70% of the patients were male. Most cases presented ocular symptoms within 1–2 weeks of COVID-19 diagnosis; ocular symptoms preceded in two cases, and one case was diagnosed 3 months after COVID-19 diagnosis [ 18 – 20 ]. About half of the patients reported no systemic illness, while hypertension was noted in four cases [ 18 , 19 , 21 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most cases presented ocular symptoms within 1–2 weeks of COVID-19 diagnosis; ocular symptoms preceded in two cases, and one case was diagnosed 3 months after COVID-19 diagnosis [ 18 – 20 ]. About half of the patients reported no systemic illness, while hypertension was noted in four cases [ 18 , 19 , 21 , 22 ]. Those who presented with pneumonia and/or respiratory failure mostly presented abnormal coagulation parameters, including D-dimer, C-reactive protein (CRP), ferritin, and fibrinogen [ 18 , 21 – 23 ], although increased D-dimer levels were also noted in patients with mild disease [ 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…About half of the patients reported no systemic illness, while hypertension was noted in four cases [ 18 , 19 , 21 , 22 ]. Those who presented with pneumonia and/or respiratory failure mostly presented abnormal coagulation parameters, including D-dimer, C-reactive protein (CRP), ferritin, and fibrinogen [ 18 , 21 – 23 ], although increased D-dimer levels were also noted in patients with mild disease [ 24 , 25 ]. Three patients had normal coagulation parameters [ 26 , 27 ]…”

Section: Resultsmentioning

confidence: 99%

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Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review

Yeo

Kim

Lee

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose Abnormal hypercoagulability and increased thromboembolic risk are common in patients with coronavirus disease (COVID-19). COVID-19 has been suggested to cause retinal vascular damage, with several studies on COVID-19 patients with retinal vascular occlusions. We reviewed and investigated studies on retinal vascular occlusions in patients diagnosed with COVID-19 and in those vaccinated for COVID-19. Methods Studies that reported retinal vascular occlusion in COVID-19 patients or in vaccinated people were identified using the terms “retinal occlusion,” together with “severe acute respiratory syndrome coronavirus 2”, “SARS-CoV-2,” “COVID-19,” “coronavirus,” and “vaccine,” through systematic searches of PubMed and Google Scholar databases until January 7, 2022. Results Thirteen cases of retinal artery occlusion (RAO) and 14 cases of retinal vein occlusion (RVO) were identified among patients diagnosed with COVID-19. Half of the patients with RAO or RVO revealed no systemic disorders except current or past COVID-19, and ocular symptoms were the initial presentation in five cases. Among patients with RAO, most presented with central RAO at 1–14 days of COVID-19 diagnosis, with abnormal coagulation and inflammatory markers. Among those with RVO, two-thirds presented with central RVO and one-third with RVO. Eleven cases with acute macular neuroretinopathy (AMN) and/or paracentral acute middle maculopathy (PAMM) were reported among patients with COVID-19, presenting scotoma resolved spontaneously in most cases. Among the 26 cases vaccinated with either mRNA or adenoviral vector vaccines for COVID-19 and presenting retinal vascular occlusions, there were more RVO cases than RAO cases, and ocular symptoms mostly occurred within 3 weeks after vaccination. One case presented bilateral AMN and PAMM after COVID-19 vaccination. Conclusion Retinal vascular occlusions might be a manifestation of COVID-19, although rare, especially in patients at risk of systemic hypercoagulability and thromboembolism. For COVID-19 vaccines, the causal relationship is controversial because there are few case reports of retinal vascular occlusions after COVID-19 vaccination.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review

Yeo

Kim

Lee

et al. 2023

Graefes Arch Clin Exp Ophthalmol

View full text Add to dashboard Cite

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“…Bikdeli et al [25] suggested that COVID-19 may predispose patients to arterial and venous thrombosis. Multiple case reports of retinal vascular occlusion have been reported [19][20][21][22][23][24][25][26][27][28][29][30][31]. Acharya et al [19] reported the first case of isolated central retinal artery occlusion (CRAO) secondary to COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Posterior segment manifestations and imaging features of COVID-19

Sanjay¹,

Agrawal²,

Jayadev³

et al. 2021

Med Hypothesis Discov Innov Ophthalmol

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Background: To report the posterior segment (uvea and retinal) manifestations and imaging characteristics of eyes of patients with and after coronavirus disease 2019 (COVID-19).Methods: We searched the PubMed/MEDLINE database to identify relevant articles using the following search terms: COVID-19, SARS-CoV-2, retina, uvea, optic nerve, retinal findings, posterior segment manifestations, and endophthalmitis. Articles published from December 1, 2019, to May 30, 2021, and indexed in PubMed/MEDLINE were screened.Results: For the purpose of this review, we included clinical features of 26 case reports and 8 case series. The posterior segment manifestations reported included cotton wool spots, retinal hemorrhages, central serous retinopathy, papillophlebitis, optic neuritis, panuveitis, multifocal retinitis, necrotizing retinitis, central retinal artery/vein occlusion, and Purtschner like retinopathy. In this review, we have also included optical coherence tomography angiography (OCTA) features that have been described in COVID-19 patients with pneumonia.Conclusions: COVID-19 patients can experience uveo-retinal manifestations even after recovery. These patients, even if asymptomatic for eye symptoms, should undergo an eye evaluation to rule out posterior segment involvement. OCTA performed in these patients revealed microvascular changes in the superficial and deep retinal plexuses. Some of these patients may require anticoagulant or antiplatelet therapy.

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“…Since then, numerous additional abducens palsies have been described in association with COVID-19 [21–23] including one with a right abducens nucleus lesion [24] and another mimicking Wernicke's encephalopathy [25]. In a case accompanied by ipsilateral central retinal artery occlusion, Hollenhorst plaques and posterior ischemic optic neuropathy in a 68-year-old man with atrial fibrillation [26], the abducens palsy was attributed to infarction, with watershed diffusion positivity seen throughout the brain on MRI, although whether the underlying etiology was embolic or vasculitic remains unclear. In three cases, the palsy resolved in under 2 weeks, such a short recovery period arguing against an ischemic etiology [27,28,29 ▪ ].…”

Section: Ophthalmoparesis and Diplopiamentioning

confidence: 99%

Efferent neuro-ophthalmic complications of coronavirus disease 2019

Dinkin

Sathi

2022

Current Opinion in Ophthalmology

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Purpose of reviewWe set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus.Recent findingsEfferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described.SummaryObserved neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.

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Embolic Abducens Palsy and Central Retinal Artery Occlusion in a Patient With COVID-19

Cited by 9 publications

References 4 publications

Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review

Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review

Posterior segment manifestations and imaging features of COVID-19

Efferent neuro-ophthalmic complications of coronavirus disease 2019

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