Neuro-ophthalmic manifestations of coronavirus disease 19

Abstract

Purpose of review To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19), documented in the literature thus far. Recent findings A small but growing literature documents cases of new onset neuro-ophthalmic disease, in the setting of COVID-19 infection. Patients with COVID-19 have experienced acute onset vision loss, optic neuritis, cranial neuropathies, and Miller Fisher syndrome. In addition, COVID-19 increases the risk of cerebrovascular diseases that can impact the visual system. Summary The literature on COVID-19 continues to evolve. Although COVID-19 primarily impacts the respiratory system, there are several reports of new onset neuro-ophthalmic conditions in COVID-infected patients. When patients present with new onset neuro-ophthalmic issues, COVID-19 should be kept on the differential. Testing for COVID-19 should be considered, especially when fever or respiratory symptoms are also present. When screening general patients for COVID-19-associated symptoms, frontline physicians can consider including questions about diplopia, eye pain, pain with extraocular movements, decreased vision, gait issues, and other neurologic symptoms. The presence of these symptoms may increase the overall probability of viral infection, especially when fever or respiratory symptoms are present. More research is needed to establish a causal relationship between COVID-19 and neuro-ophthalmic disease, and better understand pathogenesis.

Angiotensin Converting Enzyme 2 (ACE2) Expression in the Visual System

“…Our scienti c understanding of thefactors involved in SARS-CoV-2 viral transmission and a nity for multiple human host cell targets continues to evolve. There isnow an expanding list of documented impairmentsof the human visual systemand multiple types of visual dysfunction and/or vision de ciency associated with COVID-19 infection [15][16][17][18][19][20][21][22][23][24][25]46,[51][52][53][60][61][62][63]. The current study provides new insight into the distribution of the ACE2 receptor in eye and brain cells and tissues involved in visual signal processing.The ACE2 receptor is acknowledged as the major molecular receptor for SARS-CoV-2, and speci c anatomical regions of the eye and the visual circuitry of the brain contain abundantly detectable ACE2 receptor mRNA and protein.…”

“…infected patients [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Coronaviruses are known for their neurotropism towards brain cells and cells of the visual system,and COVID-19infection is currently positively associated with ocular abnormalities including blurred vision, kerato-conjunctivitis (an in ammation of the conjunctiva), conjunctival hyperemia, chemosis (a swelling of the conjunctiva) [13][14][15][16], epiphora (increased tear secretions), anosmia, diplopia (monocular or binocular), acute-onset vision loss, acquired cortical blindness caused by damage to the brain's occipital cortex and both primary and secondary brain visual processing centers [15][16][17][18], progressive monocular and binocular/bilateral blindness, eye pain with photophobia, eye pain with disturbances in extraocular movements and cranial nerve involvement [17][18][19][20], decreased visual acuity, optic neuritis, visual-associated disturbances in balance and gait issues, total or partial loss of vision in an otherwise normal-appearing eye [19][20][21][22], acute uveitisand other neurologic-ophthalmic symptoms including cranial neuropathies in the visual circuitry and a virally-induced Miller-Fisher syndrome [13][14][15]19,[20][21][22][23]…”

Internuclear ophthalmoplegia as a presenting feature in a COVID-19-positive patient

“…Neurological symptoms in COVID-19 are well established, ranging from headache, dizziness, anosmia or hyposmia, and hypogeusia, to Guillain-Barre syndrome, ischaemic and haemorrhagic strokes, and so on. 12 Reports of neuro-ophthalmic findings such as cranial nerve paresis, optic neuritis, gaze palsy, vision loss and so on are being increasingly described in the literature. [6][7][8][9][10][11][12][13][14][15][16] Multiple mechanisms in the aetiopathogenesis of neuroophthalmic manifestations in COVID-19 have been proposed, and these include postviral inflammatory syndrome, sequelae of a proinflammatory state and as a consequence of systemic conditions, such as cardiovascular disease or uncontrolled hypertension.…”

“…Neuro-ophthalmological manifestations range from isolated cranial nerve palsy [6][7][8] to supranuclear gaze palsy, 9 optic neuritis, 10 vision loss 11 and Miller Fisher syndrome. 12 We present a case of COVID-19 presenting with internuclear ophthalmoplegia (INO).…”

Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion – Teil 1: periphere Nerven

“…Mononeuropathien und Polyneuritiden der Hirnnerven nach SARS-COV2-Infektion wurden bisher vereinzelt berichtet. Beeinträchtigungen wurden für den N. opticus [50], N. oculomotorius [3 11 15], den N. abducens [11 13], N. facialis [17 21] und auch für die kaudalen Hirnnerven beschrieben [2,30]. Während erstere schon nach wenigen Tagen rückläufig waren, persistierten bulbäre Symptome länger.…”