Non-arteritic Anterior Ischemic Optic Neuropathy with Macular Star following COVID-19 Vaccination

Non-Arteritic Anterior Ischemic Optic Neuropathy Following COVID-19 Vaccination

“…Our patient did not suffer from diabetes mellitus, the most well-known risk factor for developing NAION [9], but hypertension, hyperlipidemia, and prior cataract surgery (though still controversial as a risk factor) may have predisposed her to NAION. Regarding the treatment, our patient showed the resolution of optic disc edema after administration of oral prednisolone, and this finding was also found in three of the previous reported cases, in which two of the patients even experienced improvement in visual acuity [5,7,8].…”

“…Among seven reported cases, including this study, all patients, comprising four females and three males, developed NAION unilaterally, and the onset of the ocular symptoms occurred within 9 days after COVID-19 vaccination. Most of the patients were adults aged 50 years or older except for two patients (aged 40 and 46 years) [3][4][5][6][7][8], and they had one or more risk factors for developing NAION, for instance, a small cup-to-disc ratio, diabetes mellitus, and hyperlipidemia. In fact, all previous cases were diabetic patients except for two healthy patients without any systemic or ocular diseases.…”

“…As the Delta and Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerge, people are advised to receive a vaccine booster [1], but they may have to bear the risk of developing various adverse ocular reactions after vaccination, for instance, uveitis, herpetic eye disease, acute macular neuroretinopathy, optic neuritis, and acute corneal graft rejection [2]. Non-arteritic anterior ischemic optic neuropathy (NAION) has been reported in extremely rare cases; to the best of our knowledge, only one of the six previous cases in the literature is associated with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine [3][4][5][6][7][8]. We as ophthalmologists herein present a case of developing NAION after ChAdOx1 nCoV-19 (AstraZeneca) vaccination to increase awareness of this potential adverse ocular event.…”

Optic neuropathy after COVID-19 vaccination: Case report and systematic review

“…Furthermore, the pathophysiology (and treatment) of both types of optic neuropathies is postulated to be different and it is not currently clear why some patients develop AION while others develop optic neuritis following vaccination. Documented risk factors for NAION include diabetes, small cup-to-disc ratio, hyperlipidemia, and hypertension and it is likely that the development of NAION is a multifactorial process which includes pre-existing structural compromise of the optic nerve ( Hayreh, 2009 , Behbehani, Ali and Al-Moosa, 2021 , Tsai, Liu and Su, 1998 , Elhusseiny et al, 2022 ).…”

A Case of Atypical Unilateral Optic Neuritis Following BNT162b2 mRNA COVID-19 Vaccination

“…Optic neuropathy is suspected as one of adverse events of the COVID-19 vaccine, which includes ON associated with or without demyelinating CNS diseases [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ], NA-AION [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], and NMOSD [ 8 , 9 ]. Lotan et al reviewed 14 case reports and 2 case series by electronic searches of the published literature regarding neuro-ophthalmological complications of COVID-19 vaccines and reported that optic neuritis was the most common, occurring in 61 of 76 cases (80.3%) [ 25 ].…”