Ocular findings among patients surviving COVID-19

Abstract

To describe the medium-term ophthalmological findings in patients recovering from COVID-19. Patients recovered from the acute phase of COVID-19 underwent a complete ophthalmological evaluation, including presenting and best-corrected visual acuity (BCVA), refractometry, biomicroscopy, tonometry, break-up time and Schirmer tests, indirect ophthalmoscopy, color fundus picture, and retinal architecture evaluation using optical coherence tomography. Socio-demographic data and personal medical history were also collected. According to the severity of systemic manifestations, patients were classified into mild-to-moderate, severe, and critical. Sixty-four patients (128 eyes) were evaluated 82 ± 36.4 days after the onset of COVID’s symptoms. The mean ± SD duration of hospitalization was 15.0 ± 10.7 days. Seven patients (10.9%) had mild-to-moderate, 33 (51.5%) severe, and 24 (37.5%) critical disease. Median [interquartile ranges (IQR)] presenting visual acuity was 0.1 (0–0.2) and BCVA 0 (0–0.1). Anterior segment biomicroscopy was unremarkable, except for dry eye disease, verified in 10.9% of them. The mean ± SD intraocular pressure (IOP) in critical group (14.16 ± 1.88 mmHg) was significantly higher than in severe group (12.51 ± 2.40 mmHg), both in the right (p 0.02) and left eyes (p 0.038). Among all, 15.6% had diabetic retinopathy, and two patients presented with discrete white-yellowish dots in the posterior pole, leading to hyporreflective changes at retinal pigment epithelium level, outer segment, and ellipsoid layers. The present study identified higher IOP among critical cases, when compared to severe cases, and discrete outer retina changes 80 days after COVID-19 infection. No sign of uveitis was found.

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

“…49 These changes may reflect the underlying systemic hypercoagulable, ischemic, inflammatory, and/or hypertensive state of the patient or direct invasion of the virus. 1,2,44,[46][47][48]50 Neuro-Ophthalmic Findings Up to 21% of patients with COVID-19 may have systemic neurologic signs, and 0.4% have cranial nerve impairment. 15 Potential neuro-ophthalmic associations with COVID-19 include optic neuritis and myelitis, ischemic optic neuropathy, Guillain-Barre syndrome, Miller-Fisher syndrome, and cranial neuropathies like CNIII or CNVI palsies.…”

“… 42 More severe systemic disease was associated with lower vascular density on OCT angiography (OCTA). 43 Other potential posterior segment findings included possible hyperreflective lesions in the inner and outer retina and vitreous, 1 , 2 , 44 uveitis-like multifocal evanescent white dot syndrome, 45 acute macular neuroretinopathy, 46 central retinal vein occlusion, 47 intraretinal hemorrhages, 48 and inflammatory multifocal chorioretinitis with Adie’s pupil. 49 These changes may reflect the underlying systemic hypercoagulable, ischemic, inflammatory, and/or hypertensive state of the patient or direct invasion of the virus.…”

“… 49 These changes may reflect the underlying systemic hypercoagulable, ischemic, inflammatory, and/or hypertensive state of the patient or direct invasion of the virus. 1 , 2 , 44 , 46–48 , 50 …”

Post–COVID-19 syndrome and humoral response association after 1 year in vaccinated and unvaccinated patients

“…Telogen effluvium is a disorder induced by a wide variety of endogenous and exogenous factors, including COVID-19 infection ( 2 ). Ocular morbidities in long-haulers are an emerging problem that needs to be further studied ( 24 ).…”

Retinal autofluorescence findings after COVID-19

“…The retina could be affected either by direct tissue damage from SARS-CoV-2 and its immunogenicity or by thrombotic complications [ 2 , 3 ]. Primary or secondary retinal abnormalities mostly related to vascular structures have been reported on multimodal imaging studies [ 4 – 6 ].…”