Ocular inflammatory events following COVID-19 vaccination: a multinational case series

Abstract

Background Inflammatory adverse events following COVID-19 vaccination are being reported amidst the growing concerns regarding vaccine’s immunogenicity and safety, especially in patients with pre-existing inflammatory conditions. Methods Multinational case series of patients diagnosed with an ocular inflammatory event within 14 days following COVID-19 vaccination collected from 40 centres over a 3 month period in 2021. Results Seventy patients presented with ocular inflammatory events within 14 days following COVID-19 vaccination. The mean age was 51 years (range, 19–84 years). The most common events were anterior uveitis (n = 41, 58.6%), followed by posterior uveitis (n = 9, 12.9%) and scleritis (n = 7, 10.0%). The mean time to event was 5 days and 6 days (range, 1–14 days) after the first and second dose of vaccine, respectively. Among all patients, 36 (54.1%) had a previous history of ocular inflammatory event. Most patients (n = 48, 68.6%) were managed with topical corticosteroids. Final vision was not affected in 65 (92.9%), whereas 2 (2.9%) and 3 (4.3%) had reduction in visual acuity reduced by ≤3 lines and > 3 lines, respectively. Reported complications included nummular corneal lesions (n = 1, 1.4%), cystoid macular oedema (n = 2, 2.9%) and macular scarring (n = 2, 2.9%). Conclusion Ocular inflammatory events may occur after COVID-19 vaccination. The findings are based on a temporal association that does not prove causality. Even in the possibility of a causal association, most of the events were mild and had a good visual outcome.

Acute-onset dacryoadenitis following immunisation with mRNA COVID-19 vaccine

“…Furthermore, Lin et al 9 recently described adverse ocular outcomes of acute abducens nerve palsy, uveitis, Vogt-Koyanagi-Harada disease activation, anterior ischaemic optic neuropathy and acute corneal graft rejection after Pfizer-BioNTech vaccination. Testi et al 12 reported 70 patients who presented with ocular inflammatory events within 14 days of COVID-19 vaccination, including anterior and posterior uveitis, and scleritis. Over half of this cohort had a previous ocular inflammatory event.…”

“…Given the recent introduction of COVID-19 mRNA vaccines, data on short-term and long-term side effects are still evolving. Several case reports have noted the development of intraocular immunological and inflammatory events after COVID-19 19mRNA vaccination,9 including cranial nerve palsies,10 11 uveitis,12 13 episcleritis,14 anterior scleritis,12 acute-onset central serous chorioretinopathy15 and acute macular neuropathy16 within 72 hours of receiving COVID-19 mRNA vaccinations.…”

Central Retinal Vein Occlusion Post ChAdOx1 nCoV-19 Vaccination – Can It Be Explained by the Two-hit Hypothesis?

“…These were mild non-sight threatening events that were based on a temporal association that did not prove causality. 34 Commonly proposed mechanisms to explain post-vaccine in ammation include molecular mimicry secondary to similarity between uveal peptides and vaccine peptide fragments apart from antigen-speci c cell and antibody-mediated hypersensitivity reactions. In addition, adjuvants included in the vaccines may stimulate innate immunity through endosolic or cytoplasmic nucleic acid receptors.…”

Case Report: Acute Posterior Multifocal Placoid Pigment Epitheliopathy after SARS-CoV-2 Vaccination

“…In most cases, patients present with photopsia, blurred vision, and paracentral scotomas 1,2 . In some cases, patients may present with meningeal symptoms including headaches, photophobia, stiff neck, malaise, or central nervous system vasculitis 14 . If the patient in this case exhibited any neurological symptoms, a brain MRI and lumbar puncture would have been indicated to rule out central nervous system involvement.…”