Optic neuropathy after COVID-19 vaccination: a report of two cases

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

“…The latter study, however, did not provide specific details on cases with optic nerve involvement. Elnahry et al previously reported on a pair of patients, one of whom was a 69-year-old woman who developed CNS inflammatory syndrome with neuroretinitis and papillitis following vaccination with the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech), and the other of whom was a 32-year-old woman who developed retrobulbar optic neuritis following vaccination with the CoviShield COVID-19 vaccine (AstraZeneca/University of Oxford, Cambridge, UK) ( Elnahry et al, 2021 ). Only the patient who developed retrobulbar optic neuritis demonstrated significant improvement with IV methylprednisolone.…”

“…Previously, Stübgen et al reported that there is no long-term risk of developing optic neuropathy following vaccination, but that the presence of adjuvants contributes to the process ( Stubgen, 2013 ). However, in the absence of adjuvants in several of the COVID-19 vaccines, this explanation is insufficient ( Elnahry et al, 2021 ). Clinically, it is challenging to differentiate between AION and optic neuritis, and the diagnosis is usually based on both clinical impression and multimodal imaging findings ( Levin, Rizzo and Lessell, 1996 , Elnahry and Elnahry, 2020 , Raina et al, 2020 ).…”

“…Since their introduction, COVID-19 vaccines have been associated with an assortment of ophthalmologic manifestations ( Eleiwa et al, 2021 , Ng et al, 2021 ). Separately, these events have included orbital ( Bayas et al, 2021 ), corneal ( Crnej et al, 2021 , Phylactou, Li and Larkin, 2021 ), uveitic ( Rabinovitch et al, 2021 , ElSheikh et al, 2021 ), neuro-ophthalmologic ( Elhusseiny et al, 2021 , Elnahry et al, 2021 ), retinal ( Bohler et al, 2021 , Book, Schmidt and Foerster, 2021 ), and thrombotic events ( Endo, Bahamon and Martinez-Pulgarin, 2021 ). Regarding neuro-ophthalmologic manifestations in particular, several cranial nerve palsies have been reported, including oculomotor ( Pappaterra, Rivera and Oliver, 2021 ), abducens ( Reyes-Capo, Stevens and Cavuoto, 2021 ), and facial (Bell's) nerve palsy ( Khouri, Roustit and Cracowski, 2021 , Ozonoff, Nanishi and Levy, 2021 , Shibli et al, 2021 , Wong et al, 2021 ).…”

“…Regarding neuro-ophthalmologic manifestations in particular, several cranial nerve palsies have been reported, including oculomotor ( Pappaterra, Rivera and Oliver, 2021 ), abducens ( Reyes-Capo, Stevens and Cavuoto, 2021 ), and facial (Bell's) nerve palsy ( Khouri, Roustit and Cracowski, 2021 , Ozonoff, Nanishi and Levy, 2021 , Shibli et al, 2021 , Wong et al, 2021 ). To date, a limited number of reports have been made of optic neuropathy following COVID-19 vaccination ( Elnahry et al, 2021 , Garcia-Estrada et al, 2021 , Girbardt et al, 2021 , Leber et al, 2021 , Nachbor et al, 2021 , Pawar et al, 2021 ), and a few of them have been designated as anterior ischemic optic neuropathy (AION); three non-arteritic (NAION) ( Garcia-Estrada et al, 2021 , Girbardt et al, 2021 , Nachbor et al, 2021 ), and one arteritic (AAION) ( Maleki et al, 2021 ). In this report, we describe a case of ischemic optic neuropathy following vaccination with the BNT162b2 COVID-19 vaccination (Pfizer-BioNTech, New York, NY), discuss the pathophysiology for the development of optic nerve ischemia following vaccination, and provide a systematic review of all cases of optic neuropathy following COVID-19 vaccination published to date.…”

Ocular Complications Following Vaccination for COVID-19: A One-Year Retrospective

“…The majority of the reports that we reviewed dealt with cases on the axis of optic neuritis. Elnahry et al reported on a pair of cases [112]. A 69-year-old woman presented with blurry vision in both eyes with examination revealing optic nerve head edema bilaterally.…”