Orbital Cellulitis following COVID-19 Vaccination

Abstract

A 72-year-old male patient was referred to our outpatient clinic with a painful left eye protrusion accompanied by marked conjunctival chemosis and external ophthalmoplegia being progressed despite topical and oral antibiotic therapy. He developed ocular symptoms 9 days after receiving his second SARS-CoV-2 vaccine (VeroCell). Of note, in previous history, 2 weeks after the first dose of the COVID-19 vaccine, he also developed a life-threatening laryngeal oedema treated at an emergency care unit. MRI of the orbit excluded pansinusitis as possible origin of the orbital cellulitis, and repeated COVID-19 antigen and antibody PCR tests were negative during his hospitalization. On the next day after his admittance, parenteral dexamethasone 250 mg/die treatment was commenced resulting in a quick and complete resolution of the symptoms. Due to the facts regarding this case, such as the temporal coincidence and the lack of respective comorbidity, there might be a causative relationship between the vaccination and the presented orbital cellulitis. To the best of our knowledge, this is the first report on orbital cellulitis as a possible ocular adverse event following COVID-19 vaccination.

Update on coronavirus disease 2019: Ophthalmic Manifestations and Adverse Reactions to Vaccination

“…The orbital signs resolved rapidly with systemic steroids administered under antibiotic cover. There was no evidence of sinusitis in this case unlike the published reports of orbital cellulitis after COVID-19 168 . Delayed development of orbital symptoms (>1 wk and complete resolution with steroids point towards a hypersensitivity reaction to SARS-CoV-2 vaccine) 168 .…”

“…Hári-Kovács et al 168 reported a case of unilateral orbital cellulitis without sinusitis developing in a 72-year-old man with diabetes and hypertension 9 days after the second dose of the CoronaVac vaccine. The orbital signs resolved rapidly with systemic steroids administered under antibiotic cover.…”

“…There was no evidence of sinusitis in this case unlike the published reports of orbital cellulitis after COVID-19. 168 Delayed development of orbital symptoms ( > 1 wk and complete resolution with steroids point towards a hypersensitivity reaction to SARS-CoV-2 vaccine). 168 Chuang et al 169 reported a case of Tolosa-Hunt syndrome developing 5 days after receiving the BNT162b2 mRNAbased vaccine.…”

“…168 Delayed development of orbital symptoms ( > 1 wk and complete resolution with steroids point towards a hypersensitivity reaction to SARS-CoV-2 vaccine). 168 Chuang et al 169 reported a case of Tolosa-Hunt syndrome developing 5 days after receiving the BNT162b2 mRNAbased vaccine. Tolosa-Hunt syndrome is a granulomatous inflammatory process involving the cavernous sinus and remains a diagnosis of exclusion.…”