Posterior Segment Ocular Findings in Critically Ill Patients With Covid-19

Abstract

Purpose: To describe ophthalmological fundoscopic findings in patients with COVID-19 admitted to the intensive care unit of the largest third-level referral center for COVID-19 in Mexico City.Methods: In this cross-sectional single-center study, consecutive patients admitted to the intensive care unit with a diagnosis of COVID-19 underwent fundus examination with an indirect ophthalmoscope. Clinical photographs were taken using a posterior-pole camera. We explored the association between ocular manifestations and demographic characteristics, inflammatory markers, hemodynamic factors, and comorbidities.Results: Of 117 patients examined, 74 were men; the median age was 54 years (range: 45-63 years). Forty-two patients had ophthalmological manifestations (unilateral in 23 and bilateral in 19), and 10 of these patients had more than one ophthalmological manifestation. Ocular findings were papillitis (n = 13), cotton wool spots (n = 12), retinal hemorrhages (n = 5), retinal nerve fiber layer edema (n = 8), macular whitening (n = 5), retinal vascular tortuosity (n = 4), papillophlebitis (n = 3), central retinal vein occlusion (n = 1), and branch retinal vein occlusion (n = 1). Ocular fundus manifestations were not associated with demographic characteristics, inflammatory markers, hemodynamic factors, or comorbidities.Conclusion: More than one-third of patients with severe COVID-19 had ophthalmological manifestations. The most frequent fundoscopic findings were optic nerve inflammation, microvasculature occlusion, and major vascular occlusions. We recommend long-term follow-up to prevent permanent ocular sequelae.RETINA 42:628-633, 2022C oronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical presentation of COVID-19 includes fever, dyspnea, and dry cough. However, manifestations in other systems are common. 1,2 Conjunctivitis was the first symptom of ocular SARS-

Retinal vascular occlusion risks during the COVID-19 pandemic and after SARS-CoV-2 infection

“…After ocular manifestations related to COVID-19 were reported, studies have focused on finding out whether the hypercoagulable state caused by COVID-19 can cause retinal vascular abnormality, with RVO and RAO being the most common 16 . However, although many case reports and series have reported suspected RVOs and RAOs caused by COVID-19 based on temporal relationships, the evidence for a definite correlation is yet to be found 7 – 15 , 17 .…”

The Review of Ophthalmic Symptoms in COVID-19

“…In another study of 117 patients in a critical general condition, optic disc edema was observed in 11.1% of patients, cotton wool foci in 10.3% of patients, retinal hemorrhages in 4.3%, retinal edema in 4.3%, macular whitening in 4.3%, vascular tortuosity in 3.4%, optic disc inflammation in 2.6%, central retinal vein occlusion in 0.9%, and central retinal vein branch occlusion in 0.9%. 26 , 27 …”

Ophthalmic Manifestations Among Patients Surviving COVID-19

“…However, COVID-19 can affect other organ systems, including cardiovascular, neurological, gustatory, gastrointestinal, hepatic, renal, olfactory, haematological, cutaneous, and ocular systems. 1–3 , 4 , 5 …”

“…The ocular manifestations of SARS-CoV-2 infection are not entirely understood; most studies reported ocular surface disorders. 5–7 However, there has been a growing interest in possible retinal findings in patients with COVID-19, according to the hypothesis generated by Marinho et al 8 The direct activity/immunogenicity of SARS-CoV-2 or the pro-thrombotic status reported in critically COVID-19 patients is thought to mediate these patients’ retinal damage. 9 Several lines of evidence suggest that a subgroup of patients with severe COVID-19 might suffer from cytokine storm syndrome.…”