Unilateral Optic Neuritis Associated with SARS-CoV-2 Infection: A Rare Complication

Abstract

Patient: Female, 21-year-old Final Diagnosis: Optic neuritis Symptoms: Vision changes Medication:— Clinical Procedure: — Specialty: Infectious Diseases • Neurology Objective: Rare co-existance of disease or pathology Background: Since the outbreak of the SARS-CoV-2 infection, extensive research has been conducted on the pulmonary implications of this novel disease. However, there has been limited data on the extrapulmonary manifestations. There have been few documented causes of optic involvement and little is understood about the pathophysiology around its presentation and the possible treatments to prevent long-term complications. Here, we describe a case of optic neuritis in a female patient concurrently infected with SARS-CoV-2. Given the plethora of evidence supporting neurological manifestations of the virus, we hypothesize that there is an association between our patient’s optic neuritis and her infection with SARS-CoV-2. Case Report: A 21-year-old woman with no past medical history who presented with blurry vision in her left eye. Optic neuritis was suspected with physical examination and confirmed with imaging of the optic nerve. Further diagnostic evaluation was nonsuggestive of multiple sclerosis and other demyelinating diseases; however, the patient was found to be positive for SARS-CoV-2. Steroids and remdesivir treatment were started, but without the presence of any respiratory symptoms. The patient’s symptoms completely resolved by day 5 of hospitalization and she was discharged home without any complications. Conclusions: Optic neuritis has remained an uncommon complication of SARS-CoV-2. This rather rare complication of SARS-CoV-2 is one that clinicians should be cognizant of due to the long-term implications of optic neuritis. Furthermore, it is pertinent to consider ophthalmic involvement in SARS-CoV-2 infection to appropriately guide patient care during the pandemic, as prompt treatment can lead to improved outcomes.

Ischemic Optic Neuropathy After Administration of a SARS-CoV-2 Vaccine: A Report of 2 Cases

“…Although they have been more frequently described with the SARS-CoV-2 infection, they are already well known to occur after COVID-19 vaccination. Previous cases of ischemic optic neuropathy have also been reported in patients with COVID-19 [ 21 – 26 ]. Recently, Al-Mayhani et al [ 2 ] also described VITT characteristics with arterial thrombosis; they reported 3 cases of ischemic stroke associated with COVID-19 vaccination.…”

Pediatric inflammatory multisystem syndrome induced Panuveitis associated with SARS-CoV- 2 infection: What the Ophthalmologists need to know

“…Complaints associated with SARS-CoV-2 infection include pain, redness, and photophobia, suggesting probable eye surface disease. We found no papers that analyzed the possibility that the patient could have had a paucisymptomatic SARS-CoV-2 initial infection, and that the eye involvement eventually led to the diagnosis of PIMS-TS [21][22][23][24][25][26].…”

“…There have been countless reports of ocular and neurological complications since the onset of the coronavirus pandemic [2,[20][21][22][23][24]28]. The neuro-ophthalmological symptoms are considered to represent a separate entity of COVID-19 related manifestations, with multiple underlying mechanisms, such as the high affinity for ACE2 receptors, whose existence in the eye, nerves and vascular endothelium has already been demonstrated [2][3][4][5]7,16,17,[25][26][27][28][30][31]. In this case, the panuveitis could be a feature of PIMS temporally associated with SARS-CoV-2 infection, but this remains a hypothesis and warrants further investigations and follow-up due to the risk of vision loss and the association with systemic involvement.…”

“Vision Loss” and COVID-19 Infection: A Systematic Review and Meta-Analysis

“…”Visual loss” in COVID-19 patients was reported in a few articles. Nonetheless, it has been observed that its onset may be due to viral neurotropism and indirect immunologic and neurovascular effects [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”