COVID-19 Associated Ocular Neuropathy and Panuveitis

The SARS-CoV-2 virus affects the lungs and other organs, which has many clinical manifestations. In one study of 38 consecutive COVID-19 positive patients, 5% had virus-positive conjunctivae and 32% had conjunctivitis. A new case was reported where COVID-19 led to ocular neuropathy and panuveitis. Such a case has not been reported previously. A woman in her late 50s was hospitalized for severe bilateral pneumonia. Due to recent contact with a fatal case of COVID-19, she was tested for COVID-19.

The results were positive and on day 2 post-admission, she developed blurred vision and redness in her right eye, and temporary (8-day) pain when mobilizing the globe. The right eye had a relative afferent pupil defect, central scotoma, and impaired color and contrast vision. A slit-lamp examination revealed central non-granulomatous retrodescemetic precipitates and mild anterior chamber inflammation. A fundus examination revealed noticeable pupillary edema, 2 peripapillary hemorrhages, mild vitreous inflammation, and retinal vessel narrowing in the inferior retina. No other neurological symptoms were noted.

Bacterial and viral serologies were negative. Lumbar puncture with an RT-PCR for SARS-CoV-2 was negative. She received treatment with oral and topical corticosteroids. . On day 30, when the patient could be moved, fluorescein angiography revealed optic disc neuritis and inferior retinal vasculitis. Mild papillary edema was observed. Inflammation-induced ocular neuropathy associated with SARS-CoV-2–induced panuveitis was diagnosed. This case suggests to consider inflammatory optic neuritis as a manifestation of COVID-19 and such patients should be diagnosed and treated early to avoid permanent vision loss. 

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