A woman in her 50s was hospitalised in March 2020 for severe bilateral pneumonia before testing positive for the coronavirus, following which ophthalmologists documented what is believed to be the first reported case of permanent loss of visual acuity that may have been induced by SARS-CoV-2, the virus that causes COVID-19.
Dr Jean Marc Perone writes in the journal JAMA Ophthalmology, “To our knowledge, this is the first reported case of inflammatory ocular neuropathy that was associated with uveitis, may have been induced by SARS-CoV-2, and resulted in permanent loss of visual acuity.”
Researchers from the Metz-Thionville Regional Hospital Center, Lorraine University, Mercy Hospital, say the virus has been found in tears, and known to cause conjunctivitis and asymptomatic nonneuropathic retinal lesions. But little was known about its ability to trigger serious ocular disease.
The woman developed blurred vision and redness in her right eye and temporary (eight-days) pain when mobilising the globe. Her best-corrected visual acuity was +2 logMAR (hand movement 6/600) in her right eye and 6/6 in her left. The right eye had a relative afferent pupil defect, central scotoma, and impaired colour and contrast vision.
She was treated with oral and topical corticosteroids for presumed non-infectious ocular inflammation. But 30 days after being admitted into intensive care, fluorescein angiography revealed optic disc neuritis and inferior retinal vasculitis. Mild papillary edema was also observed. She was diagnosed with inflammation-induced ocular neuropathy associated with SARS-CoV-2–induced panuveitis.
“While it remains possible these findings were idiopathic, the temporal association between SARS-CoV-2 infection and the ocular manifestations and the lack of relevant history support the possibility that SARS-CoV-2 caused the neuropathic ocular inflammation in this case,” said Dr Perone. “This case suggests that COVID-19 manifestations may include isolated inflammatory optic neuritis that leads to permanent visual acuity loss. To limit the functional consequences of ocular neuropathy in patients infected by SARS-CoV-2, it should be diagnosed and treated early.”
Read the full case here.
(Image A) Optic disc neuritis was observed along with mild leakage that associated with an inferior peripapillary hemorrhage. (Image B) Fluorescein leakage from retinal venules inferotemporal to the macula was also observed. Image: JAMA Ophthalmology
Topic: Optical News
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