Ophthalmological Post-Acute-COVID-19-Illness Sequelae
Attapon Cheepsattayakorn1,3* Ruangrong Cheepsattayakorn2 Porntep Siriwanarangsun3
1. 10th Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand
2. Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
3. Faculty of Medicine, Western University, Pathumtani Province, Thailand
Corresponding Author: Dr. Attapon Cheepsattayakorn, 10th Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand
Copy Right: © 2021 Attapon Cheepsattayakorn, 10th Zonal Tuberculosis and Chest Disease Center,143 Sridornchai Road Changklan Muang Chiang Mai 50100 Thailand.
Received Date: August 01, 2021
Published date: September 01, 2021
Ophthalmic-related COVID-19 illness can be presented in the acute COVID-19 illness phase or post-acute-COVID-19-illness phase [1]. A previous study on ocular findings in 64 COVID-19 survivors (128 eyes, 7-mild-to-moderate, 33-severe, 24-critical disease) were evaluated 82 +/- 36.4 days after the onset of COVID-19 symptoms [2]. Approximately, 15.6 % of them demonstrated diabetic retinopathy, and two patients revealed discrete white-yellowish dots in the posterior pole with hyperreflective changes at ellipsoid layers, outer segment, and retinal pigment epithelium level [2, Figure 1]. Approximately, 10.9 % of them had dry eye disease [2]. In critical group, the mean+/-standard deviation of intraocular pressure was 14.16 +/- 1.88 mmHg, whereas the severe group revealed 12.51 +/- 2.40 mmHg, both in left eyes (p = 0.038) and right eyes (p = 0.02) [2]. There was no sign of uveitis. The median interquatile range of the visual acuity and distant best-corrected visual acuity were 0.1 (0-0.2) and 0 (0.0.1), respectively [2]. The SARS-CoV-2 (COVID-19) RNA has been isolated from ocular tissues [1]. The COVID-19 manifestations of the eyelids, ocular surface and anterior segment of the eyes include follicular conjunctivitis (7.7 %-8.6 % of incidence) [1, 3-6, Figure 2], viral keratoconjunctivitis, hemorrhagic and pseudomembranous conjunctivitis, childhood conjunctivitis, episcleritis, dryness (6.9 %-37 % of incidence) [3-6], eye pain (10.3 %-31.2 % of incidence) [3-6], eye discharge (6.9 %-29.6 % of incidence) [3-6], eye redness (10.8 %-24.1 % of incidence) [3-6], eye tearing (9.7 %-22.2 % of incidence) [3-6], foreign body sensation in the eyes (6.0 %-18.5 % of incidence) [3-6], photophobia (2.6 %-16.1 % of incidence) [3-6], eye itchiness (9.6 %-15.7 % of incidence) [ 3-6], blurred vision (4.8 %-12.8 % of incidence) [3-6], burning sensation of the eyes (8.4 % of incidence) [3-6], eyelid margin hyperemia (34.5 % of incidence) [3-6], crusted eyelashes (24.1 % of incidence) [3-6], Meibomian orifices abnormality (20.7 % of incidence) [3-6], eye chemosis (3.4 % of incidence) [3-6], and episcleritis (2.2 % of incidence) [3-6]. COVID-19 manifestations of the posterior segment of the eyes include central retinal vein occlusion [1, Figure 3], central retinal artery occlusion [1, Figure 4], acute macular neuroretinopathy and paracentral acute middle maculopathy [1, Figure 5]. COVID-19 manifestations of the retina include vitritis and outer retinal abnormalities and acute retinal necrosis [1]. COVID-19 manifestation of the uvea includes serpiginous choroiditis [1]. COVID-19 manifestations of neuro-ophthalmic lesions include papillophlebitis, optic neuritis [1, Figure 6], Adie’s tonic pupil, Miller-Fisher syndrome and cranial nerve palsy, cerebrovascular accident with vision loss, and neurogenic ptosis [1]. COVID-19 manifestations of the orbits include dacryoadenitis, retino-orbital pain, orbital celluliti and sinusitis, orbital mucormycosis, and orbital histiocytic lesion [1].
In conclusion, transmission of SARS-CoV-2 (COVID-19) through eye secretions is currently investigated, whereas the SARS-CoV-2 (COVID-19) RNA has been isolated from different parts of the eyes. The causal relation of these ophthalmic conditions with SARS-CoV-2 (COVID-19) is to be answered.
Figure 1 : Demonstrating ocular fundus multimodal imaging of a 48-year-old man (critical case) 128 days after first symptoms of COVID-19. Color fundus pictures of both eyes showing white-yellowish dots (arrows). Midphase fluorescein angiography pictures of the RE (middle left) and LE (middle right) showing transmission hyperfluorescence in the retina lesions 195 days after first symptoms of COVID-19. Optical coherence tomography (OCT) of the right eye shows hyporreflectivity in the retinal pigment epithelium and ellipsoid layers, and discontinuation of photoreceptors’ outer segments (arrow).
(Source : Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and eye: a review of ophthalmic manifestations of COVID-19. Indian Journal of Ophthalmology 2021; 6 : 488-509)
Figure 2 : Demonstrating follicular conjunctivitis following COVID-19: A 30-year-old man developed bilateral follicular conjunctivitis 13 days after mild COVID-19 infection. Slit lamp examinations showed evidence of acute viral conjunctivitis. (a and d)The examination on illness day 13 showed moderate conjunctival injection and inferior palpebral conjunctival follicles. (b and e) Examinations on illness day 17 and (c and f) illness on day 19 demonstrated that treatment with ribavirin eye-drops gradually improved the patient's symptoms. (Reproduced with permission from Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, Xin N, Huang Z, Liu L, Zhang G, Wang J. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020;104:748-51)
(Source : Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and eye : a review of ophthalmic manifestations of COVID-19. Indian Journal of Ophthalmology 2021; 69 : 488-509)
Figure 3 : Vasculitic retinal vein occlusion as a manifestation of COVID-19: A 52-year-old patient presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. (a) Fundus photograph demonstrating inferior hemiretinal vein occlusion with superonasal branch retinal vein occlusion. (b) Fundus fluorescein angiogram showing the presence of dilated tortuous vein in inferior and superonasal quadrants with late phases showing staining and leakage from the vessel walls (Blue arrow), multiple areas of hypofluorescence corresponding to retinal hemorrhages clinically, suggestive of blocked fluorescence (Yellow arrow) and areas of hypofluorescence suggestive of capillary nonperfusion (Blue arrow) in involved quadrants. The macular region and optic disc also showed hyperfluorescence in late phases suggestive of leakage. (c) Spectral domain optical coherence tomography illustrating the presence of serous macular detachment (Orange arrow), cystoid macular edema, cysts located in outer nuclear layer (Blue arrow), inner nuclear layer (Red arrow) and ganglion cell layer (Green arrow) and disorganization of retinal inner layers (Yellow arrow) (Reproduced with permission from Sheth JU, Narayanan R, Goyal J, Goyal V. Retinal vein occlusion in COVID-19: A novel entity. Ind J Ophthalmol 2020;68:2291-3).
(Source : Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and eye : a review of ophthalmic manifestations of COVID-19. Indian Journal of Ophthalmology 2021; 69 : 488-509)
Figure 4 : Combined central retinal artery and vein occlusion following COVID-19: A 32-year-old lady, known hypertensive with past history of COVID-19, presented with sudden onset, painless diminution of vision in the right eye. Examination showed right eye visual acuity of finger counting at 50cm and RAPD. (a) Fundus photograph showing retinal hemorrhages in all quadrants, dilated tortuous vessels and optic disc edema. (b) SD-OCT showing neurosensory detachment with intraretinal fluid and hyper-reflectivity of inner retinal layers. (Contributed by Rajashree Salvi and Shrinivas Joshi, M M Joshi Eye Institute, Hubli, India)
(Source : Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and eye : a review of ophthalmic manifestations of COVID-19. Indian Journal of Ophthalmology 2021; 69 : 488-509)