March29, 2023

Abstract Volume: 3 Issue: 3 ISSN:

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

Ophthalmological Post-Acute-COVID-19-Illness Sequelae

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)