A case of bilateral unusual retinal hemorrhages in a COVID-19 patient

Abstract

Purpose: There have been anecdotal reports of ocular manifestations in the Coronavirus Disease 2019 (COVID-19). As the pandemic is spreading and the whole picture is yet unknown, ophthalmologists should be aware of unusual ocular presentations of COVID-19 since they could precede the development of severe respiratory distress. Methods: We report here the first case of a patient with bilateral unusual dot-blot retinal hemorrhages and retinal venous dilation who presented shortly thereafter a PCR-proven COVID-19. Case report: A 59-year-old woman presented with a 7 days history of blurred vision in both eyes. Fundus examination revealed bilateral venous stasis and dot and blot intra-retinal hemorrhages preceding the diagnosis of COVID-19 in a patient with mild respiratory symptoms that progressed within a few days to a severe respiratory distress. After 1 month of the COVID-19 treatment, fundus examination improved and fluorescein angiography demonstrated no diabetic retinopathy signs, no retinal vasculitis and no significant delay in arterial or venous filling. Conclusion: Intraretinal hemorrhages similar to those found in the retinopathy associated to blood dyscrasias could be an association with SARS-CoV-2 in the context of a coagulopathy induced by the infection.

Ocular manifestations of COVID-19

“…Optic neuritis, disk edema, vascular tortuosity, acute macular neuroretinopathy (AMN), vasculitis retinal occlusion (RVO), retinal artery occlusions, intraretinal hemorrhages, cotton wool spots, uveitis, and endogenous endophthalmitis have all been reported in COVID-19 patients. 53 – 58…”

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

“…49 These changes may reflect the underlying systemic hypercoagulable, ischemic, inflammatory, and/or hypertensive state of the patient or direct invasion of the virus. 1,2,44,[46][47][48]50 Neuro-Ophthalmic Findings Up to 21% of patients with COVID-19 may have systemic neurologic signs, and 0.4% have cranial nerve impairment. 15 Potential neuro-ophthalmic associations with COVID-19 include optic neuritis and myelitis, ischemic optic neuropathy, Guillain-Barre syndrome, Miller-Fisher syndrome, and cranial neuropathies like CNIII or CNVI palsies.…”

“… 42 More severe systemic disease was associated with lower vascular density on OCT angiography (OCTA). 43 Other potential posterior segment findings included possible hyperreflective lesions in the inner and outer retina and vitreous, 1 , 2 , 44 uveitis-like multifocal evanescent white dot syndrome, 45 acute macular neuroretinopathy, 46 central retinal vein occlusion, 47 intraretinal hemorrhages, 48 and inflammatory multifocal chorioretinitis with Adie’s pupil. 49 These changes may reflect the underlying systemic hypercoagulable, ischemic, inflammatory, and/or hypertensive state of the patient or direct invasion of the virus.…”

Retinal hemorrhage of late post COVID-19 and post vaccine related pathogenic mechanisms: A new challenge for ophthalmologist in COVID era

“…Retinal hemorrhages (subretinal, subhyaloid, or intraretinal), capillary tortuosity, and cotton balls patches are all ophthalmic symptoms of blood dyscrasia. Hype viscosity and prolonged arteriovenous passage time are assumed to be the reasons (30). Our case was a subhyaloid subtype of retinal hemorrhage.…”