Acute bilateral retrobulbar optic neuritis - An atypical sequela of COVID-19

Sainath, Dipika; Paul, Anujeet; Krishnagopal, Srikanth; Kumar, Ashok

doi:10.4103/ijo.ijo_2155_21

Cited by 16 publications

(11 citation statements)

References 11 publications

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“…Nadir acuity in 8 of 9 cases was count fingers or worse in the more-affected eye. CSF oligoclonal bands were absent in the 5 cases tested (Table 2) (5,9–13). Eye pain was present in 8/8 cases where this symptom was queried.…”

Section: Resultsmentioning

confidence: 99%

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SARS-CoV-2 Parainfectious Optic Neuropathy: 3 Case Reports and a Review of the Literature

Gluckstein,

Chwalisz,

Gilbert

et al. 2023

Journal of Neuro-Ophthalmology

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Background: Parainfectious optic neuritis is an inflammatory reaction that occurs shortly after an infection without direct invasion by a pathogen. The clinical profile depends on the infectious organism. Cases of SARS-CoV-2 parainfectious optic neuritis have been reported in the literature, but there are no reviews that have applied strict inclusion criteria to more definitively establish the clinical profile associated with SARS-CoV-2. Methods: We present 3 new cases of SARS-CoV-2 parainfectious optic neuritis. We also review the literature for definite cases by selecting only those with unambiguous clinical features and MRI findings of optic neuritis, positive SARS-CoV-2 polymerase chain reaction or serology, and the absence of myelin oligodendrocyte-glycoprotein or aquaporin-4 antibodies or other diseases associated with optic neuritis. Results: We report 2 cases of monophasic, unilateral SARS-CoV-2 parainfectious optic neuritis with optic disc edema and nadir visual acuities of finger counting. We report 1 case of mild SARS-CoV-2 parainfectious optic neuritis that featured cotton wool spots, peripapillary wrinkles and hemorrhages, and recurrence after an initial steroid taper. We identified 6 cases of unambiguous SARS-CoV-2 parainfectious optic neuritis from the literature. Combining our case series with the case reports in the literature, the average age was 42.8 years, 3/9 had bilateral disease, 6/8 had optic disc edema, 8/9 had nadir visual acuity of finger counting or worse, and all recovered visual acuity to 20/40 or better after therapy with steroids. Conclusions: SARS-CoV-2 parainfectious optic neuritis has a clinical profile that is atypical for idiopathic optic neuritis but fairly typical of parainfectious forms of optic neuritis with a severely reduced nadir visual acuity, high likelihood of bilaterality, high incidence of optic disc edema, and prompt and significant response to corticosteroids. Further study with long-term follow-up and epidemiologic investigation will be needed to further characterize this clinical entity.

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Section: Resultsmentioning

confidence: 99%

“…Most patients reported vision loss within 2 weeks of COVID-19 symptoms (mean 1.3 weeks, range of 2 days–4 weeks) (Table 1) (5,9–13). Three cases were not symptomatic with COVID-19, and the remainder exhibited a mild illness.…”

Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 Parainfectious Optic Neuropathy: 3 Case Reports and a Review of the Literature

Gluckstein,

Chwalisz,

Gilbert

et al. 2023

Journal of Neuro-Ophthalmology

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“…In the study described here, SARS-CoV-2 RNA was detected in the optic nerve oligodendrocytes in one eye ( Figure 4 B). Although the exact mechanisms remain unclear, antigenic mimicry and breakdown of the blood brain barrier have been postulated ( 28 , 29 , 30 ). It is not known whether direct viral invasion can cause or potentiate these mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Histopathology and SARS-CoV-2 Cellular Localization in Eye Tissues of COVID-19 Autopsies

Sen

Wang

Kodati

et al. 2023

The American Journal of Pathology

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“…Another case reported clinical features of bilateral ON, but MRI imaging of the orbits showed no enhancement or T2 hyperintensity, again calling the diagnosis of ON into question. 7 See ►Table 3 for cases of inflammatory papillitis associated with COVID-19. In summary, there is a wealth of literature describing anecdotal evidence of ON in association with COVID-19, especially in association with MOGAD, but the data in support of ON are lacking in some cases, and evidence for true causation remains to be provided.…”

Section: Neuro-op Covid-19 Dinkin Sathimentioning

confidence: 99%

“…In some cases, the evidence for ON was not complete, and brain magnetic resonance imaging (MRI) lacked signs of active ON. 7 In other cases, a pre-existing occult disease may be either magnified by the inflammatory state of COVID-19 or achieve CNS penetration in the setting of blood-brain barrier breakdown due to interleukin-1 (IL1) elevation. 8 In support of this hypothesis was the finding of AQP4 antibodies found retrospectively in an 11-month-old sample of blood in a patient with AQP4 antibody-associated transverse myelitis following COVID-19, despite no associated history of NMO-SD.…”

Section: Optic Neuritismentioning

confidence: 99%

Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19

Dinkin

Sathi

2023

Semin Neurol

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We set out to describe in detail the afferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, new variants of COVID-19 continue to pose an international threat, and patients with rare neuro-ophthalmic complications are likely to continue to present for care.Afferent complications from COVID-19 include homonymous visual field loss, with or without higher cortical visual syndromes, resulting from stroke, intracerebral hemorrhage, or posterior reversible leukoencephalopathy. Optic neuritis has frequently been reported, sometimes along with acute disseminated encephalomyelopathy, often in association with either myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) or less commonly aquaporin-4 seropositivity or in newly diagnosed multiple sclerosis. Ischemic optic neuropathy has rarely been reported. Papilledema, resulting either from venous sinus thrombosis or idiopathic intracranial hypertension in the setting of COVID-19, has also been described.Observed afferent neuro-ophthalmic associations need to be confirmed though larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.

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Acute bilateral retrobulbar optic neuritis - An atypical sequela of COVID-19

Cited by 16 publications

References 11 publications

SARS-CoV-2 Parainfectious Optic Neuropathy: 3 Case Reports and a Review of the Literature

SARS-CoV-2 Parainfectious Optic Neuropathy: 3 Case Reports and a Review of the Literature

Histopathology and SARS-CoV-2 Cellular Localization in Eye Tissues of COVID-19 Autopsies

Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19

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