Efferent neuro-ophthalmic complications of coronavirus disease 2019

Abstract

Purpose of reviewWe set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus.Recent findingsEfferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described.SummaryObserved neuro-ophthalmic associations need to be confirmed through 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.

COVID-19 and ocular complications: A review of ocular manifestations, diagnostic tools, and prevention strategies

“…Neuro-ophthalmic symptoms have rarely been reported following SARS-CoV-2 vaccination, but evidence for causation is lacking and the benefits of inoculation continue to far outweigh any perceived risks. 52 Orbital manifestations of COVID-19 …”