Herpetic anterior uveitis following COVID-19 vaccines: a case series

Abstract

PurposeTo report a case series of herpetic uveitis following COVID-19 vaccinations.MethodsDemographic, clinical and treatment-related data of herpetic anterior uveitis cases was collected at five tertiary eye hospitals between January 2021 and June 2022. A retrospective database review at one of the centers comparing the number of cases of herpetic eye disease before and after the introduction of COVID-19 vaccination was performed as well.ResultsTwenty-four patients (9 female, 15 male) with a mean age of 54 years (range 28–83 years) were diagnosed with herpetic uveitis, reporting an onset of symptoms 3–42 days after the first, second or third dose of COVID-19 vaccination. Median time between vaccination and onset of herpetic eye disease was 10 days (mean 12.7 ± 10.15 days) days. The administered vaccines were BNT162b2, mRNA-1273, BBIBP-CorV and Ad26.COV2.S. The cases included 11 HSV, 10 VZV and 1 CMV anterior uveitis, 2 were not further specified. There was an equal number of first episodes (n = 12, 50%) and recurrent episodes (n = 12, 50%). Response to established regimens was generally good. The retrospective database review revealed the exact same incidence of herpetic uveitis during the pandemic and ongoing vaccination compared to prior SARS-CoV-2.ConclusionThis report includes 24 cases of herpetic anterior uveitis in a temporal relationship to various COVID-19 vaccines. This study supports the potential risk of herpetic eye disease following COVID-19 vaccines, but proof of a direct, causal relationship is missing.

Herpes simplex keratitis: A brief clinical overview

“…Long-term use of systemic immunosuppressants for treating autoimmune disorders like systemic lupus erythematosus (SLE), lymphoproliferative diseases; and prophylaxis of organ transplant rejection, increases the likelihood of HSV recurrence/reactivation[ 256 - 259 ]. In certain individuals, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination triggers a cascade of autoimmune responses that can reactivate herpetic keratitis[ 260 , 261 ]. There were some reported incidences of reactivated herpetic keratitis following the reception of SARS-CoV-2 vaccines; patients' immune status before vaccination was not specified[ 262 - 266 ]; one patient had prior PKP surgery owing to HSK scarring[ 263 ].…”