Neuro-Ophthalmic Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Related Infection and Vaccination

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic created a unique opportunity to study the effects of infection and vaccination on disease. The year 2020 was dominated by infection and its consequences. The year 2021 was dominated by vaccination and its consequences. It will still take several years for full maturation of databases required for robust epidemiological studies. Therefore, this review on the implications for neuro-ophthalmology draws on resources presently available including reported adverse reactions to vaccination. Illustrative clinical cases are presented. The spectrum of pathology following infection with SARS-CoV-2 falls into 4 main categories: autoimmune, vascular, sequelae of brain damage, and miscellaneous. This review is exhaustive, but the most common conditions discussed relate to headaches and associated symptoms; vertigo, diplopia, and nystagmus; vascular complications of the eye and brain; cranial nerve (mono-)neuropathies; photophobia, ocular discomfort, and optic neuritis. Of the 36 main adverse reactions reviewed, vaccine-induced immune thrombotic thrombocytopenia is a novel complication requiring specific hematological management. Updated diagnostic criteria are summarized. It is relevant to remember taking a medication history because of side effects and to recognize the relevance of comorbidities. The clinical assessment can frequently be performed virtually. Consensus recommendations on telemedicine and the virtual assessment are summarized in a practical and compressed format. The review concludes with an epidemiological tetralogy to interrogate, in future studies, associations with (1) SARS-CoV-2 pandemic infection, (2) SARS-CoV-2 worldwide vaccination, and (3) the possibility of a rebound effect of infections in the pandemic aftermath.

Shot in the dark

“… 14 Specific ocular and neuro-ophthalmic adverse events include, eyelid edema, blepharospasm, corneal graft rejection, uveitis, episcleritis, scleritis, choroiditis, acute macular neuroretinopathy, acute zonal occult outer retinopathy, multiple evanescent white dot syndrome, Vogt-Koyanagi-Harada disease, central serous retinopathy, retinal vein occlusion, anterior ischemic optic neuropathy (arteritic and non-arteritic), Leber hereditary optic neuropathy, neuroretinitis, tonic pupil, Tolosa-Hunt syndrome, ocular motor cranial neuropathies, facial nerve palsy, myasthenia gravis, ophthalmic vein thrombosis and optic neuritis. 2 , 3 , 10 , 12 , 15 , 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 33 In a single center retrospective study from South Korea, 17 eyes from 16 patients who developed ocular disease within 1 to 7 days of receiving the COVID-19 vaccine had the following diagnoses: retinal vein occlusion (n-9 eyes), retinal artery occlusion (n-1 eye), uveitis (n=3 eyes), and angle-closure glaucoma (n=4 eyes). Twelve patients received the Janssen COVID-19 vaccine and 4 patients the Pfizer-BioNTech COVID-19 vaccine.…”

Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 and Its Vaccination: A Narrative Review

“…There are several reports of neuroophthalmic complications following COVID-19 vaccination. [77][78][79] These complications occurred after all types of vaccines. They include acute ischemic stroke, intracranial hemorrhages, and cerebral venous sinus thrombosis.…”

“…They include acute ischemic stroke, intracranial hemorrhages, and cerebral venous sinus thrombosis. [78,80] Other reported neuro-ophthalmic complications include: bilateral arteritic anterior ischemic optic neuropathy (AAION), [81] post-vaccination cranial neuropathy, that is, third [73] and sixth [82][83][84] nerve palsies, facial palsy, [84][85][86][87] multiple cranial nerve palsies, [88] pupillary abnormalities such as Horner's syndrome, Holmes-Adie pupil, miosis and mydriasis, [78] eight nerve involvement and benign paroxysmal positional vertigo, [89] and post-vaccination optic neuritis. [90][91][92] In multiple sclerosis patients, BNT162b2 mRNA vaccine was reported to be associated with a transient increase of MS symptoms in 3.8% but none of them needed treatment.…”

Optic neuritis associated with COVID-19-related vaccines

“…According to Petzold et al's review of the neurological adverse effects linked to COVID-19 post-vaccination in the UK, 85 cases of optic neuritis following COVID-19 vaccination had acceptable reviews following treatment. 10 In Taiwan, Lee and colleagues reported the first case of optic neuritis after a second vaccination with OxfordAstraZeneca, stating that early detection and treatment may help to stop demyelinating progression in those cases 11 ; Optic neuritis has reportedly occurred following administration of different COVID-19 vaccines, such as mRNA-1273, BNT162b2, or Ad26.COV2.S, according to the literature. Historically, influenza, anti-rabies, HPV, and other vaccines have all been linked to optic neuritis.…”