Neuro-Ophthalmologic Manifestations of Novel Coronavirus

Abstract

Synopsis The novel Coronavirus disease 2019 (SARS-CoV-2/COVID-19) has multiple systemic manifestations, including disease entities relevant to neuro-ophthalmologic practices, including Ischemic and hemorraghic strokes, cranial nerve palsies, Miller Fisher and Guillan-Barre syndrome, optic neuritis, and intracranial hypertension. The delivery of health care in Neuro-ophthalmology clinics has evolved to expand the role of telehealth and new management decisions regarding immunosuppresive treatment of pre-existing neuro-ophthalmologic diseases, and prone positioning causing ischemic optic neuropathy. This review article aims to summarize the associations between COVID-19 and neuro-ophthalmologic conditions based on a systematic review of current literature on the topic.

Covid-19 induced optic neuritis – A case report

“…3 Furthermore, neuroophthalmological manifestations have emerged as separate entities with multiple proposed underlying mechanisms. 4 We report a rare case of Post covid-19 Right eye Optic neuritis in a 16-year-old boy. We are labelling it as a case of Probable Post Covid -19 Right Eye optic neuritis based on temporal association with Covid -19 infection, after ruling out other aetiologies and finally as per the provisional case definitions for the association of COVID-19 with neurological disease suggested by Mark Ellul et al panel.…”

“…One possibility is direct viral invasion as COVID-19 is known to enter the cells using ACE2 receptors, which are found on the neurons and the choroidal cells in the eyes and can lead to uveitis and optic neuritis. 4 Cytokine storm is another mechanism that is debated as the cause of neuro-ophthalmological complications of COVID-19. The intense release of cytokines including Interleukin 6 can overstimulate the human body's immune system 1 and can potentiate the development of demyelinating injury to the optic nerve.…”

“…In cases where optic neuritis occurs as a part of the anti-MOG syndrome, or Neuromyelitis Optica spectrum disorders or ADEM or after recovery from COVID-19 molecular mimicry is the most plausible mechanism whereby viral antigens initiate a robust immune response against endogenous central nervous system proteins, including MOG and the myelin of the optic nerve. 4…”

Transparente Darstellung von Kasuistiken nach COVID-19-Erkrankung oder COVID-19-Impfung – eine zeitliche Koinzidenz

“…Manifestationen im Rahmen von COVID-19 sind für letztlich jede okuläre Struktur beschrieben worden 6 , 7 , 8 . So werden im Rahmen der Infektion u. a. Hirnnervenparese und Optikusneuritis 9 , 10 , 11 , orbitale Entzündung 12 , 13 , aber auch Uveitis 14 , Vaskulitis, Gefäßverschlüsse 15 , 16 oder mikrovaskuläre Veränderungen 17 , zu denen auch AMNR oder Paracentral acute Middle Maculopathy (PAMM) gezählt werden 18 , beschrieben. Seit die Impfstoffe gegen COVID-19 verfügbar sind, schließen sich Publikationen über mögliche okuläre Impfreaktionen an 19 , 20 , 21 , 22 , und es wird diskutiert, welche Folgen dies für bestimmte Patientengruppen haben könnte 23 .…”

Coronavirus Disease 2019–Related Health Disparities in Ophthalmology with a Retrospective Analysis at a Large Academic Public Hospital

“…Other neuroophthalmic findings include Guillain Barre syndrome and Miller Fisher syndrome, with cases that improved with intravenous immunoglobulin treatment. Optic neuritis and intracranial hypertension have been observed in patients with COVID-19 as well, with angiotensin-converting enzyme 2 receptor cells postulated as the method of entry; they are present in the aqueous humor, retina, retinal pigment epithelium, choroid, and conjunctival epithelium [36,37].…”