Ocular occlusions in two cases of COVID-19

Kulkarni, Mayur S; Rajesh, R; Shanmugam, Mahesh P

doi:10.4103/ijo.ijo_3139_21

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…The girl we described developed the ocular manifestation very early in the COVID-19 course, in contrast with many other reports, where patients presented CRAO later during the hospitalization or even after the discharge [ 3 , 5 , 8 , 9 ]. Moreover, unlike our report, adult patients with CRAO often presented a severe form of COVID-19, requiring hospitalization and sometimes intensive care unit (ICU) admission [ 3 , 5 , 6 , 9 , 13 ]; in addition, many of these patients had various risk factors for CRAO, being hypertension the most frequently reported [ 3 – 5 , 7 , 11 , 13 ].…”

Section: Discussioncontrasting

confidence: 97%

“…Several non-invasive treatments have been proposed and tried in some adult cases [ 4 , 7 , 8 , 11 , 13 ]; however these strategies are not uniformly supported by the current scientific literature, since there is no evidence of effectiveness [ 15 , 16 , 30 ]. In order to improve retinal oedema, and bearing in mind the known inflammatory and vasculitis tendency of SARS-CoV-2 infection, iv and oral steroids were administered to our patient, nonetheless with poor visual outcome, in accordance to other adult cases in the literature [ 9 , 12 ] and to the known prognosis of CRAO [ 3 , 8 ].…”

Section: Discussionsupporting

confidence: 69%

“…However, some cases have been described in adults, in addition to other ocular vascular occlusions [ 3 – 13 , 25 ]. Kulkarni et al presented a case of combined central retinal artery and vein occlusion (CRVO) in a 20-year-old boy [ 9 ]. For what concerns pediatric population, retinal vasculitis has been described in a child five months after an asymptomatic SARS-CoV-2 infection [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Central retinal artery occlusion in a young child affected by COVID-19: a first case report

Abbati,

Fazi,

Fortunato

et al. 2023

BMC Pediatr

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Background Central retinal artery occlusion (CRAO) is an ophthalmic emergency, and its etiology is generally ascribed to vessel occlusion by a thrombus or embolus, eventually due to a hypercoagulable state. CRAO occurrence is described even in the pediatric population, but its incidence is very rare. SARS-CoV-2 infection has a multitude of presentations, and almost any organ may be involved including the ocular district. Cases of CRAO in patients affected by COVID-19 are reported in the literature in the adult population, but not in the pediatric one. Case presentation We describe the case of a six-year-old otherwise healthy girl, who presented a sudden and complete bilateral vision loss after a one-day fever. All the clinical, ophthalmological, laboratory and instrumental investigations led to the diagnosis of a right CRAO and the suspicion of a contralateral posterior optic nerve affection. These manifestations could not be ascribed to any etiological condition apart from the documented ongoing mild SARS-CoV-2 infection. Treatment with anticoagulants and steroids was tried but the visual outcome was poor during the one-month hospitalization and at the last follow-up. Conclusions To the best of our knowledge, this is the first report of CRAO in the course of SARS-CoV-2 infection in the pediatric age. In our review of the literature, we found few cases of CRAO in adults with COVID-19; we highlighted differences in anamnestic, clinical, and interventional aspects and therefore we tried to summarize the state of the art on this topic to facilitate further studies. Even if rare, the prognosis of CRAO is poor and the thrombolytic treatment could be effective only if rapidly administered, so the disease suspicion should be high in a patient with sudden vision loss, also in pediatric age.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Central retinal artery occlusion in a young child affected by COVID-19: a first case report

Abbati,

Fazi,

Fortunato

et al. 2023

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…To the best of our knowledge, our case is the first report of CRAO in children with SARS-CoV-2 infection. Nevertheless, several cases have been reported in adults, and a combined central retinal artery and vein occlusion has been described in a 20-year-old Indian [ 49 , 50 , 51 ]. In addition, it is known that the SARS-CoV-2 infection prothrombotic effect may also involve the ocular district [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological Involvement in Children with COVID-19 and MIS-C: A Retrospective Study Conducted for More than Two Years in a Pediatric Hospital

et al. 2022

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This study aimed to evaluate the type and severity of neurological involvement in children with SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) and compare these findings between the two groups. Children hospitalized with the diagnosis of COVID-19 or MIS-C at Meyer Children’s Hospital between February 2020 and June 2022 were retrospectively studied. One hundred twenty-two patients were enrolled, 95 in the COVID-19 group and 27 in the MIS-C group. In the COVID-19 group, impairment of consciousness was found in 67.4% of patients, headache in 18.9% and about 16.8% of patients experienced seizures. In this group, three patients were diagnosed with arterial ischemic stroke and one patient was diagnosed with Guillain-Barré syndrome (GBS). In the MIS-C group, about 70% of patients experienced consciousness impairment, about 20% behavioral changes, and another 20% mood deflection. Neurological symptoms and signs were highly heterogeneous and could be differentiated in COVID-19 and MIS-C. Consciousness impairment remained the most frequent manifestation in both groups, potentially underlying an encephalopathy. We also highlight the importance of considering psychiatric symptoms in children with COVID-19 and/or MIS-C. Most neurological manifestations were mild in our series; however, severe complications such as ischemic stroke and GBS are worthy of note.

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“…Ucar et al [ 29 ] presented a case of central retinal artery occlusion (CRAO) in a patient with no known cardiovascular risk factors. Kulkarni et al [ 30 ] reported one case of choroidal artery occlusion and one case of both central retinal artery and vein occlusion in patients hospitalized for COVID-19 infection. Similarly, Acharya et al [ 31 ] described the case of a 60-year-old man hospitalized in the intensive care unit for severe respiratory disease who experienced CRAO 12 days later.…”

Section: Retinal Findings In Covid-19 Patientsmentioning

confidence: 99%

Pathogenesis of Vascular Retinal Manifestations in COVID-19 Patients: A Review

2022

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Pandemic infection secondary to coronavirus disease 2019 (COVID-19) had an important impact on the general population affecting not only respiratory tract but also many other organs. Ocular manifestations are quite common at the level of the anterior segment (conjunctivitis, dry eye), while posterior segment and, in particular, retinal findings are less frequent. In the retina, COVID-19 is associated with vascular events. Since retinal arteries and veins represent an accessible window to the microvasculature of the rest of the body, a better understanding of the profile of retinal vascular occlusive events may help elucidate mechanisms of thrombo-occlusive complications in other organs in patients affected by COVID-19. In this review, we conducted a systematic literature search focused on retinal arterial and/or retinal venous manifestations. Twenty-one studies were included, describing a wide range of manifestations from mild signs like cotton wool spots, focal and flame-shaped hemorrhages, and vein dilation to more severe retinal artery and vein occlusions. Two principal pathogenetic mechanisms are considered responsible for these complications: a hypercoagulative state and a massive inflammatory response leading to a disseminated intravascular coagulation-like syndrome.

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Ocular occlusions in two cases of COVID-19

Cited by 3 publications

References 6 publications

Central retinal artery occlusion in a young child affected by COVID-19: a first case report

Central retinal artery occlusion in a young child affected by COVID-19: a first case report

Neurological Involvement in Children with COVID-19 and MIS-C: A Retrospective Study Conducted for More than Two Years in a Pediatric Hospital

Pathogenesis of Vascular Retinal Manifestations in COVID-19 Patients: A Review

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