Papillophlebitis in a COVID-19 patient: Inflammation and hypercoagulable state

Abstract

Introduction: Papillophlebitis is a rare condition characterized by venous congestion and optic disc edema, which has been suggested to occur as a consequence of inflammation of the retinal veins or, possibly, the capillaries of the optic disc, leading to venous insufficiency and compression of the central retina vein. The disease affects healthy young adults and commonly has a benign course, however, if complications such as macular edema or ischemia appears, treatment should be instituted immediately to avoid poor prognosis. Case report: A 40-year old white male patient consulted for a slight decrease in the sensitivity of the visual field in his left eye (OS). Visual acuities (VA) were 20/20 in both eyes. OS fundus examination showed dilated and tortuous retinal vessels, disc edema, and retinal hemorrhages. The patient was diagnosed with papillophlebitis. OS VA decreased to 20/200 due to macular edema, and he was treated with a intravitreal dexamethasone implant. An exhaustive and interdisciplinary exploration process was performed, identifying a recent disease and recovery of Covid-19 as the only factor of inflammation and coagulation alteration. Other systemic diseases were excluded. We also describe a rapid decrease in disc and macular edema after intravitreal dexametasone injection, which could support the inflammatory hypothesis. Conclusion: The importance of this case lies in the possible association of papillophlebitis with the new Covid-19 disease. We believe that the inflammatory reaction and the coagulation alteration present in our patient due to Sars-Cov2 coronavirus may have acted as risk factors for the development of papillophlebitis.

Eye Protection for Patients With COVID-19 Undergoing Prolonged Prone-Position Ventilation

“…The ophthalmic findings for the 2 patients described here are most consistent with papillophlebitis, possibly related to the combined effects of increased orbital venous pressure during prolonged prone positioning and COVID-19-associated coagulopathy. [5][6][7] However, the design of this study and its findings do not provide strong evidence that the prone position itself is the cause for the fundus findings. Patients who are placed in the prone position for long periods of time are more ill, have more hypoxia, and are in a greater inflammatory state, which could also be contributing to these findings.…”

Reply to Editorial: Interpretation of OCT and fundus findings in COVID-19 patients in recent Lancet publication

“…On Fig. 3 we can see a follow-up composite of the same patient, where although the lesion is no longer visible on the fundus exam we can still spot it on b-scan OCT. Our findings are consistent with other reports that are now been presented [3][4][5]. We do appreciate all the input received.…”

Central retinal vein occlusion in a young healthy COVID-19 patient: A case report

“…Further case reports have shown COVID-19 patients presented with a paracentral acute middle maculopathy and an acute macular neuroretinopathy, 11 and a young male patient diagnosed with a Papillophlebitis. 12 …”

“…From the ocular perspective, up to this point, there have been reports of ocular infections presenting with conjunctivitis, 8 or retinal microvascular changes such as retinal microangiopathy, 9 cotton wool spots and microhaemorrhages, 10 acute middle maculopathy and an acute macular neuroretinopathy, 11 a Papillophlebitis, 12 all presented in COVID-19 patients.…”