Serial swept source optical coherence tomography of a cotton wool spot following SARS CoV2 infection

Abstract

A 33-year-old male presented with history of blurring of vision in the left eye for two months. He was seen by the local ophthalmologist and diagnosed as nongranulomatous anterior uveitis in the left eye with normal fundus. He had history of fever 20 days back and was diagnosed positive for COVID-19 by RT-PCR. He presented with acute anterior uveitis in the left eye. Fundus examination revealed a cotton wool spot close to the fovea, which was confirmed by swept-source optical coherence tomography (SS-OCT) of the macula. The patient after two months’ follow-up showed resolution of the cotton wool spot, which was confirmed by SS-OCT. Our case indicates that cotton wool spot can be an ocular manifestation of COVID-19 infection, and swept-source optical coherence tomography can precisely document the resolution of the lesion.

Ophthalmic Presentations and Manifestations of COVID-19: A Systematic Review of Global Observations

“…General vision loss (decreases in visual acuity and scotomas) was the second most common diagnosis and was documented 15 (13.2%) times. This vision loss was often temporary and 14 of 15 patients recovered to baseline vision [3,[6][7][8][9]12,16,22,24,[26][27][28][29]. The exception to this recovery was seen in the study done by Mabrouki et al, in which the patient experienced complete blindness due to optic demyelinating neuritis and optic atrophy.…”

“…In relationship to COVID-19 infection, the reported time of ophthalmic manifestations varied between studies. Earliest reported manifestations were five weeks prior to positive COVID-19 test [ 27 ], and the latest reported manifestation was three months following their history of COVID-19 infection [ 25 ]. The most reported time of manifestation was approximately one to two weeks following COVID-19 onset or positive test (12 of 27 reported cases).…”

“…Some therapies reported are more extensive due to more severe cases of COVID-19 infection, including mechanical ventilation [ 1 ]. No ocular surgeries were documented in any of the studies; the most direct ocular treatment was ophthalmically administered eye drops [ 2 , 5 , 13 , 27 ]. Most ocular complaints recorded resolved without treatment on follow-up visits.…”