Tonic Pupil Following COVID-19

Gopal, Madhumita; Selvakumar, Ambika; Padmalakshmi, Krishnakumar

doi:10.1097/wno.0000000000001221

Cited by 15 publications

(22 citation statements)

References 8 publications

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“…Unlike the results of our study, there are case reports with a tonic pupil thought that might be associated with COVID-19 [23][24][25]. This can be explained with the fact that the clinical course of COVID-19 might be characterized by individual differences.…”

Section: Discussioncontrasting

confidence: 94%

Pupil responses in patients with COVID-19

2021

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Aim To compare pupillary responses in patients with Coronavirus disease-2019 (COVID-19) during active infection and at 3rd months post-infection. Methods This study included 58 COVID-19 cases (mean age 47.23 ± 1.1 years). The scotopic, mesopic and photopic diameters were noted. Pupil diameters were noted at the 0, 1st, 2nd, 4th, 6th, 8th, and 10th seconds in reflex pupil dilation after the termination of a light. The average dilation speed was calculated at the 1st, 2nd, 4th, 6th, 8th, and 10th seconds. Pupil responses measured during COVID-19 infection and 3 months later were compared. Results The mean scotopic and mesopic pupil diameter value of during COVID-19 infection was found lower than the 3rd month post-infection. ( p = 0.001, p = 0.023; respectively). No statistically significant difference was found in the mean photopic pupil diameter and the mean pupil diameter at 0 s between measurements ( p > 0.05, p = 0.734; respectively). The mean pupil diameter was significantly lower during COVID-19 infection at the 1st, 2nd, 4th, 6th, 8th and 10th seconds ( p < 0.01, for each). The average dilation speed measurements at every second measured were lower in during COVID-19 infection than the 3rd months later ( p = 0.001; p < 0.01 for each). Conclusions Pupil responses were found significantly different in COVID-19 cases when compared with the measurements taken three months later.

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Section: Discussioncontrasting

confidence: 94%

Pupil responses in patients with COVID-19

2021

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“…The diagnosis was confirmed with the rapid miotic response of the affected pupil to pilocarpine 0.1% drop. 9 As tonic pupils are known to be caused by neurotropic viruses and our current understanding of the SARS-CoV-2 is that it does affect the nervous system, 10 that the tonic pupil in our patient may be secondary to COVID-19. Here we present a curious case of unilateral Adie's tonic pupil after SARS-CoV-2 infection.…”

Section: S Case Reportmentioning

confidence: 84%

Unilateral Adie’s Tonic Pupil after Coronavirus Disease-19 (COVID-19): A Case Report

Candella¹

2023

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Introduction: Adie’s tonic pupil is a neuro ophthalmological disorder characterized by dilated pupil, which is unresponsive to light. It is caused by damage to postganglionic fibers of the parasympathetic innervation of the eye. Recent events of the coronavirus disease 2019 (COVID-19) pandemic had suggested that severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2) had neurotropic and neuroinvasive capabilities. Purpose: To report a rare case of unilateral Adie’s tonic pupil after COVID-19. Methods: A single case report study. Case Report: A 31-year-old woman presented with a glare on the right eye 3 months ago. No other symptom was reported. No prior history of using any eye drops and trauma. Further investigation revealed a history of asymptomatic SARS CoV-2 infection. Her best-corrected visual acuity of both eyes was 1.0, but we observed an impairment of accommodation on the right eye. A fixed dilated right pupil, 8 mm in diameter, was observed without any constriction on near reflex. Slit lamp and funduscopy examination were within normal limits on both eyes. Pilocarpine 0.1% test was positive on the right eye. Neurological examinations and brain imaging was within normal limits. The patient was diagnosed with Adie’s tonic pupil. She was treated with pilocarpine 0.1% once daily. After 2 months of follow up, her complaint of glare was diminished but no improvement of near acuity was seen on the right eye. Conclusions: This case report was one of the first few cases of Adie’s tonic pupil possibly associated with COVID-19.

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“…[49] Tonic pupil is often idiopathic, but it has been associated with other infections (e.g., syphilis, Lyme's disease, influenza or herpes viruses), autoimmune processes, trauma, choroidal and orbital tumors, and surgery. [47] In each of the above cases of tonic pupil, [47] there was a delay (ranging from two days to one month) between the onset of COVID-related respiratory symptoms and development of tonic pupil. Most of the authors hypothesized that tonic pupil in COVID-19 is secondary to a post-viral delayed immunemediated injury rather than direct viral entry into the central nervous system.…”

Section: Pupillary Abnormalitiesmentioning

confidence: 97%

“…[29,30] SARS-CoV-2 is associated with pathologies of the afferent visual pathways including optic neuritis (idiopathic [5,14,[31][32][33] or immunemediated), [3,4,[17][18][19][20][21][22] optic nerve infarction, [34] papillophlebitis, [35] and idiopathic intracranial hypertension. [36][37][38] The efferent visual pathways can be lesioned by COVID-19-related isolated cranial neuropathies, [9,27,[39][40][41] nystagmus, [42][43][44][45][46] tonic pupil, [47][48][49][50][51] Horner's syndrome, [12,13,52] and opsoclonus-myoclonus-ataxia syndrome (OMAS). [53][54][55] Mucormycosis infections, [56] which are of exponentially increasing incidence in COVID-19 patients, can occur as a superinfection and result in lesions of the afferent or efferent visual pathways or even both.…”

Section: Mechanisms Of Neurologic Involvement In Covid-19mentioning

confidence: 99%

“…Tonic (Adie's) pupil refers to parasympathetic denervation of the pupil sphincter, which causes poor constriction of the pupil to the light but the reaction to the accommodation remains relatively spared. Tonic pupil has been reported in association with COVID-19, including unilateral [47] and bilateral [48] cases. One patient with COVID-19related bilateral tonic pupil also had inflammatory multifocal choroiditis.…”

Section: Pupillary Abnormalitiesmentioning

confidence: 99%

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

Feizi

Isen

Tavakoli

2023

JOVR

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Coronavirus disease 2019 (COVID-19) is a current pandemic caused by SARS-CoV-2 that has vastly affected the whole world. Although respiratory disease is the most common manifestation of COVID-19, the virus can affect multiple organs. Neurotropic aspects of the virus are increasingly unfolding, in so far as some respiratory failures are attributed to brainstem involvement. The neuro-ophthalmic manifestations of COVID-19 and the neuro-ophthalmic side effects of vaccination were reviewed. The major findings are that the SARS-CoV-2 infection commonly causes headaches and ocular pain. It can affect the afferent and efferent visual pathways by ischemic or inflammatory mechanisms. Optic nerve may be the origin of transient or permanent visual loss from papillophlebitis, idiopathic intracranial hypertension, or optic neuritis. Cerebrovascular strokes are not uncommon and may lead to cortical visual impairment or optic nerve infarction. SARSCoV- 2 may affect the pupillomotor pathways, resulting in tonic pupil (Adie’s syndrome) or Horner’s syndrome. Cranial neuropathies including third, fourth, sixth, and seventh nerve palsies have all been reported. Rhino-orbital mucormycosis superinfections in COVID-19 patients receiving steroids or other immunosuppressive therapies may result in unilateral or bilateral visual loss and ophthalmoplegia. Autoimmune conditions such as Guillain- Barré, Miller-Fisher syndrome, and ocular myasthenia have been reported.

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Tonic Pupil Following COVID-19

Cited by 15 publications

References 8 publications

Pupil responses in patients with COVID-19

Pupil responses in patients with COVID-19

Unilateral Adie’s Tonic Pupil after Coronavirus Disease-19 (COVID-19): A Case Report

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

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