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Case report links COVID-19 with permanent vision loss  

Ophthalmologists have documented what is believed to be the first reported case of permanent loss of visual acuity that may have been induced by SARS-CoV-2, the virus that causes COVID-19.

Researchers from the Metz-Thionville Regional Hospital Center, Lorraine University, Mercy Hospital, in the French city of Metz, say the virus has been found in tears, and known to cause conjunctivitis and asymptomatic nonneuropathic retinal lesions. But little was known about its ability to trigger serious ocular disease.

“To our knowledge, this is the first reported case of inflammatory ocular neuropathy that was associated with uveitis, may have been induced by SARS-CoV-2, and resulted in permanent loss of visual acuity,” lead author Dr Jean Marc Perone wrote in the journal JAMA Ophthalmology.

“In animals, other coronaviruses can cause conjunctivitis, anterior uveitis, retinitis, and disc neuritis. However, the ability of SARS-CoV-2 to induce serious ocular disease has been unknown.”

The case was diagnosed in a woman in her 50s hospitalised in March 2020 for severe bilateral pneumonia before testing positive for the coronavirus.

She developed blurred vision and redness in her right eye and temporary (eight-days) pain when mobilising the globe. Her best-corrected visual acuity was +2 logMAR (hand movement 6/600) in her right eye and 6/6 in her left. The right eye had a relative afferent pupil defect, central scotoma, and impaired colour and contrast vision.

(Image A) Optic disc neuritis was observed along with mild leakage that associated with an inferior peripapillary hemorrhage. (Image B) Fluorescein leakage from retinal venules inferotemporal to the macula was also observed. Image: JAMA Ophthalmology

The patient was treated with oral and topical corticosteroids for presumed non-infectious ocular inflammation. But 30 days after being admitted into intensive care, fluorescein angiography revealed optic disc neuritis and inferior retinal vasculitis. Mild papillary edema was also observed.

She was diagnosed with inflammation-induced ocular neuropathy associated with SARS-CoV-2–induced panuveitis.

Perone said while central nervous system involvement (eg, meningo-encephalitis) had been reported in infected patients, it could not explain his findings because the cranial magnetic resonance imaging produced clear results.

“While it remains possible these findings were idiopathic, the temporal association between SARS-CoV-2 infection and the ocular manifestations and the lack of relevant history support the possibility that SARS-CoV-2 caused the neuropathic ocular inflammation in this case,” he said.

“This case suggests that COVID-19 manifestations may include isolated inflammatory optic neuritis that leads to permanent visual acuity loss. To limit the functional consequences of ocular neuropathy in patients infected by SARS-CoV-2, it should be diagnosed and treated early.”

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