Features of the Course and Rare Ophthalmic Manifestations of Post-COVID Syndrome

Abstract

The review presents data from studies of the ophthalmological consequences of the disease caused by SARS-CoV-2, especially regarding its rare manifestations. Clinical manifestations of the post-COVID-19 syndrome disappear within about two weeks in mild cases and 3 to 12 weeks in more severe cases. 80 % of patients have more than one, often more than two, and more than 10 symptoms. In general, patients improve spontaneously and continuously over time. The ophthalmic manifestations of COVID-19 vary in nature, severity, and timing, and are more common in patients with severe systemic disease, abnormal blood counts, and inflammatory conditions. Ophthalmic manifestations can develop at any time during the course of the disease. The median time to symptom onset since COVID-19 diagnosis is 5 days for neuro-ophthalmic manifestations, 8.5 days for the ocular surface and anterior segment of the eye, and 12 days for the posterior segment and orbit. COVID-19 causes ocular manifestations in approximately 11 % of patients. The most common ocular manifestation is conjunctivitis, which affects almost 89 % of patients with eye diseases. Other much less common anterior segment anomalies caused by SARS-CoV-2 include scleritis, episcleritis, and acute anterior uveitis. Posterior segment injuries caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Rare complications of COVID-19 include rhino-orbital-cerebral mucormycosis; retrobulbar optic neuropathy, papillitis, neuroretinitis, anterior ischemic optic neuropathy, non-arterial anterior ischemic optic neuropathy; retinal white spot syndrome (MEWDS); acute unilateral anterior uveitis, serpiginous choroiditis; bilateral central serous chorioretinopathy; bilateral acute depigmentation of the iris, bilateral acute transillumination of the iris; refraction changes; complications associated with drugs used to treat COVID-19 that have toxic effects on eye tissue; and vaccine-associated uveitis.