A Case of Non-Arteritic Anterior Ischemic Optic Neuropathy with COVID-19

Abstract

Non-arteritic ischemic optic neuropathy (NAION) is thought to be caused by loss of blood flow to the optic nerve which in turn causes an acute, unilateral and painless vision loss that affects older vasculopathic patients. We report a case of a 43-year-old Hispanic male with the classic presentation of NAION in the setting of a coronavirus disease 2019 (COVID-19) infection. It is well documented that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause hypoxemia and thrombophilia in patients, both of which may contribute to the development of NAION. It is uncertain whether the association of NAION and COVID-19 was causal or coincidental but the purpose of this case report is to argue that there is biological plausibility and to help shed light on potential ophthalmologic complications of COVID-19.

Keywords: covid-19; ischemic optic neuropathy; naion; neurology; neuroophthalmology; ophthalmology; optic neuropathy; vision loss.

Figure 1. Color fundus photography of both eyes. (A) Fundus photo of the right eye showing a small microaneurysm with exudates along the superotemporal arcade without subretinal fluid and temporal pallor of the optic nerve. (B) Fundus photo of the left eye is normal with a cup-to-disk ratio of 0.3.

Figure 2. Humphrey Visual Field (HVF) 24-2 of both eyes. HVF OD is moderately reliable with 0/12 fixation losses, 0% false positive errors, and 18% false negative errors showing a dense inferior altitudinal defect that respects the horizontal meridian. HVF OS is reliable with 1/10 fixation losses, 0% false positive errors, and 0% false negative errors that does not show a specific visual loss pattern.