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Case Reports
. 2021 Jul 19;14(7):e240542.
doi: 10.1136/bcr-2020-240542.

Non-arteritic anterior ischaemic optic neuropathy sequential to SARS-CoV-2 virus pneumonia: preventable by endothelial protection?

Laura Moschetta  1 , Giuseppe Fasolino  1 , Robert W Kuijpers  2   3   4
Affiliations
Case Reports

Non-arteritic anterior ischaemic optic neuropathy sequential to SARS-CoV-2 virus pneumonia: preventable by endothelial protection?

Laura Moschetta et al. BMJ Case Rep. .

Abstract

We present a case of non-arteritic anterior ischaemic optic neuropathy (NAION) with no ocular or systemic risk factors in a patient who recovered from a recent SARS-CoV-2 pneumonia. NAION is the most common acute optic neuropathy among individuals over 50 years of age. It results from a transient hypoperfusion of the optic nerve head circulation, especially in patients with low vascular compliance due to ocular or systemic risk factors. We attribute the ophthalmological condition to a SARS-CoV-2 virus-associated endotheliopathy that can be prevented with timely protection of endothelial function with vitamins D and K2.

Keywords: COVID-19; capillary; cranial nerves; eye.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Fundus examination of right eye shows a pale optic nerve disc with sectorial swelling, dilated capillaries in the disc surface and some intrapapillary haemorrhages. The macula appears within normal limits with no signs of cilioretinal artery occlusion.
Figure 2
Figure 2
Inferior altitudinal defect in right visual field at the presentation in the eye clinic.
Figure 3
Figure 3
Fluorescein angiography of the right eye shows optic nerve fluorescein leak from superficial dilated capillaries during the retinal venous phase and the classical hyperfluorescence of superficial and deep portions of the optic disc in the late phase. No signs of cilioretinal artery occlusion were found.
Figure 4
Figure 4
Pseudo-thickening of the nerve fibre layer of the right eye due to papillary oedema. The abnormal thickening reduced in 2-month follow-up examination. RNFL, retinal nerve fibre layer.
Figure 5
Figure 5
At 2-month follow-up, superior swelling was reduced but inferior part was also involved. This aspect is highly suggestive of papillary oedema in progressive non-arteritic anterior ischaemic optic neuropathy. The macula appears within normal limits with no signs of cilioretinal artery occlusion.
Figure 6
Figure 6
Generalised reduction of light perception threshold in 1-month follow-up with preserved central and paracentral superior visual field area. Moderate improvement in mean deviation parameter in 2-month follow-up examination. MD: mean deviation, PSD: pattern standard deviation, dB: decibel
See this image and copyright information in PMC

References

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