Acute bilateral retrobulbar optic neuritis - An atypical sequela of COVID-19

Abstract

Coronavirus disease 19 (COVID-19) and its ophthalmic manifestations have been variably portrayed. We report a case of a 56-year-old female presenting with sudden-onset vision loss associated with painful extraocular muscle movements in both eyes following COVID-19. Visual acuity was counting fingers close to face. Color perception tested was inaccurate. Ocular examination revealed sluggishly reacting pupils and an otherwise unremarkable fundus picture in both eyes, giving us an impression of bilateral retrobulbar neuritis. Magnetic resonance imaging of the brain and orbit were unremarkable, while blood investigations revealed nothing suggestive. The patient dramatically improved with steroid therapy with full visual recovery and a color vision defect. This presentation of bilateral retrobulbar neuritis as a sequela of COVID-19 is presented for its rarity.

Keywords: COVID-19; Coronavirus; optic neuritis.

Figure 1

(a) Color fundus photo of the right eye showing normal fundus. (b) Color fundus photo of the left eye showing normal fundus

Figure 2

Blood investigations and cerebrospinal fluid analysis on presentation represented in tabular form

Figure 3

(a) T2 fluid-attenuated inversion recovery (FLAIR) image showing no periventricular plaques suggesting no changes of multiple sclerosis. (b) T2 DRIVE image showing retrobulbar thickening and tortuosity of the optic nerve, which is more on the right side (red arrow)

Figure 4

(a) Visual fields and optical coherence tomography images of the patient on recovery for the right eye revealing paracentral scotoma and average RNFL thickness of 111 µm. (b) Visual fields and optical coherence tomography images of the patient on recovery for the left eye revealing paracentral scotoma and average RNFL thickness of 114 µm