Non-arteritic anterior ischaemic optic neuropathy (NA-AION) and COVID-19 vaccination

Abstract

A woman in her 50s presented with diminution of vision in her left eye (OS) 4 days after COVISHIELD^TM vaccination. She had been diagnosed with non-arteritic anterior ischaemic optic neuropathy (NA-AION) of right eye (OD) 8 months earlier. The present episode revealed a best-corrected visual acuity (BCVA) of 20/50 in OD and 20/20 in OS with grade 1 relative afferent pupillary defect. Fundus evaluation showed pale disc in OD and temporal disc oedema in OS. Humphrey's visual field analysis showed incomplete inferior altitudinal defect in OD and a centro-caecal scotoma in OS. Systemic investigations were normal. OS was diagnosed with NA-AION. She was started on oral aspirin 75 mg. At 1-month follow-up, disc oedema of OS had resolved with BCVA maintaining at 20/20. The patient was lost to follow-up later. The relationship between the vaccine and the ocular event is temporal with no causal association.

Keywords: COVID-19; Eye; Immunological products and vaccines; Medical management; Neuroopthalmology.

Figure 1

Infrared photograph of the pupil in bright light at presentation showing relative afferent pupillary defect in left eye.

Figure 2

Fundus photograph of right eye showing (A) crowded hyperaemic disc with peripapillary oedema (red arrow) with fibrous remnant nasally at 8 months earlier (B) fibrous remnant at disc and pale disc with well-defined margins (red arrow) at presentation now.

Figure 3

Fundus photograph of left eye showing (A) well defined disc margin (yellow arrow) at 8 months earlier, (B) blurred temporal disc margin (yellow arrow) with cup disc ratio of 0.2:1 at presentation now.

Figure 4

Spectral domain optical coherence tomography (SD-OCT) of retinal nerve fibre layer image of left eye showing peripapillary swelling temporal to the disc.

Figure 5

Humphrey’s visual field analysis of left eye (OS) showing (A) normal fields at 8 months earlier (B) centrocaecal scotoma at presentation now.

Figure 6

Spectral domain optical coherence tomography image of retinal nerve fibre layer of right eye showing (A) peripapillary swelling (red arrow) with hyperreflective band into vitreous cavity correlating with the fibrous remnant at 8 months earlier, (B) significant reduction in peripapillary swelling (red arrow) at presentation now.

Figure 7

Humphrey’s visual field analysis of right eye (OD) showing (A) incomplete inferior altitudinal scotoma at 8 months earlier, (B) reduction in the extent of inferior altitudinal scotoma at presentation now. GHT, glaucoma hemi field test; NEg, Negative; POS, positive; PSD, pattern standard deviation; VFI, visual field indices.