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Case Reports
. 2022 Jun 15:29:e01536.
doi: 10.1016/j.idcr.2022.e01536. eCollection 2022.

"Marginal keratitis following COVID 19 vaccination"

Daniel A Farrell  1 , Sara Deacon  2 , Thomas Mauger  2
Affiliations
Case Reports

"Marginal keratitis following COVID 19 vaccination"

Daniel A Farrell et al. IDCases. .

Abstract

Purpose: To describe a novel case of marginal keratitis following COVID 19 vaccination.

Methods: Case report.

Results: A 68-year-old female received the Moderna COVID 19 vaccine. She then developed ocular irritation and peripheral corneal opacities that are characteristic of marginal keratitis. Her symptoms responded well to steroid and antibiotic ophthalmic medications. She received her second dose of the Moderna vaccine while still taking her eye drops and was then able to taper off her drops without a recurrence of symptoms.

Conclusions: Marginal keratitis represents a localized type III hypersensitivity reaction of the cornea. The SARS-CoV-2 virus that causes COVID 19 gains entry into the cell via binding of the spike protein with the ACE2 receptor. It is this spike protein that is the target for mRNA COVID-19 vaccines, such as the Moderna vaccine, allowing spike protein antigen recognition by the human immune system. The cornea has been found to have significant levels of ACE2 receptors, potentially allowing for the cornea to become a site for the antigen-antibody complex deposition necessary for a type III hypersensitivity response. This reaction should be recognized so that treatment may be provided during the initial episode and the cornea may be monitored following subsequent vaccinations.

Keywords: COVID 19 Vaccine; Marginal Keratitis; Type III hypersensitivity.

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Figures

Image 1
Image 1
A color photograph of the right eye demonstrating significant injection of the conjunctiva and several small, round peripheral corneal infiltrates.
Image 2
Image 2
A closer look at the inferior corneal infiltrates. A clear corneal zone can be seen between the corneal limbus and the infiltrates.
Image 3
Image 3
Color photograph of the superior cornea demonstrating peripheral corneal opacity and fine vascularization.
See this image and copyright information in PMC

References

    1. Mondino B.J. Inflammatory diseases of the peripheral cornea. Ophthalmology. 1988;95(4):463–472. doi: 10.1016/s0161-6420(88)33164-7. - DOI - PubMed
    1. Mannis M., Holland E. Elsevier Health Sciences; 2017. Cornea; pp. 1079–1081.
    1. Ficker L., Seal D., Wright P. Staphylococcal infection and the limbus: study of the cell-mediated immune response. Eye. 1989;3(Pt 2):190–193. doi: 10.1038/eye.1989.27. - DOI - PubMed
    1. Xia X. Domains and functions of spike protein in sars-cov-2 in the context of vaccine design. Viruses. 2021;13(1):109. doi: 10.3390/v13010109. - DOI - PMC - PubMed
    1. Mondino B.J., Adamu S.A., Pitchekian-Halabi H. Antibody studies in a rabbit model of corneal phlyctenulosis and catarrhal infiltrates related to Staphylococcus aureus. Investig Ophthalmol Vis Sci. 1991;32(6):1854–1863. - PubMed

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