Retrospective diagnosis of COVID-19 following the detection of central retinal artery occlusion

Abstract

Thromboembolic complications are being increasingly reported in patients with COVID-19 due to the associated hypercoagulability and are an important cause for morbidity and mortality. Retinal vascular occlusions especially arterial occlusions are one of the gravest ocular complications reported. This complication may occur in severe cases with cytokine storm or even in mild or asymptomatic patients and presentation can be anytime from few days to weeks after the onset of symptoms. Ophthalmologists should be aware of this new etiology when dealing with patients having features of retinal vascular occlusions and should investigate for the same in this pandemic situation. Although reverse transcriptase polymerase chain reaction is the diagnostic test for COVID-19, serological assays have a role in patients with delayed presentation. We describe the clinical features and multimodal imaging findings in a patient who presented with features of central retinal artery occlusion with cilioretinal artery sparing wherein his ophthalmic condition led to the diagnosis of previously undetected COVID-19 through serology. To the best of our knowledge, this is the first documentation of a case of isolated central retinal artery occlusion leading to a retrospective diagnosis of COVID-19.

Keywords: COVID-19; Central retinal artery occlusion; IgG antibody; serology.

Figure 1

Wide-field color fundus photo of both eyes: Right eye (a) has disc pallor, attenuated arterioles, foveal cherry red spot with retinal whitening sparing a small sector adjacent to disc with patent cilioretinal artery (arrow). Left eye (b) is normal with no diabetic retinopathy

Figure 2

Optical coherence tomography and Humphrey visual fields (central 30-2 threshold test) of both eyes: Right eye optical coherence tomography (a) shows hyperreflectivity with indiscernible inner retinal layers and abrupt transition into normal reflectivity nasally. Right eye field (c) is grossly constricted sparing a small paracentral island. Optical coherence tomography and fields of the left eye (b and d) is normal

Figure 3

Fundus autofluorescence imaging and optical coherence tomography angiography of the right eye: Fundus autofluorescence (a) clearly delineates the hypo-autofluorescent edematous retina from the hyper-autofluorescent perfused retina around the cilioretinal artery. Optical coherence tomography angiography at the level of deep vascular complex (b) demonstrate the extensive capillary drop out sparing the zone perfused by cilioretinal artery