COVID-19 vaccination and recurrent anterior uveitis

Abstract

A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following first/second dose of coronavirus disease 2019 (COVID-19) vaccination. She had skipped her weekly dose of oral methotrexate following first dose of vaccination. Following the second dose, she reduced her oral methotrexate from 25 to 15 mg on her own, but did not stop like the previous occasion. She had extensive workup for her uveitis in the past with only positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) antibodies. She developed unilateral anterior uveitis after she had COVID-19 in July 2022, which resolved with topical steroids and continuation of immunosuppression. This report illustrates that COVID-19 or its vaccination may presumably play a role in triggering the immune system and can cause recurrent ocular inflammation even in the absence of an extraocular inflammation.

Keywords: Anterior uveitis; COVID-19; Naranjo score; immunosuppression; vaccination.

Figure 1

(a) Inset shows diffuse slit-lamp illumination of the right eye showing ciliary congestion. (b) Magnified beam using 1 mm × 1 mm using Standardized Uveitis Nomenclature for grading anterior chamber cells – shows 2+ cells (red arrow)

Figure 2

(a) Inset shows diffuse slit-lamp illumination of the right eye showing lesser ciliary congestion compared to the first episode. (b) Magnified beam using 1 mm × 1 mm using Standardized Uveitis Nomenclature for grading anterior chamber cells – shows 2+ cells (red arrow)