COVID-19 presenting as a non-arteritic anterior ischemic optic neuropathy

Abstract

We present a case of a 61-year-old woman with an atypical non-arteritic anterior ischemic optic neuropathy (NA-AION) as a unique manifestation of COVID-19. Furthermore, the patient worsened after Pfizer-BioNTech COVID-19 vaccine administration. Our findings suggest that NA-AION could result from microangiopathic/thrombotic events that may occur during SARS-CoV-2 infection and/or vaccination against COVID-19. This report sheds light on possible ophthalmologic complications of COVID-19.

Keywords: optic nerve‌; optical coherence tomography angiography‌; vaccine‌; ‌SARS-CoV-2.

Figure 1.

Humphrey visual field (VF) 24–2 testing. Panel A: VF performed on March 31st 2021, showed a moderate reduction in peripheral retinal sensitivity in the right eye. Panel B: VF showed an almost complete recovery of retinal sensitivity in peripheral fields of the right eye. Panel C: VF performed on March 31st 2021, showed marked concentrical reduction of retinal sensitivity in the left eye. Panel D: total loss of visual field in the left eye.

Figure 2.

Panel A: the retinography of the right eye shows a normal optic nerve. Panel B: the retinography of the left eye shows a normal optic nerve. Panels C-D: optical coherence tomography angiography (OCTA) of the papillary and peri-papillary area in 6 × 6 SOLIX (Optovue) device. The right eye shows a normal vascularization of the superficial and deep vascular layer (Panel C). A diffuse reduction in the left eye is evident mainly in the deep vascular layer (Panel D). White arrows indicate the ischemic area. Panels E-F: normal OCT appearance of the optic nerve head in the right eye and pathologic cupping in the left eye.