The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Long-term ocular damage after recovery from COVID-19: lack of evidence Travel reimbursement from D.O.R.C. Hyperinflammation with cytokine storm and stasis with hypoxia that activates coagulation mechanisms could very well cause retinal vasculitis, thromboembolic events or venous congestion resulting in a COVID-19 associated retinal vein occlusion, papillophlebitis or retinopathy [30, 38, 39]. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and Conjunctival secretions of patients with SARS-CoV-2 infection. Process n: 309098/2020-3. 2003;362(9393):13538. The most common findings are cough, low-grade fever, and fatigue, all of which may relapse and remit. Oftalmol. It's important to note that an eye issue in a person . 2000;41(10):30118. (Fig. Breathing exercises and respiratory therapy can help. The aim of this study was to investigate potential pathological findings in the eye, especially in the retina, after recovery from an infection with SARS-CoV-2. Lin Y, Jiang H, Liu Y, Rosa Gameiro G, Gregori G, Dong C, et al. 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Prior to 2019, coronaviruses, first discovered in 1968 [1], caused two epidemic outbreaks: In Hong Kong in 2003, in the form of the Severe Acute Respiratory Syndrome (SARS) [24] and in Saudi Arabia in 2012, in form of the Middle East Respiratory Syndrome (MERS) [5, 6]. Further studies with more participants with and without acute ocular symptoms are necessary for final evidence. Therefore, our data is subjected to selection bias and may overestimate the frequency of some abnormalities found. For OCT angiography, the central 6mm fixated on the fovea were examined. These authors contributed equally: Fernando Bellissimo-Rodrigues and Rosalia Antunes-Foschini. For example, in one case . Wang, X., Sahu, K. K. & Cerny, J. Coagulopathy, endothelial dysfunction, thrombotic microangiopathy and complement activation: Potential role of complement system inhibition in COVID-19. Res. Sungnak W, Huang N, Bcavin C, Berg M, Queen R, Litvinukova M, Talavera-Lpez C, Maatz H, Reichart D, Sampaziotis F, Worlock KB, Yoshida M, Barnes JL. When I finally went to see Dr. Amber Dunn, my optometrist, she explained that the symptoms and issues I was experiencing were caused by COVID-19. Mendelson M, Nel J, Blumberg L, Madhi SA, Dryden M, Stevens W, Venter FWD. 2003;348(20):196776. CAS For the purpose of this prospective cross-sectional case study, 21 patients who had recovered from a COVID-19 infection were recruited. CAS Table 1 presents the demographic and ocular data of the 64 individuals. The frequency (n=63) of myopia (sph eq<-0.50D) and hyperopia (sph eq>+0.50D) was respectively 31.7% and 41.2% and seems not to be different when compared to prevalence data on refractive errors. Although in most patients COVID-19 manifests with fever and respiratory tract symptoms, SARS-CoV-2 infection may also involve other organs [37]. Some people develop headaches that last for months after COVID-19. Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia | NEJM. Find out about possible causes of post-COVID-19 conditions and ways to manage symptoms. sharing sensitive information, make sure youre on a federal Kidney disease. Med. J Med Virol. Holappa M, Valjakka J, Vaajanen A. Angiotensin (1-7) and ACE2, the hot spots of renin-angiotensin system, detected in the human aqueous humor. Qing H, Li Z, Yang Z, Shi M, Huang Z, Song J, Song Z. We found a lower vessel density for hospitalised patients in the surrounding quadrants of the fovea compared to control or non hospitalised patients. The macular architecture was evaluated using a standard 2015 tracking protocol, consisting of 19 horizontal sections (each from 25 frames) with a distance of 240 m between each scan, covering the 2015 quadrilateral in the retina, centered on the fovea. How often do you feel your eyes irritated? Anterior segment biomicroscopy was unremarkable, except for dry eye disease, verified in 10.9% of them. Acta Biomed. The Link Between COVID-19 and Ocular Migraine https://doi.org/10.2337/dc11-1909 (2012). Slider with three articles shown per slide. Nasiri, N. et al. The https:// ensures that you are connecting to the Med. Visual acuity was the same as pre-COVID-19 in all eyes, and no traces of ocular inflammation, infiltration or microvascular insult could be found on OCT and OCT angiography. Lancet 395, 1610. https://doi.org/10.1016/S0140-6736(20)31014-X (2020). https://doi.org/10.4103/jfmpc.jfmpc_1572_20 (2020). What I thought was allergies turned into a fever, lightheadedness, blurred vision, and more I had a severe case of COVID-19. Ophthalmol. Socio-demographic data and personal medical history were also collected. https://doi.org/10.2174/1874364101509010028. Spectral domain optical coherence tomography (SD-OCT) was performed using the Heidelberg Spectralis HRA-OCT device (Heidelberg Engineering, Heidelberg, Germany). Also, the frequency of personal history of dry eye or severe symptoms was statistically different concerning the systemic severity of the disease and sexthe frequency was higher in mild-to-moderate cases (p=0.011, two-tailed Fishers exact test) and in women (males: 4/33 (12.1%); females 12/31 (38.7%), p=0.041, two-tailed Fishers exact test). 2020;111(1):102. C. S. G. Symptoms in patients after acute COVID-19. Clinical and prodromal ocular symptoms in coronavirus disease: A systematic review and meta-analysis. Statistical significance (*** p0.001, ** p0.025) was calculated with two-sample t-test assuming different variances. All patients showed normal findings for anterior and posterior segment of both eyes. https://doi.org/10.1056/NEJMsb2005114. All patients showed normal findings for anterior and posterior segment of both eyes. This report details a patient presenting with painless vision loss in the setting of a medical history of COVID-19. I didnt hear or see any mention of the possibility that COVID-19 can cause symptoms similar to a traumatic brain injury (TBI), the way it can change your eyesight and the need for an eye exam after recovering. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. COVID-19 has been heavily linked to conjunctivitis and new studies have even found evidence that the virus creates nodules on the back of a patient's eyes, in some even after recovery. She was discharged from the hospital without answers and bounced around to various specialists to no availuntil she saw a doctor of optometry. PubMed Central Interestingly, none of our patients reported ocular complaints like conjunctivitis, eye redness or visual impairment during or after COVID-19 infection. Retinal findings in hospitalised patients with severe COVID-19. 2020. 15, 539574. Follow-up studies in COVID-19 recovered patients - is it mandatory? Google Scholar. https://doi.org/10.1016/S0140-6736(20)30183-5. WHO Coronavirus Disease (COVID-19) Dashboard https://covid19.who.int (Accessed 29 1 2021). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Non of the patients had initially ocular symptoms. Further studies with more participants with and without acute ocular symptoms are necessary for final evidence. https://doi.org/10.1111/aos.14412. JAMA Ophthalmol. Hashemi, H. et al. 10.1038/220650b0. Ophthalmol. The longer you have diabetes and the less controlled . Interestingly, the spread of the SARS-CoV-2 shows a paradoxical relationship with the spread of malaria disease in Africa [18]. Br J Ophthalmol. Zhong NS, Zheng BJ, Li YM, Null P, Xie ZH, Chan KH, et al. Insausti-Garca A, Reche-Sainz JA, Ruiz-Arranz C, Lpez Vzquez , Ferro-Osuna M. Papillophlebitis in a COVID-19 patient: inflammation and Hypercoagulable state. Among the patients with COVID-19 in the acute phase of the disease, approximately 10% exhibited ocular symptoms, particularly related to ocular surface (conjunctivitis, red eye, foreign body sensation, dry eye, photophobia, blurry vision, itching, epiphora, ocular pain, and floaters)3,4,5,6. Bining Z, Qun W, Ting L, Shengqian D, Xia Q, Hui J, et al. It's possible that ocular migraine could persist even after recovery from COVID-19 in some people. Jakob Siedlecki, Email: ed.nehcneum-inu.dem@ikceldeiS.bokaJ. Careers, Unable to load your collection due to an error. This study was approved by the ethics committee of Ludwig-Maximilians-University, Munich, Germany and adhered to the tenets of the Declaration of Helsinki. Either via the tear film and the draining tear ducts into the upper respiratory tract and the gastrointestinal tract, or theoretically via the conjunctiva into limbal superficial cells into the inner eye, where distribution via the blood or nervous system seems possible [26]. 16, 103112. In March 2020, I was one of the first people diagnosed with COVID-19 in the state of Oregon. Heart Problems in COVID Long Haulers. S. Michalakis Co-founder and shareholder of ViGeneron GmbH. Nature. 2020;27:100550. https://doi.org/10.1016/j.eclinm.2020.100550. Fritz Gerald P. Kalaw, Alexandra Warter, William R. Freeman, Emine Kaya-Guner, Aslihan Sahin, Dilek Yilmaz, Usanee Tungsattayathitthan, Narisa Rattanalert & Wantanee Sittivarakul, Dinah Zur, Michaella Goldstein, Zohar Habot-Wilner, Yu-Chun Cheng, Eugene Yu-Chuan Kang, Ching-Hsi Hsiao, Alessandro Invernizzi, Marco Schiuma, Giovanni Staurenghi, Irmak Karaca, Gunay Uludag, Quan Dong Nguyen, Haya H. Al-Ani, Joanne L. Sims & Rachael L. Niederer, Rana Khalil, Harry Petrushkin, Mark Westcott, Scientific Reports However, for some people the infection persists for months, and it's known as long Covid. Expression analysis of 2019-nCoV related ACE2 and TMPRSS2 in eye tissues. Until now, it already killed more than 2.7 million people worldwide, including Dr. Li Wenliang, an ophthalmologist in Wuhan, Hubei, China, one of the first doctors to notice and warn for its severity and rapid spread2. https://doi.org/10.1016/j.plipres.2021.101092 (2021). A small number of COVID-19 patients has been reported to suffer from acute keratoconjunctivitis. S. Michalakis Co-founder and shareholder of ViGeneron GmbH. A first step in understanding SARS pathogenesis. 2020;9(5):1269. https://doi.org/10.3390/jcm9051269. Arq. Limitations Inflammation in the eye after COVID-19 Lung recovery after COVID-19 is possible, but takes time. When a few weeks passed and I was still struggling, I didnt know what to do. Holappa M, Valjakka J, Vaajanen A. Angiotensin (1-7) and ACE2, the hot spots of renin-angiotensin system, detected in the human aqueous humor. Drosten C, Gnther S, Preiser W, van der Werf S, Brodt H-R, Becker S, Rabenau H, Panning M, Kolesnikova L, Fouchier RAM, Berger A, Burguire A-M, Cinatl J, Eickmann M, Escriou N, Grywna K, Kramme S, Manuguerra J-C, Mller S, Rickerts V, Strmer M, Vieth S, Klenk H-D, Osterhaus ADME, Schmitz H, Doerr HW. Personal consultation fees from Novartis Pharma GmbH and Bayer AG. Google Scholar. weight loss or poor appetite. 1) and the other in the RE. https://doi.org/10.1136/bmj.m3026 (2020). Vinores SA, Wang Y, Vinores MA, Derevjanik NL, Shi A, Klein DA, Detrick B, Hooks JJ. https://doi.org/10.1080/09273948.2020.1738501. They show milder courses in malaria disease and appear to be protected against SARS-CoV-2. In conclusion, our results suggest that long-term complications of the eye are unlikely after recovery from COVID-19, although receptors allowing for SARS-CoV-2 entry are present in the conjunctiva, limbal superficial cells, retina and aqueous humor. (International) B.V. B. Schworm: Speaker honoraria and travel expenses from Novartis Pharma GmbH and Topcon Corporation. I was in severe pain and had frequent migraines. As of January 2021, COVID-19 nears a 100 million cases worldwide [8]. J Virol. Sheehy, L. M. Considerations for postacute rehabilitation for survivors of COVID-19. Hypoxia, minor perfusion or vein occlusions can lead to Cotton Wool Spots (CWS), which had been also reported by another study 1 month after illness in 6 of 27 (22%) patients, pointing to an expired inflammation in the posterior segment of the eye in some patients [28]. The mean superficial parafoveal vessel density for the central fovea was 21.84.3 for not hospitalized and 21.12.9 for hospitalized patients. https://doi.org/10.1080/09273948.2020.1792512 (2020). Gene polymorphisms in angiotensin I converting enzyme (ACE I/D) and angiotensin II converting enzyme (ACE2 C-->T) protect against cerebral malaria in Indian adults - PubMed. Long-term effects of COVID-19 (long COVID) - NHS Among all, 57 (89.0%) required hospitalization and oxygen support, 29 (45.3%) required intensive care, and 23 (35.9%) needed invasive mechanical ventilation. A., Romano, A. C., Nascimento, H. & Belfort, R. Jr. Retinal findings in patients with COVID-19. We included 64 patients (128 eyes). Third, we did not control our data for climate factors, which may have influenced the results related to dry eye signs and symptoms. Among the patients with COVID-19 in the acute phase of the disease, approximately 10% exhibited ocular symptoms, particularly related to ocular surface (conjunctivitis, red eye, foreign body. Global and regional estimates of prevalence of refractive errors: Systematic review and meta-analysis. Balachandar V, Mahalaxmi I, Subramaniam M, Kaavya J, Senthil Kumar N, Laldinmawii G, Narayanasamy A, Janardhana Kumar Reddy P, Sivaprakash P, Kanchana S, Vivekanandhan G, Cho S-G. 1) the hospitalized group show a lower vessel density compared to non hospitalized and control. Terms and Conditions, Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. 4.1K views, 50 likes, 28 loves, 154 comments, 48 shares, Facebook Watch Videos from 7th District AME Church: Thursday Morning Opening Session PubMed Further studies with a longer follow-up and a larger sample size are warranted. California Privacy Statement, Bras. A p value of less than 0.05 was considered to be statistically significant. https://doi.org/10.1167/iovs.06-1024. Before contracting COVID-19 I wore glasses, but the difficulty I had seeing was unlike anything Id experienced before. J. Intern. However, a subsequent article and several letters to the authors raised serious doubts about the data interpretation in this publication, as the suggested pathologic changes most likely represent normal physiological variations and/or imaging artifacts, e.g. Carfi, A., Bernabei, R. Landi, F, & Gemelli Against, C.-P.-A. Other reported systemic symptoms include shortness of breath, chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thromboembolic conditions, depression, and other mental health conditions10,11,12. First, from the recruitment perspective, the participants might have been more likely to accept the invitation to join the study if they had ophthalmologic symptoms. However, a subsequent article and several letters to the authors raised serious doubts about the data interpretation in this publication, as the suggested pathologic changes most likely represent normal physiological variations and/or imaging artifacts, e.g. Our sample showed a higher percentage (46.8%) of patients complaining of blurry vision when compared to a previous study5. I had to take a month off work, unpaid, because I was unable to do my job safely. Napoli PE, Nioi M. Global spread of coronavirus disease 2019 and malaria: an epidemiological paradox in the early stage of a pandemic. Front Public Health. Mendelson M, Nel J, Blumberg L, Madhi SA, Dryden M, Stevens W, et al. Due to the small sample size, future studies with more participants, with and without ocular symptoms combined with a long follow up are necessary to provide further evidence. Personal consultation fees from Novartis Pharma GmbH and Bayer AG. Google Scholar. 3. During the infection, 14 of the 21 patients (66.6%) were in regular care whereas 2 patients (9.5%) received intensive care ventilation for 8.5 (SD) (0.7) days on average in the COVID ICU. Sci. Prolonged screen time from streaming can put a strain on the eyes so an annual appointment with her doctor of optometry is vital for her to stay healthy. 2020;729:139021. https://doi.org/10.1016/j.scitotenv.2020.139021. (1. 2020;181(2):271280.e8. In Serpico-19 diameters of the retinal vessels were examined unveiling higher vessel diameters compared to severity of the covid infection [29]. The mean age (SD) of the patients was 48.7 (18.3) years. Red eyes, ringing ears, sensitivity to light, trouble hearing: although a loss of taste and smell have become well-known sensory symptoms of COVID, accumulating research suggests that vision. PubMed Accessibility She said while I was sick, my brain had been deprived of oxygen and blood flow, which can cause long-term problems. Statistical significance (*** p0.001, ** p0.025) was calculated with two-sample t-test assuming different variances. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Once youve recovered from Covid-19 make sure to get your eyes checked; its an important part of taking care of yourself and getting back to who you were. -Mark from Oregon, When a friend told me they had COVID-19 I said, As soon as youre fine you need to go get your eyes checked. Struggling with the issues with my eyes, and all the things I couldnt do because my vision wasnt the same was frustrating and lonely. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. These include difficulty getting through normal activities . Article 2020;68(11):237883. 4 Ways COVID Leaves Its Mark on the Eye Ocular findings among patients surviving COVID-19, https://doi.org/10.1038/s41598-021-90482-2. Nevertheless, we believe that these results are of interest for the scientific community as late retinal damage might be rarely. Further studies with a longer follow-up and a larger sample size are warranted. 2001;119(2):17582. Covid-19-associated retinopathy: a case report. In humans, beside of keratoconjunctivitis, retinal involvement like Cotton wool spots [28] (CWS), microhaemorrhages [29], vascular occlusions [30] or hyperreflective foci [31] has been reported in COVID-19 patients. As the Pearson correlation for refractive errors between RE and LE was 0.85, we analyzed only the RE. TMPRSS2 is found mainly in the superficial conjunctiva but also together with ACE2 in limbal superficial cells [22]. Global COVID-19 Clinical Platform Case Report Form (CRF) for Post COVID condition (Post COVID-19 CRF). I did these treatments five days a week and have seen improvement. Invest. In our study we did not see more dilated vessels, microaneurysms, areas of non-perfusion or other microvascular anomalies. Although in most patients COVID-19 manifests with fever and respiratory tract symptoms, SARS-CoV-2 infection may also involve other organs [37]. Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrae 8, 80336 Munich, Germany. https://www.who.int/publications/i/item/global-covid-19-clinical-platform-case-report-form-(crf)-for-post-covid-conditions-(post-covid-19-crf-) (2021). 2020;56(00):E011. Nat. Ophthalmology 127, 14251427. 80, 1416. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. PubMed N Engl J Med. The virus poses a deadly threat to the elderly, as well as those who have pre-existing conditions. V. Brantl and B. Schworm wrote the paper, G. Weber, J. Schiefelbein examined patients, V. Brantl prepared figures and tables, T. Kreutzer, S. Michalakis, J. Siedlecki and S. Priglinger gave final supportive assistance. J. Intern. Thanks to the experience of the health care workers (HCW) and the constant exchange in the scientific community, any knowledge about patient management, triaging and current therapy recommendations was quickly and adequately accessible and under constant validation [9, 10]. The ACE2 was found in the eye in addition to the Cornea [22] and conjunctiva [23], also in the retina [24] and aqueous humor [25]. All hospitalized Patients except one (7.1%) had characteristic bilateral multifocal ground-glass opacities findings in their lungs (refer to Table1 for their blood results). After being rear-ended, Catherine spent the next two years trying to get relief from her traumatic brain injury symptoms. 2020:15. Call 314.983.4167 for assistance. "Some of us are seeing tail; some of us are seeing trunk." Along with neurological symptoms,. Besides, according to a meta-analysis on refractive errors23, the estimated pool prevalence of myopia and hyperopia for adults in South America is respectively 22 and 37.2%. Costa, .F., Bonifcio, L.P., Bellissimo-Rodrigues, F. et al. retinal vessels [34]. Hypoxia, minor perfusion or vein occlusions can lead to Cotton Wool Spots (CWS), which had been also reported by another study 1 month after illness in 6 of 27 (22%) patients, pointing to an expired inflammation in the posterior segment of the eye in some patients [28]. PubMed Central 30, 322. 2020;579(7798):2703. The role of apoptosis within the retina of coronavirus-infected mice. : acquisition of data; analysis and interpretation of data; drafting the manuscript. Nature. Tara Robertson took up gaming after completing her active military service and her new hobby came with a sharp increase in screen time. Ocul Immunol Inflamm. The aim of this study was to investigate potential pathological findings in the eye, especially in the retina, after recovery from an infection with SARS-CoV-2. ISSN 2045-2322 (online). In our study we did not see more dilated vessels, microaneurysms, areas of non-perfusion or other microvascular anomalies. Ophthalmic Physiol. Most people who get COVID-19 will have mild illness. Retinal findings in hospitalised patients with severe COVID-19. Studies on animal coronavirus infection models have reported retinal involvement evident as retinal vasculitis, retinal degeneration or collapse of the blood-retinal barrier [35, 36]. Concerning refractive errors on the right eyes (RE), 20 (31.7%) had myopia<0.50D and 26 (41.2%) had hyperopia>+0.50D. Based on clinical data, patients were classified into mild-to-moderate (7 patients, 10.9%); severe (33 patients, 51.5%); and critical (24 patients, 37.5%). Selective neuronal mitochondrial targeting in SARS-CoV-2 infection affects cognitive processes to induce brain fog and results in behavioral changes that favor viral survival. Together, they were able to work through a treatment plan to help Mark on his road to recovery. Meaning Our results indicate that long-term eye complications are unlikely or rare after recovery from COVID-19. Google Scholar. Since its first detection in Wuhan in December 2019, a novel strain entitled SARS-CoV-2 has erupted into a long-lasting global pandemic, that was declared as such by the WHO in March 2020 [7]. frequent need to urinate. Hyperinflammation with cytokine storm and stasis with hypoxia that activates coagulation mechanisms could very well cause retinal vasculitis, thromboembolic events or venous congestion resulting in a COVID-19 associated retinal vein occlusion, papillophlebitis or retinopathy [30, 38, 39]. Long-term ocular damage after recovery from COVID-19: lack of evidence https://doi.org/10.4103/ijo.IJO_2306_20. 2020:15. Goldmann tonometry (mmHg) and refractometry with values displayed in spherical equivalent (sph eq), defined as spherical error plus half the cylindrical error, were also registered. Article While Covid-19 is commonly associated with infection of the lungs, heart and other vital organs, a growing body of evidence suggests that infection can also impact the eye. (0. Hamming I, Timens W, Bulthuis M, Lely A, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. 2003;348(20):197785. Lin Y, Jiang H, Liu Y, Rosa Gameiro G, Gregori G, Dong C, Rundek T, Wang J. Age-related alterations in retinal tissue perfusion and volumetric vessel density. National Library of Medicine Median [interquartile ranges (IQR)] presenting visual acuity was 0.1 (00.2) and BCVA 0 (00.1). The .gov means its official. Ocular Fundus multimodal imaging of a 48-year-old man (critical case) 128 days after first symptoms of COVID-19.