Nodular Scleritis after COVID-19 Vaccine; CRVO after COVID-19 Vaccine

Thousands of patients are now receiving the COVID-19 vaccines. Recently we started seeing patients who report they have had some symptoms after receiving the vaccine. This does not apply causation at all but wanted to report these. 

We saw a patient with significant nodular scleritis 2 weeks after receiving the Pfizer Covid-19 vaccine. She reports her mother had a CRVO (Central Retinal Vein Occlusion) 2 weeks after this vaccine as well.

Photos are on their way. 

Curious. 

Also one of our surgeons has seen 3 patients with diplopia after the J&J vaccine with no other findings. 

This is all thus far. 

SLC

References:

1. This is a poor reference (& has poor grammar) but is the only mention of CRVO after a COVID-19 vaccine I could find to date. Thus this risk is very rare & likely unrelated. 

https://in.news.yahoo.com/covid-vaccination-11-deaths-far-153326102.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAClTRtD5TLAoCtSNqQOkcDmUiZahjiLGG5WbJs0WhP1II8fpGYsCD5T0Q2zZyEZj6dq4Hj5J_Mr8Nn76-wm4nLWBDLoymcTdwY1PDk3JmFFS2BcGe3tpazRReGeSW797NgKP9Z9st89B05hKIuavoz2zDt3erW6lTqBjDGpFb5t9

Ani

COVID Vaccination: ‘11 deaths so far,’ informs Health Ministry

15 February 2021

New Delhi, Feb 15 (ANI): “35 cases required hospitalization, 11 deaths have been reported in hospitals during last 31 days of COVID vaccination drive,” informed Health Ministry Joint Secretary Mandeep Bhandari on February 15. Bhandari said, “Percentage of hospitalisation against vaccination is 0.0004%. In the last 24 hours, there is one case that required hospitalisation. This is due to central retinal vein occlusion after blood pressure increased. Patient is now stable at the hospital in Indore.”

CRVO has been reported from the infection of COVID-19:

https://retinatoday.com/articles/2020-sept/retinal-vein-occlusion-associated-with-covid-19

CRVO is due to a thrombus in the central retinal vein as it exits the globe within the optic nerve. Often patients with CRVO have systemic risk factors such as hypertension, diabetes. cardiovascular disease, or a hypercoagulable state. Our patient had none of these risk factors for CRVO. Although ulcerative colitis has been reported as a rare association with CRVO, no such association has been reported with microscopic colitis, a less severe form of inflammatory bowel disease.3 As noted, COVID-19 infection can cause hypercoagulability.

Retinal microvascular changes have been reported with COVID-19, including subtle cotton wool spots and microhemorrhages but not a retinal vascular occlusion.4

The timing of COVID-19 infection, as documented by antibody testing in this patient, with visual symptoms and findings of a CRVO, suggest an association between the two conditions. The pathogenesis is consistent with COVID-19 inducing a hypercoagulable state, which can lead to CRVO.

Clinicians should be aware that eyes of patients with COVID-19 infection are at risk for vascular occlusive events and that visual symptoms may occur even with milder forms of systemic viral infection. This may help distinguish COVID-19 from other common forms of upper respiratory illness not known to induce a hypercoagulable state.