Anton Nicoleta, Bogdănici Camelia Margareta, Brănișteanu Daniel Constantin, Ilie Ovidiu-Dumitru, Pavel Irina Andreea, Doroftei Bogdan
Surgery Department, Faculty of Medicine, University of Medicine and Pharmacy, 700115 Iasi, Romania.
Ophthalmology Clinic, St. Spiridon County Emergency Hospital, 700111 Iasi, Romania.
J Clin Med. 2023 May 31;12(11):3795. doi: 10.3390/jcm12113795.
The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism secondary to viral antigens. The manifestations are atypical, being present even in the absence of the systemic symptoms typical of a SARS-CoV-2 infection. In this article, we introduce a series of three clinical cases with neuro-ophthalmological manifestations associated with COVID infection that were shown in Ophthalmology Clinic of St. Spiridon Emergency Hospital. Case 1 is that of a 45-year-old male patient with no personal history of general pathology or ophthalmology, with binocular diplopia, painful red eyes, and lacrimal hypersecretion with a sudden onset of about 4 days. Based on the evaluations, a positive diagnosis of orbital cellulitis in both eyes is made. Case 2 is that of a 52-year-old female patient with general PPA (personal pathological antecedents) of SARS-CoV-2 infection 1 month prior to presentation with decreased visual acuity in the right eye and a positive central scotoma, preceded by photopsia and vertigo with balance disorders. The diagnosis is made at the right eye for retrobulbar optic neuritis and post-SARS-CoV-2 infection status. The last clinical case is that of a 55-year-old male patient known to have high blood pressure (HBP) with a sudden, painless decrease in VARE approximately 3 weeks post-SARS-CoV-2 immunization (Pfizer vaccine first dose). The diagnosis is made after consulting all the RE results for central retinal vein thrombosis. Conclusions: Although the cases were quickly and efficiently investigated and the treatment was administered adequately by a multidisciplinary team (cases 1 and 3), the evolution was not favorable in all three situations. Atypical neuro-ophthalmological manifestations can also be present in the absence of systemic symptoms typical of SARS-CoV-2 infection.
新型冠状病毒肺炎（COVID-19）感染对全球的大流行影响包括影响多个器官和系统的临床表现，以及与该感染相关的各种神经眼科表现。这些表现较为罕见，要么继发于病毒的存在，要么通过病毒抗原继发的自身免疫机制出现。这些表现不典型，即使在没有严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染典型全身症状的情况下也会出现。在本文中，我们介绍了在圣斯皮里东急诊医院眼科诊所就诊的3例与COVID感染相关的神经眼科表现的临床病例。病例1是一名45岁男性患者，无一般病理学或眼科个人病史，突发双眼复视、眼红疼痛及泪液分泌过多约4天。经评估，确诊为双眼眶蜂窝织炎。病例2是一名52岁女性患者，在就诊前1个月有SARS-CoV-2感染的一般个人病理史（PPA），右眼视力下降，中心暗点阳性，之前有闪光幻视和伴有平衡障碍的眩晕。诊断为右眼球后视神经炎和SARS-CoV-2感染后状态。最后一例临床病例是一名55岁男性患者，已知患有高血压（HBP），在接种SARS-CoV-2疫苗（辉瑞疫苗第一剂）后约3周突然出现无痛性视力下降（VARE）。经查阅所有视网膜电图（RE）结果后诊断为视网膜中央静脉血栓形成。结论：尽管这些病例得到了快速有效的检查，并且由多学科团队进行了充分的治疗（病例1和3），但在所有三种情况下病情进展都不理想。在没有SARS-CoV-2感染典型全身症状的情况下，也可能出现非典型神经眼科表现。
