Sitaula Sanjeeta, Shah Chiranjiwi, Shah Ganga Sagar, Ojha Rajeev
Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Department of Optometry, B. P. Smriti Hospital, Kathmandu, Nepal.
Case Rep Ophthalmol Med. 2025 Jul 26;2025:6694537. doi: 10.1155/crop/6694537. eCollection 2025.
The coronavirus disease 2019 (COVID-19) primarily involves the respiratory system, but can manifest with a variety of neuro-ophthalmic symptoms. Here, we describe three cases presenting with neuro-ophthalmic manifestations secondary to COVID-19 at a tertiary center in Nepal. The first case was a 42-year-old male with sudden onset painless loss of vision noticed in the right eye (RE) after COVID-19 infection. Examination findings in the RE showed best corrected visual acuity (BCVA) of 6/18 with relative afferent pupillary defect positive and superior sectoral disk edema in the same eye. The case was diagnosed as RE nonarteritic ischemic optic neuropathy associated with COVID-19 infection. Our second case was a 41-year-old female who developed bilateral sudden diminution of vision associated with headache and vomiting on the third day of testing positive for COVID-19 infection. She had bilateral BCVA of 6/12 and sluggishly reacting pupils in both eyes. Dilated fundus examination showed established disk edema. Imaging of the brain showed dural venous sinus (transverse and sagittal) thrombosis. So, the diagnosis of papilledema secondary to COVID-19 associated cerebral venous sinus thrombosis (CVST) was established. The third case was a 40-year-old male with right sixth cranial nerve palsy, ischemic stroke involving the right occipital lobe and posterior limb of the right internal capsule along with thrombosis of the left common iliac artery in the absence of any other preexisting vascular risk factors. Severe inflammatory reaction to COVID-19 causing a hypercoagulable state may be the causal factor in neuro-ophthalmic findings in our case series.
2019冠状病毒病（COVID-19）主要累及呼吸系统，但可表现出多种神经眼科症状。在此，我们描述了尼泊尔一家三级中心出现的3例继发于COVID-19的神经眼科表现病例。首例病例为一名42岁男性，在感染COVID-19后右眼突然出现无痛性视力丧失。右眼检查结果显示最佳矫正视力（BCVA）为6/18，相对传入性瞳孔障碍阳性，同眼有上象限视盘水肿。该病例被诊断为与COVID-19感染相关的右眼非动脉性缺血性视神经病变。我们的第二例病例是一名41岁女性，在COVID-19检测呈阳性的第三天出现双眼视力突然下降，并伴有头痛和呕吐。她双眼的BCVA均为6/12，双眼瞳孔反应迟钝。散瞳眼底检查显示视盘水肿已形成。脑部影像学检查显示硬脑膜静脉窦（横窦和矢状窦）血栓形成。因此，确诊为继发于COVID-19相关脑静脉窦血栓形成（CVST）的视乳头水肿。第三例病例是一名40岁男性，患有右侧第六颅神经麻痹、累及右侧枕叶和右侧内囊后肢的缺血性中风以及左侧髂总动脉血栓形成，且不存在任何其他既往血管危险因素。对COVID-19的严重炎症反应导致高凝状态可能是我们病例系列中神经眼科表现的病因。
