Sight-threatening ocular manifestations in the post-coronavirus pandemic era
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 4 (2025),
30 January 2026
,
Page 181-195
https://doi.org/10.51329/mehdioptometry238
Abstract
Background: Coronavirus disease (COVID-19) infection can be associated with post-recovery sight-threatening complications like optic neuritis, retinal vascular occlusions, endophthalmitis, and panophthalmitis. This study was conducted to explore the various sight-threatening post-COVID-19 ophthalmic manifestations.Methods: This retrospective observational case series included seven patients who were diagnosed with sight-threatening manifestations post-COVID-19. They underwent detailed ophthalmic and systemic evaluation, including laboratory investigations for systemic hypercoagulable and inflammatory markers.
Results: Seven Indian patients (6 males:1 female, age range 37–66 years) presented to us with severe eye pain, acute loss of vision, redness, and watering after being diagnosed and treated for COVID-19 infection. The time from COVID-19 diagnosis to ocular sampling was 14–60 days (median 27), that of ocular symptoms to ocular sampling 1–50 days (median 4). Visual acuity ranged from no perception of light to 20/36. Three patients were pre-existing diabetics, two developed diabetes during their COVID-19 treatment. Diagnosis included one case of central retinal artery occlusion, one case of vitreous hemorrhage with retinal vasculitis, two cases of presumed bacterial endogenous endophthalmitis, one case of presumed fungal endophthalmitis, and two cases of panophthalmitis, one of them bilateral. Patients with infective intraocular inflammation were subjected to blood, ocular specimens, and urine cultures, which yielded growth in some patients. PCR of ocular specimens were positive for panfungal and/or eubacterial genome. Treatment included oral and systemic antimicrobial therapy with or without systemic steroids, with intravitreal antibiotics and/or steroids in selected cases. Final visual outcome ranged from no perception of light to 20/20.
Conclusions: Patients in this group had both vascular occlusions and infection as a cause of sight-threatening visual loss. Functional visual outcome may not be achieved in this diverse group of patients. Multi-specialty management was required in most of the cases. Larger prospective studies with controls are required to clarify pathogenesis, optimal screening, and management strategies for post-COVID-19 ocular complications.
Keywords:
- coronavirus disease 2019
- COVID 19
- central retinal artery occlusion
- vasculitides
- infectious endophthalmitides
- panophthalmitides
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4. Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, García-Layana A. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med. 2021 Jan;289(1):116-120. doi: 10.1111/joim.13156. Epub 2020 Jul 30. PMID: 32729633.
5. Dumitrascu OM, Volod O, Bose S, Wang Y, Biousse V, Lyden PD. Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban. J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104982. doi: 10.1016/j.jstrokecerebrovasdis.2020.104982. Epub 2020 May 23. PMID: 32689586; PMCID: PMC7245224.
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7. Sanjay S, Srinivasan P, Jayadev C, Mahendradas P, Gupta A, Kawali A, Shetty R. Post COVID-19 Ophthalmic Manifestations in an Asian Indian Male. Ocul Immunol Inflamm. 2021 May 19;29(4):656-661. doi: 10.1080/09273948.2020.1870147. Epub 2021 Mar 18. PMID: 33733987.
8. Sanjay S, Gowda PB, Rao B, Mutalik D, Mahendradas P, Kawali A, Shetty R. "Old wine in a new bottle" - post COVID-19 infection, central serous chorioretinopathy and the steroids. J Ophthalmic Inflamm Infect. 2021 May 14;11(1):14. doi: 10.1186/s12348-021-00244-4. PMID: 33987731; PMCID: PMC8118683.
9. Sanjay S, Mutalik D, Gowda S, Mahendradas P, Kawali A, Shetty R. "Post Coronavirus Disease (COVID-19) Reactivation of a Quiescent Unilateral Anterior Uveitis". SN Compr Clin Med. 2021;3(9):1843-1847. doi: 10.1007/s42399-021-00985-2. Epub 2021 Jun 7. PMID: 34124585; PMCID: PMC8184259.
10. Sanjay S, Kawali A, Mahendradas P, Shetty B. Post Coronavirus Disease (COVID)-19 Disease and Unilateral Visual Impairment. Curr Eye Res. 2021 Dec;46(12):1938. doi: 10.1080/02713683.2021.1905001. Epub 2021 Mar 25. PMID: 33729900.
11. Mahendradas P, Hande P, Patil A, Kawali A, Sanjay S, Ahmed SA, Thomas S, Shetty R. Bilateral Post Fever Retinitis With Retinal Vascular Occlusions Following Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV2) Infection. Ocul Immunol Inflamm. 2022 Oct-Nov;30(7-8):1715-1720. doi: 10.1080/09273948.2021.1936564. Epub 2021 Jul 6. PMID: 34228600.
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