A clinical case of central retinal artery occlusion after pneumonia caused by SARS-CoV-2 (COVID-19)

In domestic and foreign medical periodical literature, highlighting the problem of ophthalmopathology against the background of coronavirus infection, the lesion of the anterior segment of the eye is most often described. It is extremely hard to find reports about pathology of the retina, optic nerve or central parts of the visual analyzer. However, it is widely acknowledged that there is a high risk of developing coagulopathy against the background of COVID-19 infection, which leads to occlusion and thrombosis of retinal vessels, ischemic neuropathies. The problem of irreversible loss of vision due to circulatory disorders of the retinal vessels was urgent even before the wide spread of coronavirus infection due to the high prevalence of atherosclerosis, hypertension and type 1 and 2 diabetes in the population. Also, it is widely known that occlusions and thrombosis of retinal vessels can be formidable harbingers of the developing life-threatening conditions. Knowledge about the high risk of vascular ophthalmopatology against the background of a previous COVID-19 infection by the primary echelon ophthalmologists, early diagnostics and treatment of ischemic conditions of the posterior segment of the eye will reduce the frequency of irreversible vision loss due to these diseases, secondary neovascular glaucoma cases, and will also help to send patients to the multidisciplinary hospitals in a timely manner for the prevention of fatal complications of coagulopathy. The article provides a brief overview of foreign literary sources regarding the history of outbreaks of coronavirus infection in the world, as well as possible ways of damage to the organ of vision by the coronavirus. A clinical case of damage to the vascular bed of the retina in both eyes due to coagulopathy against the background of pneumonia caused by COVID-19 is presented, which is actual due to the low illumination of similarly cases.

1. World Health Organization. Summary table of SARS cases by country, 1 November 2002 – 7 August 2003. Geneva (Switzerland): World Health Organisation (WHO); 2003.

2. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report 1. URL: https://apps.who.int/iris/bitstream/handle/10665/330760/nCoVsitrep21Jan2020-eng.pdf?sequence=3&isAllowed=y [date of access: 20.08.2021].

3. Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and sources of endemic human coronaviruses. Adv Virus Res. 2018; 100: 163-188. doi: 10.1016/bs.aivir.2018.01.001

4. Vassilara F, Spyridaki A, Pothitos G, Deliveliotou A, Papadopoulos A. A rare case of human coronavirus 229E associated with acute respiratory distress syndrome in a healthy adult. Ca s e R e p I n f e c t D i s. 2018; 2018: 6796839. doi: 10.1155/2018/6796839

5. Loon SC, Teoh SCB, Oon LLE, Se-Thoe SY, Ling AE, Leo YS, et al. The severe acute respiratory syndrome coronavirus in tears. Br J Ophthalmol. 2004; 88(7): 861-863. doi: 10.1136/bjo.2003.035931

6. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: Is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol. 2020; 5(4): 335-337. doi: 10.1016/S2468-1253(20)30048-0

7. van der Hoek L, Pyrc K, Jebbink MF, Vermeulen-Oost W, Berkhout RJM, Wolthers KC, et al. Identification of a new human coronavirus. Nat Med. 2004; 10(4): 368-373. doi: 10.1038/nm1024

8. Vabret A, Mourez T, Dina J, van der Hoek L, Gouarin S, Petitjean J, et al. Human coronavirus NL63, France. Emerg Infect Dis. 2005; 11(8): 1225-1229. doi: 10.3201/eid1108.050110

9. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei province, China. JAMA Ophthalmol. 2020; 138(5): 575-578. doi: 10.1001/jamaophthalmol.2020.1291

10. Zhou C. Coronavirus: Whistle-blower Dr Li Wenliang confi rmed dead of the disease at 34, after hours of chaotic messaging from hospital. URL: https://www.scmp.com/news/china/society/article/3049411/coronavirus-li-wenliang-doctor-who-alerted-authorities-outbreak [date of access: 14.03.2020].

11. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei province, China. JAMA Ophthalmology 2020; 138(5): 575-578. doi: 10.1001/jamaophthalmol.2020.1291

12. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID‐19 pneumonia: A random association? Eur Heart J. 2020; 41(19): 1858. doi: 10.1093/eurheartj/ehaa254

13. Oripov OI, Bilalov EN. COVID-19-associated cavernous sinus thrombosis: A case report. J Ophthalmol (Ukraine). 2021; 2: 69-71.

14. Murchison AP, Sweid A, Dharia R, Theofanis TN, Tjoumakaris SI, Jabbour PM, et al. Monocular visual loss as the presenting symptom of COVID-19 infection. Clin Neurol Neurosurg. 2021; 201: 106440. doi: 10.1016/j.clineuro.2020.106440

15. Lecler A, Cotton F, Lersy F, Kremer S, Héran F. SFNR’s COVID Study Group. Ocular MRI findings in patients with severe COVID-19: A retrospective multicenter observational study. Radiology. 2021; 299(2): E226-E229. doi: 10.1148/radiol.2021204394