Association of Ocular Adverse Events With Inactivated COVID-19 Vaccination in Patients in Abu Dhabi

Abstract

Importance: As vaccinations against COVID-19 continue, potential ocular adverse events should be reported in detail to increase awareness among the medical community, although typically, a causal relationship cannot be established definitively.

Objective: To describe ocular adverse events that occur soon after receiving an inactivated COVID-19 vaccination (Sinopharm).

Design, setting, and participants: This case series took place from September 2020 to January 2021 at Cleveland Clinic Abu Dhabi, a tertiary referral center. Patients who reported ocular adverse events and presented within 15 days from the first of 2 doses of an inactivated COVID-19 vaccine were analyzed.

Main outcomes and measures: Each patient underwent Snellen best-corrected visual acuity that was then converted to logMAR, applanation tonometry, and biomicroscopic examination with indirect ophthalmoscopy. Color fundus photography was obtained with a conventional 9-field fundus photography camera or with a widefield fundus photography system. Optical coherence tomography and optical coherence tomographic angiography images were obtained. Sex, race, age, and clinical data were self-reported.

Results: Nine eyes of 7 patients (3 male individuals) presenting with ocular complaints following COVID-19 vaccine were included in the study. The mean (SD) age was 41.4 (9.3) years (range, 30-55 years); the mean best-corrected visual acuity was 0.23 logMAR (range, 0-1 logMAR; approximate Snellen equivalent, 20/32). The mean time of ocular adverse event manifestations was 5.2 days (range, 1-10 days). One patient was diagnosed with episcleritis, 2 with anterior scleritis, 2 with acute macular neuroretinopathy, 1 with paracentral acute middle maculopathy, and 1 with subretinal fluid.

Conclusions and relevance: In this case series study of 7 patients, the timing of transient and ocular complications 5.2 days after vaccination with an inactivated COVID-19 vaccine supported an association with the ocular findings, but a causal relationship cannot be established from this study design.

Figure 1.. Scleritis Associated With Inactivated COVID-19 Vaccine

A and B, Right and left eye of a patient who presented with bilateral anterior scleritis 10 days after receiving the first dose of an inactivated COVID-19 vaccine (Sinopharm). The patient started taking topical steroid drops, and the bilateral episode completely resolved at 2-week follow-up (C and D).

Figure 2.. Acute Macular Neuroretinopathy After Inactivated COVID-19 Vaccine

A patient with an ocular history of central serous chorioretinopathy, in the left eye visible (A) with a serous pigment epithelial detachment and a thick choroid presented with profound loss of central vision 1 week after receiving the inactivated COVID-19 vaccine (Sinopharm). Spectral-domain optical coherence tomography showed hyperreflectivity of the outer plexiform layer, Henle fiber layer, and outer nuclear layer with attenuation of the photoreceptors (B, yellow arrowheads), compatible with acute macular neuroretinopathy. Swept-source optical coherence tomographic angiography at the level of the deep capillary plexus (C) showed a semilunar area of signal absence (pink arrowheads) corresponding with the hyperreflective deep spectral-domain optical coherence tomography lesion that may be a sign of slower deep capillary flow or an artifact from the outer retina changes. The patient was closely observed and at 2-month follow-up the tomographic picture had resolved (D).

Figure 3.. Paracentral Acute Middle Maculopathy in a Patient Receiving Inactivated COVID-19 Vaccine

One patient developed a sudden paracentral scotoma in the left eye after receiving the inactivated COVID-19 vaccine (Sinopharm). The patient’s fundus examination revealed a dot hemorrhage superior to the fovea (A). Optical coherence tomography angiography revealed a superior enlargement of the foveal avascular zone (B). This fundus and optical coherence tomographic angiography finding corresponded with a round area of hyperreflectivity superior to the fovea on en face swept-source optical coherence tomography (C) that on B-scan swept-source optical coherence tomography presented as an opacification of the inner layers (D). These imaging features may be consistent with paracentral acute middle maculopathy or be secondary to intraretinal hemorrhage.