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All authors have read and agreed to the published version of the manuscript. A total of 23 articles reported ocular findings associated with COVID-19 vaccinations (Table 1). MRI showed SOV thrombosis with no contrast filling [32]. 2020;383:19201931. BNT162b2 (Pfizer/BioNTech, Mainz, Germany) [3] and mRNA-1273 (Moderna, Cambridge, MA, USA) [4] belong to the category of lipid nanoparticle (LNP)-formulated mRNA COVID-19 vaccines, while ChAdO1 (University of Oxford/AstraZeneca, Oxford, UK) [5] and Ad26.COV2.S (Johnson & Johnson/Janssen, New Brunswick, NJ, USA) [6] belong to the category of adenovirus vector COVID-19 vaccines. Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine. The coronavirus disease 2019 (COVID-19) pandemic has had profound and lasting consequences since 2019. The patients characteristics were reviewed from two articles. and transmitted securely. A 57-year-old female had new onset floaters of the left eye within days of her second Moderna COVID-19 vaccination, which progressively worsened prompting her to present for evaluation. Brain MRI with venography revealed CVST with right frontal subarachnoid hemorrhage and a cortical venous infarct. Adenoviral vector vaccines can cause ocular disease by inducing an immunologic response to the spike antigen or to components of the chimpanzee or human adenovirus. Papilledema, left visual extinction, and right gaze deviation were noted. Macular optical coherence tomography angiography analysis in diabetes mellitus patients with a history of Covid-19. [(accessed on 21 September 2021)]; Available online: Sahin U., Muik A., Derhovanessian E., Vogler I., Kranz L.M., Vormehr M., Baum A., Pascal K., Quandt J., Maurus D., et al. IgG-ELISA for the PF4-heparin complex antibody was positive. The virus can lead to hazy vision and black spots, known as floaters. Reyes-Capo D.P., Stevens S.M., Cavuoto K.M. Slit lamp, fundus examination, and non-contrast magnetic resonance imaging (MRI) of the brain and orbits were unremarkable. The mean duration between COVID-19 vaccination and onset of neural symptoms was six (range 214) days. It is also essential to establish the response of autoimmune disease patients to vaccines and if the response is suboptimal in this population. Advancing public health The AMA leads the charge on public health. Elenga N, Martin E, Gerard M, Osei L, Rasouly N. Unilateral diplopia and ptosis in a child with COVID-19 revealing third cranial nerve palsy, Acute isolated near vision difficulty in patients with COVID-19 infection, Retinal manifestations in patients with SARS-CoV-2 infection and pathogenetic implications: a systematic review, Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine, Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine, Safety and efficacy of NVX-CoV2373 Covid-19 vaccine, Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19, Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK, Development of an inactivated vaccine candidate for SARS-CoV-2, Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBIBP-CorV: a randomised, double-blind, placebo-controlled, phase 1/2 trial. ElSheikh RH, Haseeb A, Eleiwa TK, Elhusseiny AM. Two cases of graves disease following SARS-CoV-2 vaccination: an autoimmune/inflammatory syndrome induced by adjuvants. J Family Med Prim Care. The following day, she developed left-sided weakness and eye deviation to the right. Although vaccines against COVID-19 have been developed and approved under emergency use authorization, various adverse events have also been reported after COVID-19 vaccination. 2021 Mar;69(3):488-509. doi: 10.4103/ijo.IJO_297_21. Furthermore, of the published cases with clear ocular pathology demonstrated on examination and investigation, most recovered well with swift initiation of treatment. However, as the VKH reactivation was reported six weeks after receiving the second dose of vaccination, it is difficult to establish a temporal association between COVID-19 vaccination and VKH reactivation based on this single case report. Currently, EMA has approved four vaccines that are protective against SARS-CoV-2 [1,2]. Schultz NH, Srvoll IH, Michelsen AE, et al. reported a 20-year-old female with a history of oral contraceptives and with bilateral flickering scotoma after administration of the ChAdO1 COVID-19 vaccine [19]. 2020;586:594599. Characteristics of ocular manifestations after receiving COVID-19 vaccine and their related reports are presented in Table 1. Review of literature of ocular manifestations after COVID-19 vaccine. On examination, right esotropia of 25 diopters in primary gaze, 30 diopters in the right gaze, 10 diopters in the left gaze, and a severe abduction limitation of the right eye were noted. Case of superior ophthalmic vein thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccine against SARS-CoV-2. While the COVID-19 vaccines have, so far, not caused notable side effects related to vision, vaccines for several other conditions have been linked to eye and vision problems. Book B.A.J., Schmidt B., Foerster A.M.H. and transmitted securely. Uveitis following the BNT162b2 mRNA vaccination against SARS-CoV-2 infection: a possible association, Corneal graft rejection after COVID-19 vaccination. We identified five case reports26,28,31,37,40 and one multicenter, retrospective case series35 describing uveitis after COVID-19 vaccination. IgG-ELISA for the PF4-heparin complex antibody was positive, while CT venogram showed CVST. Y.-K.L. Moreover, 15 cases of TTS were reported in the United States after administration of 7.98 million doses of Ad26.COV2.S COVID-19 vaccination during 2 March21 April 2021 [47]. 2023 Jan 13;10:1051378. doi: 10.3389/fpubh.2022.1051378. NXL and RA conceived and planned the review. Vaccines (Basel). For this narrative review, relevant publications were identified through a computerized database search of MEDLINE, EMBASE and Google Scholar. It's a journey that Myra, who lives in Monterey, California . Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. Book et al. Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; moc.liamtoh@90911tnecniv. Rejections were also reported following three penetrating keratoplasty (PKP) cases36,43; all three were male; 1 case had a previous re-graft. June 30, 2022 / 12:36 PM / CBS News. Before The patient reported that 69 hours prior to presentation he received the first dose of the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine. reported that a 44-year-old female and a 63-year-old male had purpuric lesions on the upper eyelids occurring 2125 days after vaccination with the second dose of BNT162b2 COVID-19 vaccine. 2022 Jun 9;11(12):3318. doi: 10.3390/jcm11123318. Y.-K.L. Dicks M.D., Spencer A.J., Edwards N.J., Wadell G., Bojang K., Gilbert S.C., Hill A.V., Cottingham M.G. reported a 29-year-old previously healthy female with blurring of vision of the left eye nine days after receiving the first dose of the ChAdO1 COVID-19 vaccine. The patients characteristics were reviewed in four articles. The results showed that, among 686 cases, one case developed uveitis several weeks after the first dose of the vaccine and two cases developed uveitis after the second dose of the vaccine [28]. U.S. Food & Drug AdministrationCOVID-19 Vaccines. Reports on such adverse effects are rare, and further longitudinal, multicenter studies are required to prove such associations, if any. The patient was diagnosed with right abducens nerve palsy [30]. Acute-onset central serous retinopathy after immunization with COVID-19 mRNA vaccine. Other possible effects induced by mRNA vaccines include microangiopathy, localized vasculitis, and demyelination, which cause the presence of eyelid purpuric and ecchymotic lesions and abducens nerve palsy [11,30]. Goyal et al. The central corneal thickness was 660 m and 622 m in the right and left eyes, respectively. The mRNA vaccine can increase free extracellular mRNA, which may increase the permeability of endothelial cells and cause choriocapillaris leakage. Laboratory investigations revealed thrombocytopenia. Regarding post-vaccination thrombosis, rare cases of post vaccination immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis (CVST) after administration of the adenovirus vector vaccines ChAdOx1 nCoV-19 and Ad26.COV2 have been well described.5257 Anatomically, CVST post-COVID-19 vaccination has been reported to occur in virtually all the dural venous sinuses,52 and a majority of patients are females.52 This section focuses on superior ophthalmic vein thrombosis, as reported in two isolated cases.21,58 Both patients received the ChAdOx1 nCoV-19 vaccine. and Y.-H.H. Douxfils J., Favresse J., Dogne J.M., Lecompte T., Susen S., Cordonnier C., Lebreton A., Gosselin R., Sie P., Pernod G., et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Contact your doctor . The patients characteristics were reviewed in five articles. Opinions. 1 New research shows that Covid-19 causes eye problems, leading to hazy vision or black spots as the virus attacks the retina Credit: Getty not mentioned in the article. National Library of Medicine At the end of three weeks, there was recurrence of choroidal thickening and systemic corticosteroid therapy was recommenced. One patient developed a sudden paracentral scotoma in the left eye after receiving the inactivated COVID-19 vaccine (Sinopharm). conducted a case series of six patients with CVST with thrombocytopenia after receiving the Ad26.COV2.S vaccine. Thus, other studies are needed to prove a causal link between the observed event and the vaccine, which may contribute to future vaccine development. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination, Cerebral venous thrombosis after vaccination against COVID-19 in the UK: a multicentre cohort study, US case reports of cerebral venous sinus thrombosis with thrombocytopenia after Ad26.COV2.S vaccination, March 2 to April 21, 2021, COVID-19 vaccine-associated cerebral venous thrombosis in Germany. Subramony R., Lin L.C., Knight D.K., Aminlari A., Belovarski I. Bayas A, Menacher M, Christ M, Behrens L, Rank A, Naumann M. Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination. COVID-19 Vaccines and Thrombosis-Roadblock or Dead-End Street? Ocular coherence tomography (OCT) demonstrated slight hyperreflectivity of the outer nuclear and plexiform layers and disruption of the ellipsoid zone. Acute corneal endothelial graft rejection following COVID-19 vaccination. reported that a 50-year-old previously healthy male developed slight visual impairment 11 days after receiving the first dose of the ChAdO1 COVID-19 vaccine. Bayas et al.21 described a 55-year-old female with bilateral SOV thrombosis on post-dose day 10, also definitively diagnosed on MRI showing filling defects and T2 enhancement of both SOV. Several adverse events, including ocular manifestations, have been reported after vaccination. Acute macular neuroretinopathy: A comprehensive review of the literature. In our literature review, there were seven patients who had retinal manifestations. Left eye posterior synechiae, AC cells, and KPs were noted. The symptoms resolved 72 h after topical glucocorticoid administration. Ocular adverse effects of COVID-19 vaccinations include facial nerve palsy, abducens nerve palsy, acute macular neuroretinopathy, central serous retinopathy, thrombosis, uveitis, multiple evanescent white dot syndrome, Vogt-Koyanagi-Harada disease reactivation, and new-onset Graves Disease. Bragazzi NL, Hejly A, Watad A, Adawi M, Amital H, Shoenfeld Y. ASIA syndrome and endocrine autoimmune disorders, Immune-mediated disease flares or new-onset disease in 27 subjects following mRNA/DNA SARS-CoV-2 vaccination, COVID-19 vaccines: modes of immune activation and future challenges, Type I interferon-mediated monogenic autoinflammation: the type I interferonopathies, a conceptual overview. Fluorescein angiography (FA) revealed mild peripheral vascular leakage. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. reported a 27-year-old female who took oral contraceptives and developed an acute paracentral scotoma after receiving the first dose of the ChAdO1 COVID-19 vaccine [18]. Researchers believe that eye-related effects after COVID-19 vaccination may happen due to the body's immune response to the vaccine. At present, given the nascent nature of COVID-19 vaccines and evolving data on their adverse effects, it is imperative to emphasize that no causality can be established from this review. MEWDS cases were not treated. References cited within the identified articles were used to further augment the search. Laboratory examination revealed thrombocytopenia. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, Corneal graft rejection after penetrating keratoplasty (PKP), Corneal graft rejection after Descemet membrane endothelial keratoplasty (DMEK), Acute zonal occult outer retinopathy (AZOOR), Reactivation of Vogt-Koyanagi-Harada (VKH) Disease, Arteritic anterior ischemic optic neuropathy (AAION), Superior ophthalmic vein (SOV) thrombosis, Thrombocytopenia with acute ischemic stroke and bleeding, adverse events, coronavirus disease 2019 (COVID-19), ophthalmology, vaccines. The COVID-19 pandemic has galvanized the development of new vaccines at an unprecedented pace. Onset of Graves disease (GD) in two subjects was reported a few days after the first dose of BNT162b2.42 One patient had suffered a prior COVID-19 infection and a history pulmonary arterial hypertension. Seasonal flu vaccine In rare cases, some patients who've received the flu vaccine experienced like eye redness, eye pain and blurred vision. Crnej et al. Ocular Immunology and Inflammation, September 2021 OCT was performed, which showed macular serous detachment of the neurosensory retina, with OCT angiography showing general attenuation of choriocapillaris flow signal in the area of serous retinal detachment. Other possible causes of thrombosis include spike protein interactions with different C-type lectin receptors, heparan sulfate proteoglycans, and the CD147 receptor. In our literature review, there were three patients who developed neural manifestations. A diagnosis of bilateral simultaneous acute endothelial graft rejection was made. In this study, we aimed to review all reported ocular side effects of the available COVID-19 vaccines. Common side effects of the MMR vaccine include fever, mild rash, swollen cheek or neck glands, and temporary joint pain (mostly in teenage and adult females). Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: Two open, non-randomised phase 1/2 studies from Russia. After full-text evaluation, 18 studies were excluded due to no relevant and 1 study was excluded due to unknown vaccine. The https:// ensures that you are connecting to the She had bilateral blurring of vision, pain, photophobia, and redness three weeks after the second dose of the vaccine. He has not received funding for his work in this publication. Panovska-Stavridis et al. An ocular adverse event was defined as any adverse event related to the eye, adnexa, or vision. Available online: The Centre for Evidence-Based Medicine. The .gov means its official. Bhler A.D., Strm M.E., Sandvig K.U., Moe M.C., Jrstad .K. reported that a 23-year-old male who had no significant medical history developed ocular symptoms after receiving the BNT162b2 vaccine. However, the headache worsened, and new homonymous hemianopia occurred the following day. In our literature review, there were 12 patients with ocular manifestations. reported a 22-year-old female and a 28-year-old female who were on long-term oral contraceptives they developed acute onset of paracentral scotoma two days after receiving the ChAdO1 COVID-19 vaccine. doi: 10.1038/s41586-020-2607-z. OCT showed ganglion cell complex thinning, and the retinal nerve fiber layer appeared normal in both eyes. Some of the reported ocular manifestations of COVID-19 infection include conjunctivitis, episcleritis, uveitis, vascular changes in the retina and cotton wool spots, optic neuritis, ocular motility deficits from cranial nerve palsies, and transient accommodation deficits.813. Inclusion in an NLM database does not imply endorsement of, or agreement with, HHS Vulnerability Disclosure, Help reported that a middle-aged, previously healthy male developed a sudden onset of darkening of the visual field three days after receiving the second dose of BNT162b2 COVID-19 vaccine. The other case was a 67-year-old female who developed ecchymosis on the upper eyelids 10 days after the first dose of BNT162b2 COVID-19 vaccine. A novel chimpanzee adenovirus vector with low human seroprevalence: Improved systems for vector derivation and comparative immunogenicity. Horozoglu F, Sener H, Evereklioglu C, Polat OA. COVID causes eye problems by attacking the retina, researchers say. J. Med. Lastly, adenovirus vectors may interact with the CD46 receptor or platelet factor 4 antibodies to cause thrombosis [1]. There were 19 patients with anterior uveitis whereas two patients were diagnosed to have multiple evanescent white dot syndrome (MEWDS) (after receiving the initial diagnosis of anterior uveitis). The initial onset of VKH was severe, necessitating infliximab infusions which were continued as regular maintenance therapy. HHS Vulnerability Disclosure, Help Ocular adverse effects of COVID-19 vaccines: A systematic review. On fluorescein angiography (FA), a single point of leakage was noted following the ink-blot pattern. I did these treatments five days a week and have seen improvement. The mRNA vaccines, including BNT162b2 and mRNA-1273, contain codon-optimized sequences for spike protein synthesis and use the authentic signal sequence for its biosynthesis [41]. A 73-year-old male with a history of PKP in the left eye due to keratoconus and underwent regrafting due to late endothelial failure two years prior. Severe acute respiratory syndrome-coronavirus-2 spike (S) protein based vaccine candidates: State of the art and future prospects. COVID-19, vaccination, ocular inflammation, adverse effects, uveitis. Abbreviations: F female, M male, N.A. Eye care professionals and other clinicians should be aware of these rare but possible ocular adverse effects after COVID-19 vaccination, especially those that are sight-threatening in nature. Mazzatenta C., Piccolo V., Pace G., Romano I., Argenziano G., Bassi A. Purpuric lesions on the eyelids developed after BNT162b2 mRNA COVID-19 vaccine: Another piece of SARS-CoV-2 skin puzzle? The search comprised the following keywords: COVID, COVID-19, SARS-COV-2, coronavirus, vaccination, ocular complications, ocular manifestation, thrombosis, retinopathy, maculopathy, uveitis, ocular inflammation. Search results were screened for relevance. Repeat CT showed right parietal lobe hemorrhage [35]. The patient was prescribed spironolactone, and all symptoms eventually resolved on follow up. B-scan showed bilateral choroidal thickening. A diagnosis of left eye acute anterior uveitis was made [23]. The United States Food and Drug Administration (FDA) initially reported that the observed frequency of reported Bells palsy in the vaccine group was consistent with the expected background rate in the general population, providing no clear basis to conclude a causal relationship.44,45 Ozonoff et al.32 commented that such reporting was misconceived. Renisi et al. To comprehensively identify the ocular manifestations of COVID-19 vaccination, we systematically searched three databases, including Embase, Medline (Ovid), and Cochrane Central for studies on related topics. Nature. 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