1Eye Clinic, Clinical Center of Montenegro and Medical Faculty, University of Montenegro, Podgorica, Montenegro
2Eye Clinic, Clinical Center of Serbia, Belgrade, Serbia
3Eye Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
4Private Eye Clinic ‘Dr Lutovac’, Berane, Montenegro
5School of Medicine, University of Montenegro, Podgorica, Montenegro
Coronavirus disease 2019 (COVID-19) causes ocular manifestations in approximately 11% of patients. Most patients typically develop ocular symptoms within 30 days of the onset of the first COVID-19 symptoms. The most common ocular manifestation is conjunctivitis, which affects nearly 89% of patients with eye problems. Other much less common anterior segment abnormalities caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are scleritis, episcleritis, and acute anterior uveitis. Posterior segment abnormalities caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Herein, we report a rare manifestation of COVID-19 and multiple evanescent white dot syndrome (MEWDS) of the retina. In April 2021, a 40-year-old female patient was admitted to the Eye Clinic of Clinical Center of Montenegro (Podgorica, Montenegro). The patient’s main complaint was sudden vision impairment, which occurred 14 days after a positive polymerase chain reaction (PCR) test result for SARS-CoV-2 infection. A complete eye examination was performed, followed by fundoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA) tests. The results showed retinal changes associated with MEWDS. The patient underwent additional examinations to rule out common causes of multifocal retinitis, all of which were unremarkable. Therefore, it was concluded that retinitis was a complication of COVID-19. Given its non-invasive nature, fundus examination should be used as a standard screening method for retinal changes in patients with COVID-19.
Feng Y, Park J, Zhou Y, Armenti ST, Musch DC, Mian SI. Ocular Manifestations of Hospitalized COVID-19 Patients in a Tertiary Care Academic Medical Center in the United States: A Cross-Sectional Study. Clin Ophthalmol. 2021;15:1551-6. doi: 10.2147/OPTH.S301040. PubMed PMID: 33880013; PubMed Central PMCID: PMCPMC8053508.
Guemes-Villahoz N, Burgos-Blasco B, Garcia-Feijoo J, Saenz-Frances F, Arriola-Villalobos P, Martinez-de-la-Casa JM, et al. Conjunctivitis in COVID-19 patients: frequency and clinical presentation. Graefes Arch Clin Exp Ophthalmol. 2020;258:2501-7. doi: 10.1007/s00417-020-04916-0. PubMed PMID: 32860573; PubMed Central PMCID: PMCPMC7455778.
Hu K, Patel J, Swiston C, Patel BC. Ophthalmic Manifestations Of Coronavirus (COVID-19). Treasure Island (FL): StatPearls; 2022.
Invernizzi A, Torre A, Parrulli S, Zicarelli F, Schiuma M, Colombo V, et al. Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. EClinicalMedicine. 2020;27:100550. doi: 10.1016/j.eclinm.2020.100550. PubMed PMID: 32984785; PubMed Central PMCID: PMCPMC7502280.
Zicarelli F, Mantovani A, Preziosa C, Staurenghi G. Multimodal Imaging of Multiple Evanescent White Dot Syndrome: A New Interpretation. Ocul Immunol Inflamm. 2020;28:814-20. doi: 10.1080/09273948.2019.1635169. PubMed PMID: 31414928.
Papasavvas I, Mantovani A, Tugal-Tutkun I, Herbort CP, Jr. Multiple evanescent white dot syndrome (MEWDS): update on practical appraisal, diagnosis and clinicopathology; a review and an alternative comprehensive perspective. J Ophthalmic Inflamm Infect. 2021;11:45. doi: 10.1186/s12348-021-00279-7. PubMed PMID: 34921620; PubMed Central PMCID: PMCPMC8684571.
Abu-Yaghi NE, Hartono SP, Hodge DO, Pulido JS, Bakri SJ. White dot syndromes: a 20-year study of incidence, clinical features, and outcomes. Ocul Immunol Inflamm. 2011;19:426-30. doi: 10.3109/09273948.2011.624287. PubMed PMID: 22106911; PubMed Central PMCID: PMCPMC3346947.
Rousseau A, Fenolland JR, Labetoulle M. [SARS-CoV-2, COVID-19 and the eye: An update on published data]. J Fr Ophtalmol. 2020;43:642-52. doi: 10.1016/j.jfo.2020.05.003. PubMed PMID: 32631687; PubMed Central PMCID: PMCPMC7260525.
Ostergaard L. SARS CoV-2 related microvascular damage and symptoms during and after COVID-19: Consequences of capillary transit-time changes, tissue hypoxia and inflammation. Physiol Rep. 2021;9:e14726. doi: 10.14814/phy2.14726. PubMed PMID: 33523608; PubMed Central PMCID: PMCPMC7849453.
Tavallali A, Yannuzzi LA. MEWDS, Common Cold of the Retina. J Ophthalmic Vis Res. 2017;12:132-4. doi: 10.4103/jovr.jovr_241_16. PubMed PMID: 28540002; PubMed Central PMCID: PMCPMC5423364.
Pellegrini M, Veronese C, Bernabei F, Lupidi M, Cerquaglia A, Invernizzi A, et al. Choroidal Vascular Changes in Multiple Evanescent White Dot Syndrome. Ocul Immunol Inflamm. 2021;29:340-5. doi: 10.1080/09273948.2019.1678650. PubMed PMID: 31697565.