J. Med. Ravichandran S., Natarajan R. Corneal graft rejection after COVID-19 vaccination. 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. Goyal et al.28 described bilateral choroiditis in a 34-year-old male 9 days after the second dose of AZD1222. After 10 days, she developed ecchymoses, periorbital and lower extremity petechiae, and intermittent shortness of breath. It's a journey that Myra, who lives in Monterey, California . A review of the incidence of such conditions is timely and would be beneficial to ophthalmologists and general physicians alike, in identifying patients who may be at a higher risk of ocular adverse events so that protocols for close monitoring of patients at risk can be designed and implemented. Careers. 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. This inflammation can cause blood clots to form. COVID-19 Vaccine Side Effects and Vision - All About Vision government site. Four articles described corneal graft rejection soon after receiving a COVID-19 vaccination.25,34,36,43 Phylactou et al.34 reported two cases of allograft rejection following Descemets membrane endothelial keratoplasty (DMEK); both were female. Wolf et al. Painful or red eyes, headache, nausea, and vomiting. However, evidence has shown that during transcription, alternative splice events might cause the formation of C-terminally truncated, which may lead to formation of soluble spike protein. Ocular Manifestations after Receiving COVID-19 Vaccine: A - PubMed Bilateral Acute Macular Neuroretinopathy after Vaccination against SARS-CoV-2. Other possible causes of thrombosis include spike protein interactions with different C-type lectin receptors, heparan sulfate proteoglycans, and the CD147 receptor. He had right eye congestion and blurred vision three weeks after the first dose of the ChAdO1 COVID-19 vaccine. FDA's decision came one day after an agency panel of outside advisers supported the recipe change. A 66-year-old female who underwent DMEK of the right eye 21 days prior developed blurred vision seven days after the first dose of the vaccine. Helmchen et al. The platelet count ranged from 7000 to 113,000 platelets per cubic millimeter, and most cases were positive for PF4-heparin antibodies [48]. As Graves disease is known to involve orbits and/or ocular surface, we have included this two cases in this comprehensive review even though the reported cases did not had any ocular manifestations at time of presentation. 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. 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. Severe acute respiratory syndrome-coronavirus-2 spike (S) protein based vaccine candidates: State of the art and future prospects. reported a 33-year-old previously healthy female who developed progressive nasal field defect in her left eye and flashes in both eyes. Rare ocular side effects have been noted after COVID-19 vaccination Dias et al. IgG-ELISA for PF4-heparin complex antibodies was negative. For both DMEK cases, slit lamp examination and anterior segment optical coherence tomography (OCT) revealed moderate conjunctival injection, diffuse corneal oedema, and fine keratic precipitates limited to the donor endothelium with anterior chamber cells. Choi M, Seo MH, Choi KE, Lee S, Choi B, Yun C, Kim SW, Kim YY. The mRNA vaccine can increase free extracellular mRNA, which may increase the permeability of endothelial cells and cause choriocapillaris leakage. 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. In our literature review, there were eight patients with vascular thrombosis and related ocular manifestations. Infrared reflectance imaging showed bilateral circumscribed paracentral dark lesions that matched outer plexiform layer thickening and discontinuity of the ellipsoid band on OCT. A diagnosis of bilateral AMN was made. the contents by NLM or the National Institutes of Health. The patient presented with a right eye floater that rapidly progressed to severe visual loss within 12hours. Renisi G, Lombardi A, Stanzione M, Invernizzi A, Bandera A, Gori A. Anterior uveitis onset after bnt162b2 vaccination: is this just a coincidence? Schultz NH, Srvoll IH, Michelsen AE, et al. Ophthalmologists and generalists should be aware of the possible, albeit rare, ocular adverse effects after COVID-19 vaccination. reported a 71-year-old male with a history of endothelial decompensation after phacoemulsification and who underwent DMEK of the right eye for five months [15]. While facial nerve palsy is a reported adverse event in other vaccinations,32 such as influenza and meningococcal conjugate vaccinations, mRNA-based vaccines might follow a different immune mechanism. Left eye ciliary injection, corneal edema, Descemet folds, and keratic precipitates (KP) were noted, and corneal graft rejection was diagnosed. Panuveitis following vaccination for COVID-19, Reactivation of Vogt-Koyanagi-Harada disease under control for more than 6 years, following anti-SARS-CoV-2 vaccination, Characteristics of endothelial corneal transplant rejection following immunisation with SARS-CoV-2 messenger RNA vaccine. While generally safe and effective, in a fraction of subjects (perhaps genetically or otherwise predisposed), the administration of adjuvants can lead to an autoimmune or inflammatory syndrome.52 The adjuvants included in COVID-19 mRNA vaccines stimulate innate immunity through endosolic or cytoplasmic nucleic acid receptors.67 Several autoimmune diseases, particularly connective tissues diseases are associated with an altered nucleic acid metabolism and processing which may trigger an immune response following immunization.68,69. Any discrepancies were resolved via discussion until consensus was reached. On the other hand, 1 study was identified from websites, while another article was identified through a citation search. While their respective trial reports on vaccine safety have shown that ocular adverse effects are rare, the possible manifestations are still a cause for concern, given the scale of the current vaccination campaign against COVID-19. Currently, EMA has approved four vaccines that are protective against SARS-CoV-2 [1,2]. Uveitis as a predictor of predisposition to autoimmunity, Vaccines and multiple sclerosis: a systematic review, Taylor and Francis - PMC COVID-19 Collection, https://www.fda.gov/media/144416/download, https://www.fda.gov/media/144673/download, A case report of bilateral superior ophthalmic vein thrombosis post-vaccination, Conjunctival congestion, retroorbital pain, diplopia, A case report of acute macular neuroretinopathy (AMN) post-vaccination, A case report of Bilateral Acute Macular Neuroretinopathy post-vaccination, A case report of Bells Palsy post-vaccination, A case report of DMEK rejection post-vaccination, A case report of juvenile idiopathic arthritis-associated anterior uveitis post-vaccination, A case report of acute-onset central serous retinopathy (CSR) post-vaccination, A case report of bilateral multifocal choroiditis post-vaccination, Right eye floater that progressed gradually from the periphery toward the center, A case report of panuveitis post-vaccination, Reduction in visual acuity, ocular pain, red eye, photophobia, A case series of numerical imbalance in incidences of Bells palsy between vaccine and placebo arms during trials, A case report of reactivation of Vogt-Koyanagi-Harada disease post-vaccination, A case report of Descemet membrane endothelial keratoplasty (DMEK) patients with graft rejection post-vaccination, Multicentre, retrospective study describing vaccine-related uveitis and multiple evanescent white dot syndrome post-vaccination, A case report of PKP patient with graft rejection post-vaccination, A case report of anterior uveitis post-vaccination, A case report of Bells palsy post-vaccination. Nature. Fundus fluorescein angiography showed point leakage. Doctors still are learning about how the coronavirus affects the eyes. 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. and transmitted securely. 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. After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines. It's like having specks of dust or dirt stuck to the lens of a . Itching Discharge It's important to note that while eye symptoms have been reported in relation to positive COVID-19 cases, it is uncommon for it to be the only symptom. Initial findings showed thrombocytopenia of 18109/L and high D-dimer levels of 35712g/L. The mean duration between COVID-19 vaccination and onset of ocular symptoms was 14.0 (range 721) days. All symptoms resolved within 5days. Among 36,901 vaccine arm participants in combined data, there were seven Bells palsy cases (1:5272) compared with one Bells palsy case among placebo arm participants (1:36,938). Furthermore, there is heterogeneity in terms of investigations performed, affecting analysis of the cases. This review provides a comprehensive overview of COVID-19 vaccine-induced ocular adverse effects. The COVID-19 vaccines included in these studies are mRNA vaccines and adenoviral vector vaccines, both of which do not contain the spike protein. Goyal et al. and Y.H.H.) However, the overall benefits of the COVID-19 vaccine in preventing COVID-19 are well established. Mambretti M., Huemer J., Torregrossa G., Ullrich M., Findl O., Casalino G. Acute Macular Neuroretinopathy following Coronavirus Disease 2019 Vaccination. J Clin Med. We screened a total of 305 titles and abstracts for eligibility. In two patients, the visual symptoms lasted <24h. On optical coherence tomography (OCT), hyperreflectivity of the outer nuclear and plexiform layers was seen along with disruption of the ellipsoid zone. Before The relationship between adenoviral vector vaccines and all of the ocular symptoms mentioned should be further investigated. I did these treatments five days a week and have seen improvement. Sharifian-Dorche M, Bahmanyar M, Sharifian-Dorche A, Mohammadi P, Nomovi M, Mowla A. Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID-19 vaccination; a systematic review. Those eligible for the RSV vaccine should talk with their . The central corneal thickness was 660 m and 622 m in the right and left eyes, respectively. An mRNA Vaccine against SARS-CoV-2Preliminary Report. COVID-19 Vaccine and Your Eyes - Healthline Collela et al.24 and Repajic et al.38 provided detailed expositions of the signs and symptoms that led to a diagnosis of Bells palsy in COVID-19 BNT162b2 vaccine recipients. 2023 Jul;261(7):1771-1780. doi: 10.1007/s00417-022-05954-6. He developed blurred vision and metamorphopsia in his right eye 69 h after receiving the BNT162b2 COVID-19 vaccine. Y.-K.L. These soluble spike variants may induce thrombotic events via an antibody-mediated mechanism when binding to ACE2-expressing endothelial cells in blood vessels [41,45]. Two of the PKP rejections manifested 13 to 14days after receiving the first dose43 of the vaccine, while the third occurred after 21days, also from the first dose.36, Regarding corneal graft rejection, any systemic immune dysregulation may compromise corneal ocular immune privilege and increase the patients susceptibility for rejection.59There is a report about acute corneal endothelial graft rejection with coinciding COVID-19 infection.60 Inflammation in COVID-19 patients is characterized by increased tumor necrosis factor (TNF) and interleukin-6 (IL-6) production.61 Cells of the innate immune system can invade the cornea and result in the up regulation of cytokines (including TNF, chemokines) and other pro-inflammatory molecules, which can result in rejection of the corneal transplants. Furthermore, the expressed spike antigen in the circulation can directly cause disturbance in vascular endothelial cells or induce a proinflammatory and procoagulant response, which leads to AMN. BCVA improved to 20/25 with a clear cornea one week later. Cunningham E.T., Jr., Moorthy R.S., Fraunfelder F.W., Zierhut M. Vaccine-Associated Uveitis. 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]. In conclusion, although ocular manifestations may develop after receiving the COVID-19 vaccine, people are still encouraged to get vaccinated since the benefits outweigh the risks. Vaccinations in the autoimmune population decreases the burden of infection. Seventeen days after vaccination, she suddenly lost consciousness, and thrombocytopenia was noted. Epub 2022 Oct 14. NEW YORK (AP) The next round of COVID-19 vaccines will target one of the latest versions of the coronavirus, the Food and Drug Administration said Friday. The patient's fundus examination revealed a dot hemorrhage superior to the fovea (A). Side effects of BNT162b2 mRNA COVID-19 vaccine: A randomized, cross-sectional study with detailed self-reported symptoms from healthcare workers. 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. -, Jackson L.A., Anderson E.J., Rouphael N.G., Roberts P.C., Makhene M., Coler R.N., McCullough M.P., Chappell J.D., Denison M.R., Stevens L.J., et al. aNational Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, bYong Loo Lin School of Medicine, National University of Singapore, Singapore, cMoorfields Eye Hospital, NHS Foundation Trust, London, UK, dCentre of Ophthalmology, University of Tuebingen, Tuebingen, Germany, eDepartment of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore, fSingapore Eye Research Institute, The Academia, Singapore, gDepartment of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, hDepartment of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India, iMicroInvasive Ocular Surgery Clinic, Lausanne, Switzerland, jDepartment of Ophthalmology, University of Leiden, Leiden, The Netherlands, kLee Kong Chian School of Medicine, Nanyang Technological University, Singapore. reported that a 23-year-old male who had no significant medical history developed ocular symptoms after receiving the BNT162b2 vaccine. 2021 Dec;69(12):3398-3420. doi: 10.4103/ijo.IJO_2824_21. 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). Ravichandran et al. The reviewed studies raised our concern for the ocular manifestations after COVID-19 vaccination. Available online: Al Khames Aga Q.A., Alkhaffaf W.H., Hatem T.H., Nassir K.F., Batineh Y., Dahham A.T., Shaban D., Al Khames Aga L.A., Agha M.Y.R., Traqchi M. Safety of COVID-19 vaccines. Mudie LI, Zick JD, Dacey MS, Palestine AG. Ischemic retinal events after COVID-19 vaccination A systemic search was performed on 22 August 2021 through Embase, Medline, and Cochrane Library for publications on ocular manifestations after COVID-19 vaccination. Bhler A.D., Strm M.E., Sandvig K.U., Moe M.C., Jrstad .K. Moher D., Liberati A., Tetzlaff J., Altman D.G. Both received a dose of the BNT162b2 vaccine and reported symptoms 23days after. PRISMA flow diagram of the articles analyzed. Identification of estrogen and progesterone receptor mRNA expression in the conjunctiva of premenopausal women. Biomolecules. Y.-K.L. After adjustment for pre-existing immune- or inflammatory-related disorders, diabetes, and a previous episode of peripheral nerve palsy, odds ratio (OR) for exposure to the vaccine among cases was insignificant at 0.84 (95%CI 0.371.90, p-value=0.67). Rejections were also reported following three penetrating keratoplasty (PKP) cases36,43; all three were male; 1 case had a previous re-graft. This patient had a history of 3 episodes of Bells palsy, A case report of isolated abducens nerve palsy post-vaccination, A case report of possible uveitis post-vaccination, Reduction in visual acuity, visual distortion, A case-control study of association between facial nerve palsy between vaccinated and unvaccinated groups, A case report of Graves disease activation post-vaccination, A case report of penetrating keratoplasty (PKP) patients with graft rejection post-vaccination, Blurred vision, ocular discomfort, red eye. There was a 3+ afferent pupillary defect in the right eye. However, the relative rarity of AMN and the temporal association between the vaccine administration and the onset of the disease should be taken into consideration. Funduscopic examination and autoimmune or infection lab screening did not reveal any alterations. COVID Can Cause Strange Eye and Ear Symptoms Macular degeneration. Federal government websites often end in .gov or .mil. Of special interest in this time of epidemic is the safety of COVID-19 . Vaccines (Basel). and Y.-H.H., who participated in management and interpretation of the data. 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]. 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). 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. Updated Covid vaccines need to target XBB omicron variants this fall, FDA staff says . [(accessed on 21 September 2021)]. Quality rating of the studies was ranked according to Quality Rating Scheme for Studies and Other Evidence [8] and Oxford Centre for Evidence-based Medicine for ratings of individual studies [9]. UT Southwestern facilities are safer than ever, and patients can feel confident in returning for ophthalmology care. . The .gov means its official. However, she was also diagnosed with asymptomatic COVID-19 shortly after the onset of ocular symptoms [24]. 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. Federal government websites often end in .gov or .mil. Jerusalem Post Health & Wellness Pfizer COVID-19 vaccine linked to rare cases of eye inflammation - study Twenty-one people developed anterior uveitis and two developed Multiple Evanescent. Furer V., Zisman D., Kibari A., Rimar D., Paran Y., Elkayam O. National Library of Medicine Blauenfeldt R.A., Kristensen S.R., Ernstsen S.L., Kristensen C.C.H., Simonsen C.Z., Hvas A.M. Thrombocytopenia with acute ischemic stroke and bleeding in a patient newly vaccinated with an adenoviral vector-based COVID-19 vaccine. Ocular Manifestations after Receiving COVID-19 Vaccine: A Systematic Review The coronavirus disease 2019 (COVID-19) pandemic has had profound and lasting consequences since 2019. The mean age of the patients was 59.3 (range 4079) years old. reported that a 40-year-old female taking infliximab for VKH disease for six years had reactivation six weeks after the second dose of BNT162b2 COVID-19 vaccine. MacIntyre C.R., Veness B., Berger D., Hamad N., Bari N. Thrombosis with Thrombocytopenia Syndrome (TTS) following AstraZeneca ChAdOx1 nCoV-19 (AZD1222) COVID-19 vaccinationA risk-benefit analysis for people <60 years in Australia. U.S. Food & Drug AdministrationCOVID-19 Vaccines. Spinal MRI revealed myelitis at Th710, while aquaporin-4 (AQP4) was negative in serum and cerebrospinal fluid. Pandemic's impact on patients' eye health comes into focus He also developed light confusion, asthenia, and profound nausea [39]. Included studies were categorized in this study and divided based on the involved part of the eye. We also searched the references of the included studies for more relevant articles. There may thus be a role for further workup for more widespread inflammatory disease in individuals who develop ocular inflammatory events following COVID vaccination. Haseeb AA, Solyman O, Abushanab MM, Abo Obaia AS, Elhusseiny AM. The mean age of these patients was 24.7 (range 2033) years old. A diagnosis of bilateral simultaneous acute endothelial graft rejection was made. The https:// ensures that you are connecting to the OCT on both eyes showed a segmented and disrupted ellipsoid zone in the right eye and a very thin ellipsoid zone in the left eye. The patients characteristics were reviewed in five articles. Fundoscopy of the left eye revealed a delicate teardrop-shaped macular lesion located nasally with respect to the fovea. The mean age of the patients was 35.2 (range 2343) years old. In a case series study, Mazzatenta et al.
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