COVID-19 Associated Central Retinal Vein Occlusion

Central retinal vein occlusion
Fundus photographs and optical coherence tomography (OCT) images of the left eye of a patient with central retinal vein occlusion (CRVO) associated with COVID-19 infection. (A) Optomap, Daytona image of the left eye showing multiple retinal haemorrhages spread in all four quadrants of the fundus with optic disc hyperaemia and dilated retinal vessels suggestive of CRVO. (B) OCT image of the left eye at presentation showing cystoid macular oedema, shallow neurosensory detachment and intact outer retinal layers. (C) Colour fundus image of the left eye at 1-month presentation showing reduction of the retinal haemorrhages. (D) OCT image of the left eye at 1-month follow-up visit showing resolution of the macular oedema.

Central retinal vein occlusion, a secondary manifestation of COVID-19

Retinal findings associated with SARS-CoV-infection are because of activated thrombotic microangiopathy and hypercoagulable state, leading to retinal artery and venous occlusions. Although, there is not enough literature on vein occlusion associated with COVID-19. This article describes a case of central retinal vein occlusion and macular oedema, secondary to COVID-19 infection. The case is of a 56-year-old healthcare professional who was working at a COVID-19 hospital in South India. She presented to a tertiary eye care hospital with complaints of a 1-month history of decreased vision in her left eye.

Her medical history revealed that she was diagnosed with diabetes 5 years ago and was prescribed oral hypogylcaemic agents. Examination of the right eye showed best-corrected visual acuity of 6/6, N6 (+2.00 DS), whereas in the left eye of 6/18, N10 (+1.75 DS). Her blood pressure on the day of presentation was 124/82 mm Hg. Other examinations including intraocular pressure in both eyes, anterior segment examination and pupillary reaction were all within normal limits. Fundus examination of the right eye was within normal limits. On the contrary, the left eye showed scattered retinal haemorrhages and a few microaneurysms in all four retinal quadrants. Other findings included: dilated retinal vessels and hyperaemic discs. The findings were consistent with non-ischaemic CRVO and macular oedema and coexistent mild stage of non-proliferative diabetic retinopathy.

Investigation findings showed a cystoid macular oedema with intact outer retinal layers and shallow neurosensory detachment

Doctors further advised a spectral domain coherence tomography using Spectralis machine. The findings showed a cystoid macular oedema with intact outer retinal layers and shallow neurosensory detachment. Considering the fact that she presented to the hospital during an ongoing pandemic, she was also tested for COVID-19 antibodies. Her test results were positive for SARS-CoV-2 IgG and negative for IgM. PCR testing was not required because she was not ill enough for hospital admission. Based on the initial findings, doctors diagnosed the patient with retinal vein occlusion associated with COVID-19. She was started on low-dose aspirin and advised intravitreal anti-VEGF therapy.

A month later the patient’s visual acuity showed significant improvement without having undergone intravitreal anti-VEGF therapy. Optical coherence tomography showed a complete resolution of macular oedema. Doctors put her on low-dose tablet aspirin 150 mg and was called for a follow up after 3 months.


COVID-19-associated central retinal vein occlusion treated with oral aspirin

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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