Optic nerve pathology after Pfizer and AstraZeneca vaccines
This article describes the cases of two patients who presented with optic nerve pathology after the administration of the Pfizer-BioNtech and AstraZeneca-Oxford vaccines for COVID19. In addition to the implication for the management of post-vaccine CNS inflammation.
First Case Report – CNS Inflammatory Syndrome
The first case is of a 69-year-old female who presented to the ER with bilateral optic nerve head oedema. The symptoms started sixteen days after she got her second dose of the Pfizer-BioNTech vaccine. The doctors diagnosed her with CNS inflammatory syndrome post-vaccination. They treated her with 1 gram IV methylprednisolone per day. Furthermore, her optic disc swelling showed improvement and her vision stabilized after the treatment.
Second Case Report – Optic Nerve Enhancement
The second case is of a 32-year-old female who presented to the ER with sudden onset of blurred vision in her left eye, six days after getting the first dose of AstraZeneca-Oxford. Moreover, the blurring of the vision was progressive. Doctors examined her posterior segment, which revealed swelling in the left optic disc. They also did an MRI of the brain, spine, and orbit. The results were significant for optic nerve enhancement.
Doctors made a diagnosis of unilateral post-vaccination optic neuritis. They treated her with intravenous methylprednisolone for three days. Furthermore, it was followed by oral prednisone. As a result, the swelling in her optic disc resolved and her visual field improved. Her 6/6 vision recovered.
Conclusion
Doctors and patients should be knowing of the potential risks of CNS inflammatory syndromes after the administration of the COVID19 vaccination. Furthermore, neuroimaging and analysis of the cerebrospinal fluid can aid in diagnosing the cause of vision loss. However, more studies are needed for the evaluation of the spectrum, in addition to the frequency of the involvement of the optic nerve in association with the COVID19 vaccination.
