Ayman G Elnahry1, Zainab B Asal2, Noreen Shaikh3,4, Kate Dennett3,5, Mai N Abd Elmohsen1, Gehad A Elnahry1,6, Azza Shehab7, Michal Vytopil8,9, Leila Ghaffari8,9, Geetha K Athappilly3,5, David J Ramsey3,5. 1. Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt. 2. Department of Clinical Nutrition, Children Cancer Hospital, Cairo, Egypt. 3. Department of Ophthalmology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Peabody, MA, USA. 4. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 5. Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA. 6. Department of Ophthalmology, Armed Forces College of Medicine, Cairo, Egypt. 7. Department of Ophthalmology, Faculty of Medicine, Minya University, Minya, Egypt. 8. Department of Neurology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA, USA. 9. Department of Neurology, Tufts University School of Medicine, Boston, MA, USA.
Abstract
PURPOSE: We report two cases of optic nerve pathology after the administration of the Pfizer-BioNTech and AstraZeneca-Oxford COVID-19 vaccines, respectively, and describe the implications for management of post-vaccination central nervous system (CNS) inflammation. CASE REPORTS: A 69-year-old woman presented with bilateral optic nerve head oedema, 16 days after the second dose of the Pfizer-BioNTech vaccine. She was diagnosed with post-vaccination CNS inflammatory syndrome and was treated for five days with intravenous methylprednisolone at a dose of 1 gram per day. Her optic disc swelling improved, and her vision stabilised. A 32-year-old woman presented six days after her first dose of the AstraZeneca-Oxford vaccine with two days of sudden onset of progressive blurring of vision in her left eye. Posterior segment examination revealed left optic disc swelling, and an MRI of the brain, orbit, and cervical spine was significant for left optic nerve enhancement. The patient was diagnosed with a unilateral post-vaccination optic neuritis. She was treated with a three-day course of intravenous methylprednisolone followed by oral prednisone. Her optic disc swelling and visual field improved, and she recovered 6/6 vision. CONCLUSIONS: Clinicians and patients should be aware of the potential for post-vaccination CNS inflammatory syndromes associated with COVID-19 vaccine administration. Neuroimaging and cerebrospinal fluid analysis may aid in the diagnosis of the cause of vision loss. Further studies are needed to evaluate the spectrum and frequency of optic nerve involvement associated with COVID-19 vaccination.
PURPOSE: We report two cases of optic nerve pathology after the administration of the Pfizer-BioNTech and AstraZeneca-Oxford COVID-19 vaccines, respectively, and describe the implications for management of post-vaccination central nervous system (CNS) inflammation. CASE REPORTS: A 69-year-old woman presented with bilateral optic nerve head oedema, 16 days after the second dose of the Pfizer-BioNTech vaccine. She was diagnosed with post-vaccination CNS inflammatory syndrome and was treated for five days with intravenous methylprednisolone at a dose of 1 gram per day. Her optic disc swelling improved, and her vision stabilised. A 32-year-old woman presented six days after her first dose of the AstraZeneca-Oxford vaccine with two days of sudden onset of progressive blurring of vision in her left eye. Posterior segment examination revealed left optic disc swelling, and an MRI of the brain, orbit, and cervical spine was significant for left optic nerve enhancement. The patient was diagnosed with a unilateral post-vaccination optic neuritis. She was treated with a three-day course of intravenous methylprednisolone followed by oral prednisone. Her optic disc swelling and visual field improved, and she recovered 6/6 vision. CONCLUSIONS: Clinicians and patients should be aware of the potential for post-vaccination CNS inflammatory syndromes associated with COVID-19 vaccine administration. Neuroimaging and cerebrospinal fluid analysis may aid in the diagnosis of the cause of vision loss. Further studies are needed to evaluate the spectrum and frequency of optic nerve involvement associated with COVID-19 vaccination.
Entities:
Keywords:
COVID-19 vaccine; Central nervous system; neuroinflammation; optic neuropathy