Optic Neuropathy after COVID-19 Vaccination: Case Report and Systematic Review

Abstract Purpose: To report a case of anterior ischemic optic neuropathy (AION) following COVID-19 vaccination and provide a systematic review of all published cases of optic neuropathy following COVID-19 vaccination. Methods: A systematic literature search was performed using PubMed and Ovid MEDLINE for cases of optic neuropathy following COVID-19 vaccination. Terms used in the search included “COVID-19 vaccination”, “optic neuropathy”, “optic neuritis”, and “ischemic optic neuropathy”. Titles and abstracts were initially screened then full texts of eligible studies were reviewed for data extraction. Only cases published in the English language, peer reviewed, and that included details on optic nerve involvement were included. All study types were eligible for inclusion. Results: Including our patient, a total of 10 patients (8 females) were identified as developing optic neuropathy following COVID-19 vaccination. Five patients (50.0%) were diagnosed with AION, while 4 (40.0%) were diagnosed with optic neuritis. One patient was diagnosed with papillitis and neuroretinitis. Three patients (30.0%) had bilateral involvement. Mean age of patients was 48.5±19.7 years. Mean time from vaccination to onset of ophthalmic symptoms was 6.5±6.4 days. Mean presenting visual acuity was logMAR 0.598±0.621 (20/79, Snellen). For the 8 eyes which had both presenting and final follow-up visual acuity, mean presenting vision was logMAR 0.369±0.420 (20/47) and at final follow-up was 0.114±0.261 (20/26; P=0.184). Conclusion: COVID-19 vaccination may result in optic neuropathy in the form of optic neuritis and ischemic optic neuropathy. Further studies are needed to determine the incidence, management, and prognosis of optic neuropathies associated with COVID-19 vaccination.