Optic neuropathy after COVID-19 vaccination: a report of two cases

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.

Keywords:

• Central nervous system
• COVID-19 vaccine
• neuroinflammation
• optic neuropathy

Acknowledgements

We thank each patient and acknowledge the support of all those who helped them to complete the necessary work-up and evaluations, as well as Dr. Shiyoung Roh, Dr. Derek O’Hagan, Dr. Kathryn Moynihan Ramsey, Timothy Tivnan, and Carol Spencer, Lahey Hospital Librarian, for research support. D.J. Ramsey is the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health.

Authors’ contributions

AGE, GKA, and DJR conceived the study and wrote the manuscript. ZBA, NS, KD, MNAE, GAE, AS, MV, LG collected the clinical data. All authors read and approved the manuscript.

Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study. No data are available.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics statement

The institutional review boards of Lahey Hospital and Medical Center and of Cairo University declared the study exempt from review by virtue of being a retrospective report of two cases. Both patients signed a written informed consent to publish this information.

Additional information

Funding

DJR: Supported by the Harry N. Lee Family Chair in Innovation, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Peabody, MA.