2022 Top Story in Eye Care: Effects of COVID-19 Vaccination on the Eye

The eye care story I would like to highlight for 2022 is "COVID-19 Vaccination and the Eye," which was published in the American Journal of Ophthalmology.¹ The authors report on the ocular side effects of the COVID-19 vaccination based on a literature review and a population-based surveillance system. I chose this story because, even though the COVID-19 pandemic started in December 2019, 3 years ago, it is still a threat to our health worldwide. We have several approved vaccines available to prevent severe COVID-19 infections, and acute myocarditis, cerebral venous thrombosis, and thrombocytopenia have been reported as rare, severe adverse effects associated with the vaccines.2,3 There are, however, limited data on the ocular side effects. 

The literature review performed by Wang et al used four electronic databases: MEDLINE, EMBASE, PubMed, and the Cochrane Database of Systemic Reviews. The World Health Organization Programme for International Drug Monitoring public online databases were used for the population-based surveillance.

The most common COVID-19–associated ocular side effect was uveitis. The onset of symptoms was seen within 30 days of vaccine administration in the majority of affected individuals. Some of these patients had no previous history of uveitis or autoimmune diseases. The majority of the patients presented with only anterior uveitis. Other types of uveitis reported were multiple evanescent white dot syndrome (MEWDS), intermediate uveitis, multifocal choroiditis, panuveitis, scleritis, and Vogt-Koyanagi-Harada disease reactivation. The ocular inflammation was treated with topical, intravitreal, or systemic steroids, with complete resolution in patients with reported follow-up. MEWDS resolved with conservative treatment. Other reported side effects were herpes zoster ophthalmicus (3 patients) and herpes simplex stromal keratitis (1 patient), which were reported within 1 week of COVID-19 immunization. Corneal graft rejection was reported in 7 patients. Retinal disorders reported after COVID -19 vaccination included acute macular neuroretinopathy (6 patients), acute zonal occult outer retinopathy (1 patient), and suspected central serous chorioretinopathy (1 patient), which were reported within 15 days of immunization. There have been a few reported patients with COVID-19 vaccine–associated optic neuropathies: 2 patients with optic neuritis and 1 patient with bilateral anterior ischemic optic neuropathy. Other neuropathies reported to the ophthalmologist included Bell’s palsy (6 patients) and abducens nerve palsy (1 patient). Similar to systemic thrombotic events, there have been 2 reported patients with superior ophthalmic vein thrombosis associated with thrombotic thrombocytopenia.

Only a few reported patients had ocular adverse events associated with the COVID-19 vaccination. Vaccine-associated uveitis⁴ and other ocular effects have been previously reported with other vaccines; therefore, the occurrence of ocular conditions following COVID-19 vaccination is not unexpected. The associations represent a temporal relationship to vaccine administration and do not represent direct cause and effect. Some of the associations occurred in patients with no prior disease. In other patients, the presentation represents the reactivation of an inactive disease. The overall risk is low, and the majority of patients had a complete resolution to baseline with appropriate treatment. The possibility of experiencing these rare side effects is not a contraindication for receiving the COVID-19 vaccine. Patients should be counseled about the potential very low risk of ocular effects. Physicians should encourage patients to report ocular symptoms and decreased vision after vaccine administration.