Grusiga ögon covid
Since December , coronavirus disease (COVID) has become a global pandemic caused by the highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] Initially, there were several reports of eye redness and irritation in COVID patients, both anecdotal and published, supporting conjunctivitis as an ocular manifestation of SARS-CoV-2 infection. Reports. All content on Eyewiki is protected by copyright law and the Terms of Service.
This content may not be reproduced, copied, or put into any artificial intelligence program, including large language and generative AI models, without permission from the Academy. Advancements in the understanding of disease pathogenesis enabled the creation of novel treatments and vaccinations. Although the COVID burden has slowly decreased, many countries remain concerned due to outbreaks of new variants of the disease [1] [2].
COVID usually presents with fever, cough, and shortness of breath, with a range of presentations from asymptomatic to multiorgan failure and death. The infection is not purely a respiratory and can result in coagulopathies, acute kidney injury, neurological injury, and cardiac arrest. Of importance, multiple neuro-ophthalmic presentations of COVID have been described in the literature [3]. To date, COVID has spread to over countries causing over million confirmed cases since it was declared a pandemic.
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The omicron variant remains a major concern for over countries per a recent report from the WHO. The United States is the country with the highest number of reported infections and deaths caused by the disease. COVIDrelated deaths were the third most common cause of death in following heart disease and cancer. Those that were at the highest risk of severe infection were above the age of 60 and had underlying medical comorbidities [1].
It is responsible for close to 7 million deaths, according to The WHO. The SARS-CoV-2 virus has multiple structural proteins, of which the spike S protein is of fundamental importance in disease transmission. This S protein facilitates viral entry into host cells by binding the angiotensin-converting enzyme 2 ACE2 receptors. These receptors are abundant in the respiratory epithelium allowing for the respiratory infection.
After infection, SARS-CoV-2 replication results in direct virus mediated damage followed by inflammation and over secretion of cytokines caused by immune activation of monocytes, neutrophils, and T lymphocytes. Severe COVID infections might result in a cytokine storm resulting in increased local and systemic inflammation with the development of pulmonary edema with increased vascular permeability. While the respiratory system is the primary target of SARS-CoV-2, other organs that could be impacted include the kidneys, cardiovascular system, hepatobiliary system, gastrointestinal system, and central nervous system.
This is due to the presence of ACE2 receptors in a variety of organs, including the esophagus, cardiac cells, bladder urothelial cells, kidney proximal tubular cells, and the brain [1] [5]. The virus can access the brain by spreading to the olfactory nerves, the meninges, choroid plexus, or through hematogenous route. Abnormal immune activation could also contribute to the neuronal disturbances observed in patients with COVID as pro-inflammatory cytokines can cause damage and the virus can potentially stimulate abnormal auto-antibody production [5].
The ACE-2 receptor is expressed in neurons and glial cells. The neuro-ophthalmic presentations of COVID may concur with systemic and pulmonary symptoms, or days to weeks after disease resolution [6].
4 Ways COVID Leaves Its Mark on the Eye
The sensitivity is imperfect and therefore diagnosis should also be guided by clinical data and epidemiological history. Serological tests that detect the humoral response against SARS-CoV-2 are recommended from the second week of infection and onwards. These tests detect antibodies directed against virus proteins [7]. Significant progress in disease management has been made in understanding and management of COVID, with the rapid development of vaccines and therapeutics.
The therapeutic options currently available include anti-SARS-CoV-2 monoclonal antibodies, antiviral drugs, immunomodulator agents, and corticosteroids. The most prevalent neuro-ophthalmic manifestations of COVID infection include ocular pain and headache. The mechanism of developing headaches and ocular pain in COVID infection is not clear, but it postulated that activation of the trigeminal neve by vasculopathy or viral insult, hypoxia, or increased inflammatory cytokines are responsible for these symptoms [6].
One case of optic neuritis was described in the recovery phase of the infection. It was presumed that the infection triggered the production of autoimmune antibodies [3] [5]. There have been reported cases of cerebrovascular ischemia caused by COVID infection with infarction of the optic nerve after occlusion of the internal carotid artery, central retinal artery, and ophthalmic artery. COVID has been linked to damage to the third, fourth, sixth, and seventh cranial nerves.
These manifestations can arise on their own or in conjunction with other disorders such as Miller Fisher syndrome, myasthenia gravis, and elevated intracranial pressure [6].
Symptoms of ocular motor abnormalities such as ptosis and diplopia have been reported in COVID individuals from the onset of typical symptoms to days later [8]. A case study also described the onset of myasthenia gravis in COVID patients with positive cholinergic receptor antibodies [11]. Nystagmus has been described with COVID associated benign paroxysmal positional vertigo, acute labyrinthitis, and encephalitis. Following severe systemic COVID infection, immune-mediated encephalitis can also result in oscillopsia with ataxia and myoclonus [12] or opsoclonus myoclonus ataxia syndrome [13].
COVID infection can result in a pro-inflammatory and hypercoagulable condition, which can lead to disorientation, increased intracranial pressure, papilledema, and a false localizing sixth nerve palsy after cerebral venous sinus thrombosis [14] [15]. Children infected with COVID can develop a multisystem inflammatory disease, which can lead to pseudotumor cerebri [16]. Infection with COVID increases stroke risk which can cause visual defects if the posterior circulation and visual pathways are affected [17].
There are several cases linking COVID infection with posterior reversible vasoconstriction syndrome PRES , which can cause patients to develop visual field defects [18]. Tonic Adie pupil has been associated with COVID infection in one case, also with inflammatory multifocal choroiditis and trochlear nerve palsy, thought to be a result of immune-mediated injury and not direct viral neuronal injury [6].