PROGRESSIVE IMMUNOLOGICAL OCULAR INFLAMMATION POST COVID-19 RELATED INFECTION: FIRST REPORTED CASE

To present a challenging case of nodular episcleritis with crystalline keratopathy which progressed to develop Corneal melt (Peripheral Ulcerative Keratitis; PUK) in a patient after contracting COVID-19 Infection.

Corneal and external disease services, Department of Ophthalmology, University Hospital Coventry and Warwickshire, Coventry, United Kingdom

Retrospective Case report

A 55-year-old female presented to eye casualty with sectoral congestion of her left eye with mild discomfort. She also complained of photophobia, and normal vision. Detailed past medical history did not give any medical history nor did she have any past ocular history to report. Her best corrected distance visual acuities were 0.0 LogMAR in both eyes. Ocular examination revealed a healthy looking right eye. The left eye had signs of nodular sectoral Episcleritis with crystalline keratopathy in the deeper stromal layers of the nasal peripheral cornea. No anterior chamber inflammation was seen, but her intraocular pressures were asymmetrically raised between both eyes (right – 16mm Hg and left – 25mmHg on Goldmann applanation tonometry [GAT]). She was treated with topical steroids and anti-glaucoma therapy, which initially controlled the Episcleritis signs, but then started to develop frequent recurrence as soon inspite on topical therapy. Her crystalline keratopathy would lead to stromal oedema and increase in haze during the recurrences. She was investigated multiple times for COVID via blood test and RT-PCR of the tear samples from both her eyes which came back to be negative. Immunological testing was found to be completely normal.

 

From the time of presentation in Feb 2021, over a period of 6 months the episcleritis progressed to scleritis and PUK with nasal corneal thinning and overlying epithelial defect. Infectious and vasculitic causes were excluded with help from the rheumatological team. Eventually she was then started on oral prednisolone (1mg/kg BW) and put on a very slow tapering course. This resulted in disease control and brought the patient into remission and recovery with stabilisation of disease. At the time of this abstract patient is on low dose Oral Prednisolone 5mg once a day with no recurrence, with an aim to stop steroids completely in 4 weeks over a further tapering course.

This is the first case to report a moderately severe ocular inflammatory process being triggered post COVID infection. Till date we have not been able to establish positive COVID antibodies or COVID from blood or tear samples. But it cannot be just a co-incidence that she started to develop ocular inflammation within 2 weeks of developing a confirmed COVID-19 Infection. We would like to highlight this case so that Ophthalmic community are aware of occurrence of ocular Inflammation as a side effect of COVID -19 infection and treat them accordingly.