Radiology Insights into COVID-19 Ocular Abnormalities

Article: COVID-19 Linked to Potentially Dangerous Eye Abnormalities
Source: Radiological Society of North America
Published: February 16, 2021

MRI showing several hyperintense nodules of the posterior pole
of the globe, located in the macular region (white arrowhead)
and extramacular region (black arrowhead), as well as
focal temporal retinal detachment of the left eye (arrow)

The COVID-19 pandemic has affected the entire globe since its onset in early 2020, including impact in all specialties of healthcare. Within ophthalmology, SARS-CoV-2 has been linked with ocular complications from conjunctivitis to retinopathy. Insight from radiology provides additional clues of ocular abnormalities in individuals with severe COVID-19. A study by researchers at the French Society of Neuroradiology (SFNR), from a sample of 129 patients with severe COVID-19 who underwent brain MRI, found that nine of those patients, eight of whom had spent time in the intensive care unit (ICU) for COVID-19, had abnormal MRI findings of the globe. Specifically, the MRI scans showed one or more nodules in the posterior pole, the first time these findings have been described using MRI. The nodules occurred in the macular region in all nine patients, eight of whom showed a bilateral presentation and two of whom additionally had nodules beyond the macula. The mechanism of nodule formation is unknown, although the researchers speculate a relation to inflammation triggered by the virus as well as inadequate ocular venous drainage while prone or intubated during hospitalization. This study aligns with other research showing that COVID-19 has greater impact on those with preexisting health conditions; among the nine patients with eye nodules, two had diabetes, six were obese, and two had hypertension. Eight of the nine patients were men. The researchers will monitor the COVID-19 survivors to see if there is any visual impairment from the nodules. The first author of the study comments that because patients with severe COVID-19 are often being treated for much more severe, life-threatening conditions, eye problems could go unnoticed in the clinic. He states, “Our study advocates for screening of all patients hospitalized in the ICU for severe COVID-19. We believe those patients should receive specific eye-protective treatments.” Additionally, the researchers will conduct a prospective study with dedicated high-resolution MRI to explore the eye and orbit in patients with mild to moderate COVID-19.

My rating of this study: ⭐⭐

Lecler A, Cotton F, Lersy F, et al. "Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study." Radiology.  16 February 2021. https://doi.org/10.1148/radiol.2021204394