ABSTRACT
Purpose@#We report a case of neuroretinitis combined with external ophthalmoplegia in a patient who developed a cerebral venous sinus thrombosis after administration of a SARS-CoV-2 vaccine.Case summary: A 26-year-old woman who was on oral contraceptives was diagnosed with a cerebral venous sinus thrombosis 1 month after the first injection of a SARS-CoV-2 vaccine (BNT162b2, Pfizer-BioNTech). The levels of factors 8 and 9 were elevated on the blood test. The corrected visual acuities were 0.3 in both eyes. A complete limitation of abduction and esotropia were evident in the left eye. Both eyes exhibited optic disc swelling and hemorrhage and retinal nerve fiber layer swelling. Subretinal fluid was apparent in the right eye. Three weeks later, the optic disc swellings and hemorrhages had worsened and both eyes evidenced macular stars. After 10 months, the corrected visual acuities improved to 0.9 in both eyes. Ocular motor function and the esotropia also improved. However, the overall contraction of the visual field did not. @*Conclusions@#SARS-CoV-2 vaccination can trigger cerebral venous sinus thrombosis, neuroretinitis, and external ophthalmoplegia. In patients with risk factors for such thrombosis, the possibility of ophthalmic complications should be considered after administration of a SARS-CoV-2 vaccine.
ABSTRACT
Purpose@#We report an atypical case of ischemic oculomotor palsy occurring sequentially in both eyes and then improving, followed by a new abducens palsy in a diabetic patient with poor blood sugar control.Case summary: A 51-year-old woman presented with diplopia, dizziness, and pain in the right eye and was diagnosed with oculomotor palsy in the right eye. Magnetic resonance imaging of her brain was normal but glycated hemoglobin concentration was 13.4%. After 2 months, the third nerve palsy in the right eye had recovered completely but a new third nerve palsy occurred in the left eye. 1 month later, the symptoms had improved, and the patient did not return to our clinic until 18 months later, when she returned with new diplopia. This time, she was diagnosed with a sixth nerve palsy in the left eye and was observed while controlling her blood sugar. She recovered after 4 months. @*Conclusions@#Generally, cranial nerve palsies occur unilaterally in situations that can cause ischemia, such as diabetes, high blood pressure, and hyperlipidemia. Rarely, they occur bilaterally, or two or more cranial nerve palsies occur simultaneously. However, it is very rare that cranial nerve palsy occurs sequentially in both eyes under the same systemic blood sugar control. Diabetic patients with poor blood sugar control require long-term monitoring, considering the possibility of symptoms developing in both eyes with a time lag or other forms of ischemic cranial nerve palsy.