COVID-19 vaccination, dengue hepatitis, and recurrent unilateral anterior uveitis.

A 36-year-old Asian Indian male presented with redness and pain in his right eye of 1 week duration. He was diagnosed to have right acute anterior uveitis and had a history of being admitted at a local hospital for dengue hepatitis a month earlier. He had been on adalimumab 40 mg three weekly once and oral methotrexate 20 mg/week for human leucocyte antigen (HLA) B27 spondyloarthropathy and recurrent anterior uveitis. Our patient had re-activation of his anterior chamber inflammation on three distinct occasions: first, 3 weeks following recovery from coronavirus disease 2019 (COVID-19), the second after the second dose of COVID-19 vaccination, and the third after recovery from dengue fever-associated hepatitis. We propose molecular mimicry and bystander activation as the postulated mechanisms for the re-activation of his anterior uveitis. In conclusion, patients with auto-immune diseases can have recurrent ocular inflammation following COVID-19 or its vaccination or dengue fever as seen in our patient. The anterior uveitis is usually mild and responds to topical steroids. Additional immuno-suppression may not be needed. Mild ocular inflammation following vaccination should not deter individuals from getting COVID-19 vaccination.

Granulomatous anterior uveitis following mRNA-based COVID-19 vaccination: A case report.

A 23-year-old patient presented with complaints of redness, pain, photophobia, and blurred vision in the right eye 15 days after she received the third dose of BNT162b2 vaccination. Ocular examination revealed 2+ cellular reactions in the anterior chamber and mutton fat keratic precipitate with no vitritis or retinal alterations. Active uveitis findings regressed with corticosteroid and cycloplegic eye drops. We present a case of unilateral granulomatous anterior uveitis following the BNT162b2 vaccination, with no etiologic factor in uveitis work-up and no previous history of uveitis before vaccination. This report demonstrates a potential causal association of coronavirus disease 2019 (COVID-19) vaccine with granulomatous anterior uveitis.

COVID-19 vaccination and recurrent anterior uveitis.

A 35-year-old Asian Indian female previously diagnosed with bilateral anterior uveitis and on oral methotrexate developed bilateral anterior uveitis following first/second dose of coronavirus disease 2019 (COVID-19) vaccination. She had skipped her weekly dose of oral methotrexate following first dose of vaccination. Following the second dose, she reduced her oral methotrexate from 25 to 15 mg on her own, but did not stop like the previous occasion. She had extensive workup for her uveitis in the past with only positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) antibodies. She developed unilateral anterior uveitis after she had COVID-19 in July 2022, which resolved with topical steroids and continuation of immunosuppression. This report illustrates that COVID-19 or its vaccination may presumably play a role in triggering the immune system and can cause recurrent ocular inflammation even in the absence of an extraocular inflammation.

Acute exacerbation of ocular graft-versus-host disease and anterior uveitis after COVID-19 vaccination (preprint)

Background: To report a case of acute exacerbation of ocular graft-versus-host disease (GVHD) and anterior uveitis following coronavirus disease 2019 (COVID-19) vaccination. Case presentation: A 60-year-old man with primary myelofibrosis and GVHD after receiving allogeneic hematopoietic stem cell transplantation (HSCT), developed acute exacerbation of ocular GVHD and anterior uveitis after receiving first dose of COVID-19 vaccine. Erythema of the eyelids, conjunctival hyperemia, superficial punctate keratopathy, and prominent anterior chamber inflammation in both eyes were revealed. Ocular GVHD and anterior uveitis were managed with mainly topical corticosteroid, antibiotics, and systemic corticosteroid, but were difficult to control. Successful treatment was achieved with intravitreal injection of dexamethasone 6 months later. Conclusions: Clinicians should beware of the rare refractory anterior uveitis and acute exacerbation of ocular GVHD after COVID-19 vaccination in patients undergoing HSCT. Early diagnosis and aggressive treatment should be considered to reduce the likelihood of severe complications.

Psoriatic arthritis: one year in review 2022.

Psoriatic arthritis is a systemic autoimmune disease, in which a characteristic heterogeneous inflammatory involvement of entheses and both peripheral and axial joints tends to be associated with different clinical features, in particular skin or nail psoriasis, but also inflammatory bowel diseases, or acute anterior uveitis. Patients with PsA are at higher risk of developing comorbidities, in particular metabolic syndrome, with a significant impact on their quality of life. Although the advanced knowledge in the pathogenetic mechanisms of PsA helped in developing an abundant therapeutical armamentarium, the available drugs might still show a suboptimal efficacy. However, the frontier of "personalised medicine" could promote further future improvement in the quality of care of patients. In this paper we reviewed the literature on PsA of 2020 and 2021 (Medline search of articles published from 1st January 2020 to 31th December 2021).

Covid-19 association with anterior uveitis (post-covid acute anterior uveitis).

The Covid-19 outbreak in Wuhan on 31st December 2019 soon became a pandemic. Ocular manifestations in post covid patients have been widely reported. Anterior uveitis is a common form of intraocular inflammation observed on a daily basis by Ophthalmologists. Diagnosis of AAU is relatively simple but identification of its etiology is difficult, specifically with Covid-19. Post Covid-19 AAU is not reported in Pakistan yet. The patient in the given case is investigated thoroughly, no possible cause of AAU is identified. The patient was managed for uveitis.

Unique presentations of aspergillosis endogenous endophthalmitis in two hospitalized patients with severe COVID-19.

We present two ICU-hospitalized patients with coronavirus disease-19 (COVID-19) presenting with endogenous endophthalmitis in one eye and variable manifestations of chorioretinitis in the fellow eye. Two diabetic patients (57 and 62 years old) showed anterior uveitis and yellowish-white subretinal infiltrations. The fellow eye of one patient showed patches of choroiditis, while the other showed full retinal thickness infiltrations. A workup yielded high serum titers of galactomannan, diagnostic of aspergillosis. The widespread use of high doses of corticosteroids in the management of COVID-19 may predispose to various secondary fungal opportunistic infections and may manifest in different forms of chorioretinal infiltration.

Herpes Simplex Virus 1 Anterior Uveitis following Coronavirus Disease 2019 (COVID-19) Vaccination in an Asian Indian Female.

PURPOSE: To describe a case of herpes simplex virus 1 (HSV 1) infection following coronavirus disease 2019 (COVID-19) vaccination in an Asian Indian female. METHODS: Retrospective case report. RESULT: A 40-year-old female presented with decreased vision, pain, and photophobia of 2 weeks duration. She reported receiving the second dose of COVISHIELDTM (ChAdOx1-S [recombinant]) 1 week prior to the onset of ocular symptoms. Left eye examination revealed granulomatous anterior uveitis. Aqueous sample from the left eye tested positive for HSV1 by polymerase chain reaction(PCR) method. She was managed with oral antiviral therapy, topical steroids, and cycloplegic agent and showed significant improvement of inflammation within 1 week and resolved within 3 weeks. CONCLUSION: This report demonstrates a potential association of HSV 1 anterior uveitis with COVID-19 vaccination. A high index of suspicion of viral etiology is warranted when uveitis presents with reduced corneal sensations and pigmented keratic precipitates, following a recent history of COVID-19 vaccination.

Herpetic anterior uveitis following Pfizer-BioNTech coronavirus disease 2019 vaccine: two case reports.

PURPOSE: To describe two cases of herpetic anterior uveitis after inoculation of the first dose of Pfizer-BioNTech coronavirus disease 2019 vaccine. METHODS: Case 1: a healthy 92-year-old Caucasian woman developed symptomatic unilateral anterior uveitis for 3 days after Pfizer-BioNTech coronavirus disease 2019 vaccination (Pfizer Inc.). The episode fully resolved with topical and oral antiviral treatment. Case 2: a previously healthy 85-year-old Caucasian woman with left hemicranial signs of herpes zoster infection, associated with herpetic keratouveitis for 3 days after Pfizer-BioNTech coronavirus disease 2019 vaccination. Treatment with topical antibiotics and both oral and topical antiherpetic medication was administered, and she recovered successfully in 5 weeks. CONCLUSION: Clinicians should be aware of the possibility of eye inflammation in the form of herpetic reactivation after coronavirus disease 2019 vaccination.

Anterior Uveitis following COVID Vaccination: A Summary of Cases from Global Reporting Systems.

PURPOSE: COVID-19 vaccines are currently undergoing long-term safety monitoring, including for ocular side effects. Uveitis following vaccination has been described previously with other vaccines and warrants evaluation for COVID-19 vaccines, especially given their widespread use. CASE REPORTS: We present two cases of patients who developed anterior uveitis following the Moderna COVID-19 vaccine, as reported to the National Registry for Drug-Induced Ocular Side Effects. We also summarize reports of anterior uveitis following COVID-19 vaccination as reported to the World Health Organization global database of individual case safety reports. CONCLUSIONS: Based on the temporal pattern of ocular inflammation following vaccine delivery in these cases, an association may be present between uveitis and COVID-19 vaccination. Further investigation to explore this association is warranted to guide patient care.

UVEITIS AFTER THE BNT162b2 mRNA VACCINATION AGAINST SARS-CoV-2 INFECTION: A Possible Association.

PURPOSE: To describe uveitis cases after the BNT162b2 mRNA SARS-CoV-2 vaccination. METHODS: This is a multicenter, retrospective study. Vaccine-related uveitis diagnosis was supported by the classification of the World Health Organization Adverse Drug Terminology and the Naranjo criteria. RESULTS: Twenty-one patients (23 eyes) with a mean age of 51.3 years (23-78 years) were included. Eight of the 21 patients had a known history of uveitis. The median time from previous to current attack was 1 year (0.5-15 years). There were 21 anterior uveitis cases, two with bilateral inflammation. Eight cases occurred after the first vaccination and 13 after the second vaccination. All but three presented as mild to moderate disease. Two patients developed multiple evanescent white dot syndrome after the second vaccination. The mean time from vaccination to uveitis onset was 7.5 ± 7.3 days (1-30 days). At final follow-up, complete resolution was achieved in all but two eyes, which showed significant improvement. One case of severe anterior uveitis developed vitritis and macular edema after the second vaccination, which completely resolved after an intravitreal dexamethasone injection. CONCLUSION: Uveitis may develop after the administration of the BNT162b2 mRNA vaccine. The most common complication was mild to moderate anterior uveitis, while multiple evanescent white dot syndrome can also occur less frequently.

Ocular inflammatory events following COVID-19 vaccination: a multinational case series (preprint)

Background: Inflammatory adverse events following COVID-19 vaccination are being reported amidst the growing concerns regarding vaccine’s immunogenicity and safety, especially in patients with pre-existing inflammatory conditions. Methods Multinational case series of patients diagnosed with an ocular inflammatory event within 14 days following COVID-19 vaccination collected from 40 centres over a 3 month period in 2021. Results Seventy patients presented with ocular inflammatory events within 14 days following COVID-19 vaccination. The mean age was 51 years (range, 19-84 years). The most common events were anterior uveitis (n = 41, 58.6%), followed by posterior uveitis (n = 9, 12.9%) and scleritis (n = 7, 10.0%). The mean time to event was 5 days and 6 days (range, 1-14 days) after the first and second dose of vaccine, respectively. Among all patients, 36 (54.1%) had a previous history of ocular inflammatory event. Most patients (n = 48, 68.6%) were managed with topical corticosteroids. Final vision was not affected in 65 (92.9%), whereas 2 (2.9%) and 3 (4.3%) had reduction in visual acuity reduced by ≤ 3 lines and > 3 lines, respectively. Reported complications included nummular corneal lesions (n = 1, 1.4%), cystoid macular oedema (n = 2, 2.9%) and macular scarring (n = 2, 2.9%). Conclusion Ocular inflammatory events may occur after COVID-19 vaccination. The findings are based on a temporal association that does not prove causality. Even in the possibility of a causal association, most of the events were mild and had a good visual outcome.

Acute Uveitis following COVID-19 Vaccination.

PURPOSE: To describe a case of juvenile idiopathic arthritis (JIA)-associated anterior uveitis after receiving the Sinopharm COVID-19 vaccine. METHODS: A retrospective case report. RESULTS: An 18-year-old girl, with a history of antinuclear antibody positive oligoarticular JIA, presented with bilateral anterior uveitis 5 days after the second dose of the Sinopharm COVID-19 vaccine. Ocular examination revealed anterior uveitis with reduced visual acuity in both eyes. Anterior segment optical coherence tomography showed hyperreflective dots in the anterior chamber (AC) and fine endothelial granularities representing the circulating cells in the AC. Uveitis in both eyes resolved gradually after topical steroid treatment without recurrence. CONCLUSION: This report demonstrates a potential causal association of COVID-19 vaccine with anterior uveitis.

Anterior uveitis onset after bnt162b2 vaccination: is this just a coincidence?

BACKGROUND: Uveitis is a vision-threatening inflammation and is considered an ophthalmic emergency. It generally arises as a result of autoimmune conditions, infections, or ocular trauma, but it may also occur as an isolated disorder. Over the past decades, several cases of vaccine-associated uveitis have been described, with the hepatitis B virus vaccine being the leading cause. CLINICAL CASE: A case of anterior uveitis in a 23-year-old male, with onset 14 days after the second dose of BNT162b2 COVID-19 vaccine, is reported here. Initial symptoms were pain, photophobia, and red eye. Ocular examination showed pericheratic and conjunctival hyperaemia, posterior synechiae, and anterior chamber cells ± keratic precipitates in the lower quadrants. The posterior segment did not show any alteration, and optical coherence tomography ruled out the presence of cystoid macular oedema. After a 10-day treatment course of topical steroids and cycloplegic eye drops, the ocular inflammatory signs disappeared and visual acuity was completely restored. Even if causality remains presumed, a warning should be given to physicians about the possibility of eye inflammation following SARS-CoV-2 vaccination.

COVID-19-related Ocular Hypertension Secondary to Anterior Uveitis as Part of a Multisystemic Inflammatory Syndrome.

It is the consensus of the medical community that ocular complications associated with Coronavirus Disease 2019 (COVID-19) are mild, self-limiting, and there are no reports to date of a sight-threatening event. We report a patient with a systemic inflammatory syndrome in the context of COVID-19, with ophthalmological (uveitis), dermatological (erythema and skin nodules), and cardiovascular (edema) manifestations. The anterior uveitis led to an increase in the intraocular pressure that failed to respond to clinical treatment and prompted a surgical intervention to save the vision. To the best of our knowledge, this is the first report of a COVID-19-related ocular hypertension. Timely surgical intervention was key to save the vision in the patient's only eye.

Bilateral Acute Anterior Uveitis and Corneal Punctate Epitheliopathy in Children Diagnosed with Multisystem Inflammatory Syndrome Secondary to COVID-19.

Purpose: To report bilateral anterior uveitis and corneal punctate epitheliopathy in children with multisystem inflammatory syndrome (MIS-C) secondary to coronavirus disease (COVID-19).Participants and methods: Five patients who were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies and diagnosed with MIS-C were evaluated. Ophthalmologic examinations were performed in order to reveal ocular findings in MIS-C disease.Results: Slit lamp examinations showed bilateral non-granulomatous acute anterior uveitis in all patients and severe corneal punctuate epitheliopathy in three of the patients. These ocular findings mostly disappeared with treatment in about one week.Conclusion: Bilateral non-granulomatous acute anterior uveitis and dry eye can be detected in patients diagnosed with MIS-C secondary to COVID-19. Even if generally, COVID-19 is not a life threatening disease in children by itself, inflammatory ocular manifestations can be detected in MIS-C secondary to COVID-19.

Outcomes of the Ophthalmic Examinations in Patients Infected by SARS-CoV-2.

Purpose: To evaluate ophthalmic examination results which were performed with slit-lamp biomicroscope, in patients with laboratory-confirmed SARS-CoV-2 infection.Methods: In the present study, 50 patients with laboratory-confirmed SARS-CoV-2 infection, were enrolled. Ophthalmic examination with slit-lamp biomicroscopy was performed and the results were evaluated.Results: The mean age of 50 patients (24 females, 26 males) included in this study, was 58,26 ± 18,91 years. In nine patients, bilateral acute follicular conjunctivitis was present. In two patients, acute anterior uveitis was seen. Optic disc and macula were normal in all patients. Preauricular lymphadenopathy (LAP) was found in 6 (12%) patients. Of these six patients, five had follicular conjunctivitis, and one had anterior uveitis.Conclusion: Acute follicular conjunctivitis with preauricular LAP and anterior uveitis were detected and no fundus pathologies were found in detailed ophthalmic examination in patients with laboratory-confirmed SARS-CoV-2 virus infection.