Abducens Palsy and Anosmia Associated with COVID-19: A Case Report

To report the case of acute isolated abducens nerve palsy and anosmia in a healthy 69-year-old female following SARS-CoV-2 infection.

This is a case report of a previously healthy 69-year-old Caucasian female who presented to the emergency eye centre with a four-day history of binocular, horizontal diplopia eight days after testing positive for SARS-CoV-2 infection. Anosmia was her isolated symptom of COVID-19.

The patient was diagnosed with left abducens nerve palsy. Aetiology was presumed to be post-viral as the patient was not diabetic and had no pre-existing microvascular risk factors. Diplopia resolved within 3.5 weeks. Measurements confirmed complete spontaneous recovery of the abducens palsy within 6 weeks.

Cranial nerve palsies may constitute part of the neurological spectrum of COVID-19 disease. This case report aims to raise awareness amongst clinicians of coronavirus-induced neurological symptoms. Research suggests SARS-CoV-2 infection can trigger an aberrant immune response in some individuals, causing inflammatory nerve damage leading to anosmia and neuropathy. This case report supports the hypothesis that direct or indirect virally mediated injuries along the routes of the cranial nerves can cause neuropathy and olfactory dysfunction. The longer latency effects of COVID-19 infection are not well understood. The long-term rehabilitation of patients exposed to COVID-19 is a major public health concern requiring multidisciplinary expertise. This case report highlights the value of the Orthoptist in the diagnosis and care of patients experiencing neuropathy following COVID-19 exposure.