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Central retinal artery occlusion in a young child affected by COVID-19: a first case report
Giulia Abbati1, Camilla Fazi2,3, Pina Fortunato4
1Pediatric and Neonatology Unit, Santo Stefano Hospital, Prato, Italy. giulia.abbati@uslcentro.toscana.it.
Insights
This case report details the first instance of central retinal artery occlusion (CRAO) in a child with SARS-CoV-2 infection. The rare pediatric COVID-19 complication resulted in severe vision loss despite treatment.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Central retinal artery occlusion (CRAO) is a rare ophthalmic emergency, typically caused by thrombus or embolus, often linked to hypercoagulable states.
- While CRAO occurs in children, its incidence is very low.
- SARS-CoV-2 (COVID-19) has been associated with various organ involvements, including ocular manifestations, with reported CRAO cases primarily in adults.
Conclusions:
- This is the first reported case of CRAO in a pediatric patient with SARS-CoV-2 infection.
- The prognosis for CRAO is generally poor, with limited treatment efficacy if not administered rapidly.
- High clinical suspicion for CRAO is crucial in pediatric patients presenting with sudden vision loss, even during mild SARS-CoV-2 infection.
Background:
Central retinal artery occlusion (CRAO) is an ophthalmic emergency, and its etiology is generally ascribed to vessel occlusion by a thrombus or embolus, eventually due to a hypercoagulable state. CRAO occurrence is described even in the pediatric population, but its incidence is very rare. SARS-CoV-2 infection has a multitude of presentations, and almost any organ may be involved including the ocular district. Cases of CRAO in patients affected by COVID-19 are reported in the literature in the adult population, but not in the pediatric one.
Case Presentation:
We describe the case of a six-year-old otherwise healthy girl, who presented a sudden and complete bilateral vision loss after a one-day fever. All the clinical, ophthalmological, laboratory and instrumental investigations led to the diagnosis of a right CRAO and the suspicion of a contralateral posterior optic nerve affection. These manifestations could not be ascribed to any etiological condition apart from the documented ongoing mild SARS-CoV-2 infection. Treatment with anticoagulants and steroids was tried but the visual outcome was poor during the one-month hospitalization and at the last follow-up.
Conclusions:
To the best of our knowledge, this is the first report of CRAO in the course of SARS-CoV-2 infection in the pediatric age. In our review of the literature, we found few cases of CRAO in adults with COVID-19; we highlighted differences in anamnestic, clinical, and interventional aspects and therefore we tried to summarize the state of the art on this topic to facilitate further studies. Even if rare, the prognosis of CRAO is poor and the thrombolytic treatment could be effective only if rapidly administered, so the disease suspicion should be high in a patient with sudden vision loss, also in pediatric age.
