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Bilateral interstitial keratitis following COVID-19: a case report
Nathalie Dalloul Daher1, Zeba A Syed2
1Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, 840 Walnut Street, Suite 920, Philadelphia, PA, 19107, USA.
Background:
Although the primary target of severe acute respiratory syndrome coronavirus 2 is the respiratory tract, the expression of the angiotensin-converting enzyme 2 receptor in other tissues facilitates viral entry in others parts of the body, including ocular structures. Ocular manifestations may occur before, during, or after systemic infection.
Case Presentation:
We report the case of a 60-year-old male who presented with bilateral interstitial keratitis after the onset of COVID-19, with ocular symptoms starting within 7 days after systemic symptoms. Laboratory investigation did not identify any alternative etiology for his disease, although the possibility of Epstein-Barr virus or herpes simpex virus could not be definitively ruled out. The patient had already developed significant corneal scarring and visual debilitation by the time topical steroids were initiated, and his final corrected visual acuity with rigid gas permeable contact lenses was 20/50 and 20/80 in the right and left eye, respectively.
Conclusions:
The involvement of ocular tissue by the virus can lead to permanent sequelae such as severe visual loss, and clinicians should be aware of and recognize ophthalmic manifestations of this disease to prompt early intervention.
Insights
COVID-19 can affect the eyes, causing conditions like interstitial keratitis. Early recognition of these ocular symptoms is crucial to prevent severe vision loss from the virus.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Virology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily targets the respiratory system but can affect other organs.
- Angiotensin-converting enzyme 2 (ACE2) receptors, present in ocular structures, facilitate SARS-CoV-2 entry into eye tissues.
- Ocular manifestations of COVID-19 can precede, coincide with, or follow systemic infection.
Observation:
- A 60-year-old male developed bilateral interstitial keratitis 7 days after COVID-19 symptom onset.
- No alternative etiology was identified, though Epstein-Barr virus and herpes simplex virus were considered.
- The patient experienced significant corneal scarring and visual impairment before topical steroid treatment.
Findings:
- The patient's final corrected visual acuity was 20/50 (right eye) and 20/80 (left eye) with rigid gas permeable contact lenses.
- Interstitial keratitis is a potential ocular complication of COVID-19.
Implications:
- Ocular involvement by SARS-CoV-2 can result in permanent vision impairment.
- Ophthalmologists and clinicians must be vigilant for ophthalmic signs of COVID-19.
- Prompt recognition and intervention for ocular manifestations are essential to mitigate severe visual loss.
