Recurrent nodular episcleritis as a manifestation of long COVID

A woman in her 50s presented with redness, eye pain, watering and photophobia of the left eye starting 1 week after she tested positive for COVID-19. She was diagnosed with left eye episcleritis and started on topical steroids. As the steroids were being gradually tapered, she developed a recurrence. The cycle of treatment-tapering-recurrence repeated itself such that nine episodes were noted within a span of 3 years. An exhaustive diagnostic work-up including infective and autoimmune blood tests, rheumatology assessment and COVID-19 conjunctival swabs and tear samples were done, and no underlying conditions or triggers could be identified, attributing 'long COVID' as the likely causative. Long COVID is the continuation or development of new symptoms after the initial COVID-19 infection, with no other explanation. It is estimated to affect nearly 65 million people worldwide, with >200 symptoms, involving different organ systems. The ocular manifestations of long COVID are less well-known.