Corneal complications of common vaccinations

To summarize and evaluate the current literature concerning corneal complications associated with common vaccinations, particularly keratitis and corneal graft rejection following vaccination against SARS-CoV-2, Varicella-Zoster, and Influenza.

Small case series and reports have documented keratitis/herpesvirus reactivation and corneal graft rejection following vaccination, prompting concern from ophthalmologists regarding vaccination timing and management of patients. Recent population-based studies have reported higher risks of herpesvirus keratitis and herpes zoster ophthalmicus recurrence associated with the COVID-19 and varicella zoster vaccinations in rare cases, often in patients with identified risk factors. Similarly, corneal graft rejection rates appear to be stable following vaccination when compared with unvaccinated individuals, with the bulk of vaccine-associated rejection noted to occur with penetrating keratoplasties and in patients at a higher risk for rejection.

While the benefits of vaccination continue to outweigh the risks, clinicians must identify and balance patient-specific risk factors for corneal complications to inform individual management and counseling, potentially with heightened steroid use in the postvaccination period and more stringent follow up for signs of keratitis or graft rejection.