A potential new symptom of COVID-19: Eye nodules

Over the course of the pandemic, coronavirus disease 2019 (COVID-19) has been determined to be a systemic disease, and while the eye is less affected than some other organs, the findings regarding ocular involvement continue to be reported.

In a recent study reported in Neuroradiology,¹ ocular nodules were found in the posterior pole and outside of the macular region.

A team of investigators, led by Augustin Lecler, MD, from the Department of Neuroradiology at Rothschild Foundation Hospital in Paris, France, studied a cohort of 147 patients with severe COVID-19 infections who had undergone magnetic resonance imaging (MRI) between March 4 and May 1.

After 18 patients with poor MRI images were excluded, 129 patients comprised the study cohort in this retrospective, observational, multicenter study. The patients

underwent MRIs because of delayed awakening, persisting agitation and confusion, or agitation and hallucinations.

Ocular nodules were identified on MRI in 9 patients.

“All 9/9 (100%) patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region,” Lecler noted in the report.

Three of the patients had undergone ophthalmologic examinations, during which the nodules were not visible. The investigators suggested in the report that this may have occurred because of the lack of sensitivity of the clinical examination or the delay between the completion of the MRI evaluation and the ophthalmologic examination.

The investigators suggested a few hypotheses for the origins of the nodules that included direct retinal and retinal pigment epithelial infiltration by the virus, vasculitis, or an autoimmune process; an ocular microangiopathic syndrome ultimately resulting in retinal ischemia; and a Valsalva retinopathy secondary to orbital proptosis that occurs when the ocular venous system is affected by increased central venous pressure, leading to an inadequate ocular venous drainage seen in patients who are prone or intubated.

“Screening of these patients might improve the management of potentially severe ophthalmologic manifestations of the virus,” the investigators concluded in the report.

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Reference

1. Lecler A, Cotton F, Lersy F, et al. Ocular MRI findings in patients with severe COVID-19: a retrospective multicenter observational study. Radiology 2021; Published Online Feb 16 2021; https://doi.org/10.1148/radiol.2021204394