Neuro-ophthalmic Manifestations of Coronavirus Disease 19

Alanna K. Tisdale; Bart K. Chwalisz


Curr Opin Ophthalmol. 2020;31(6):489-494. 

In This Article


Understanding of COVID-19's pathogenesis, clinical features, and natural history is limited and continues to evolve. Although fever and respiratory system dysfunction are often discussed, it has become abundantly clear that infection with COVID-19 can impact various systems of the body. COVID-19 infection has been associated with acute onset neuro-ophthalmic disease. In the literature, thus far there are case reports of new vision loss, new onset optic neuritis, cranial nerve palsies, and Miller Fisher syndrome.

In the setting of the current pandemic, clinicians should be aware of the associations between COVID-19 and neuro-ophthalmic disease. When patients present with new onset neuro-ophthalmic issues, COVID-19 should be kept on the differential. SARS-COV-2 testing should be considered, especially when fever or respiratory symptoms are also present.

Frontline physicians should keep neuro-ophthalmic signs and symptoms in mind, when screening the general patient for COVID-19 infection. When asking new patients whether they have experienced 'fever, shortness of breath, cough, and sore throat', clinicians should also ask whether they have experienced symptoms such as: double vision, decreased vision, pain with eye movements, gait difficulties, or other neurologic abnormalities. The presence of these symptoms may increase the probability of viral infection.

This is still a new area of study, with few cases in the literature. It is possible that other neuro-ophthalmic diagnoses are associated with COVID-19 infection as well. More research needs to be done to establish a causal relationship between COVID-19 and neuro-ophthalmic disease, and better understand pathogenesis.