Case Report: Retinal Vasculitis in Two Adolescents After COVID-19 Vaccination

PURPOSE

To report two cases of bilateral retinal vasculitis in adolescents following COVID-19 vaccination.

STUDY DESIGN

Case report.

RESULTS

 We report the first two cases of retinal vasculitis in adolescents following COVID-19 vaccinations. Both patients received recent second-dose COVID-19 vaccinations (7 weeks and 4 weeks respectively), and presented with bilateral retinal vasculitis and vitritis. Investigations did not reveal other causes of retinal vasculitis. Both patients' retinal vasculitis settled with a short course of oral prednisolone.

CONCLUSION

Although rare, the temporal association between vaccination, bilateral eye involvement, and the absence of alternative infective or inflammatory causes, makes this a plausible etiology. mRNA vaccinations may cause an autoimmune reaction via host antigenic mimicry, and systemic vasculitis has previously been described. We believe that a short interval between COVID-19 vaccination doses might be a risk factor for the development of retinal vasculitis in adolescents, and clinicians should be aware to elicit vaccination history.

Frosted branch angiitis after smallpox vaccination

Purpose

To describe a patient presenting with frosted branch angiitis soon after small-pox vaccination.

Observations

Frosted branch angiitis (FBA) is an acute onset retinal vasculitis featuring prominent perivascular sheathing in otherwise healthy individuals. FBA has been associated with noninfectious and infectious etiologies. This report describes a twenty-year-old African American female who developed bilateral frosted branch angiitis one week after small-pox vaccination. At presentation, the patient had bilateral, para-central visual field defects and subjective visual disturbances. On dilated exam, the patient demonstrated diffuse vasculitis bilaterally. The patient's field defects and clinical exam responded dramatically to oral prednisone therapy.

Conclusions and Importance

Acute idiopathic frosted branch angiitis is a rare condition which was temporally associated with small-pox vaccination.

Bilateral Panuveitis with Occlusive Vasculitis following Coronavirus Disease 2019 Vaccination

PURPOSE

To report a case of bilateral panuveitis and occlusive vasculitis following COVID-19 vaccination.

STUDY DESIGN

Case report.

RESULTS

A 41-year-old otherwise healthy male presented with progressive vision loss and floaters starting 48 hours after a first dose of COVID-19 vaccine. Examination initially showed bilateral anterior uveitis, but this evolved into bilateral panuveitis with occlusive vasculitis despite topical corticosteroids over two weeks. The patient underwent extensive testing for other etiologies which were excluded. He was successfully treated with a gradual taper of topical and systemic corticosteroids leading to improvement of signs and symptoms. Follow-up is maintained for observation of avascular zones with possible neovascularization which could require laser as needed.

CONCLUSIONS

The temporal association between vaccine and presentation makes this a plausible etiology. This remains a rare adverse event, but clinicians should be aware of this possibility to include it in their differential diagnosis when confronted with idiosyncratic ocular presentations.

Ocular adverse events following vaccination: overview and update

The Food and Drug Administration has licensed, approved, and expanded guidelines for dozens of vaccines since 2010. Although advancements in biotechnology have made vaccines more effective and safer, none are completely free from adverse effects. Many vaccines have been implicated in causing ocular adverse events based on the temporal association of exposure and putative complication. Determination of causality is difficult. We provide an overview of vaccine side effects and also examine the English literature and the Vaccine Adverse Events Reporting System (VAERS) from 2010 through 2020 for vaccine-implicated ocular adverse events. While reactions of eyelids and conjunctiva are commonly reported, the most frequently implicated serious adverse events are optic neuritis and various patterns of intraocular inflammation. Live attenuated vaccines have the potential to cause ocular infection from vaccine-strain organisms, particularly in those immunosuppressed. While postmarketing registries for suspect vaccination adverse events, such as VAERS, are unable to determine causal associations, they are a mainstay in signaling suspected trends that require investigation. The majority of probable and possible serious ocular adverse effects are distinctly uncommon.

Retinal vasculitis: A framework and proposal for a classification system

Retinal vasculitis, a poorly understood process involving inflammation or ischemia of the retinal vessel wall, may occur in association with a systemic process, although it can also be isolated to the retina. Because of the limited ability to perform histopathological studies on retinal vessels, there is no gold standard for diagnosis. Thus, there is utility in creating a classification system for retinal vasculitis and improving diagnostic strategies for this disease. We provide a framework for understanding retinal vasculitis based on size, location, and etiology. We hope that this information can be implemented in the clinical setting to provide some diagnostic strategies for this often confusing entity.

[Local choroiditis after influenza vaccination (a clinical case study)]

The article describes a difficult case of differential diagnosis of local choroiditis developed after influenza (flu) vaccination in a patient with bronchial asthma who receives systemic steroid therapy.

Retinal artery vasculitis secondary to administration of influenza vaccine

There are many differential diagnoses in investigating patients who present with retinal vasculitis, and the laboratory investigations used to investigate this have low-to-moderate sensitivity and/or specificity. Diagnoses include conditions such as tuberculosis or sarcoidosis, which may require long courses of antibiotics or immunosuppression. Influenza vaccination has been recognised as a cause of vasculitis for decades, although a purely ocular presentation is rare. We present a case of a 78-year-old Caucasian woman presenting with a single vessel arterial vasculitis of the right eye 8 weeks following influenza vaccination at her local general practitioner practice. We encourage ophthalmologists, rheumatologists and uveitis specialists to consider influenza vaccine as a cause of ocular vasculitis if the vaccine has been recently administered.