The Heterogeneous Presentations of De Novo and Recurrent Ocular Inflammation following COVID-19 Vaccination: A Multi-Center Report and a Review of the Literature.

Abstract

Purpose: To describe the patterns of ocular inflammation following COVID-19 vaccination, assess underlying commonalities and understand outcomes.

Methods: Retrospective, multicenter cohort study, conducted between 2020 and 2021. Patients with no previous uveitis history (de novo) or a known uveitis history (recurrent) who developed ocular inflammation within 42 days of COVID-19 vaccination were identified. Characteristics of the uveitis, treatment approaches and clinical outcomes were assessed.

Results: Fifty-five eyes of 39 patients with ocular inflammation temporally related to vaccination were identified. Twenty-two patients (36 eyes) were de novo, while 17 (19 eyes) were recurrent. Anterior uveitis was most common. HLA-B27 positivity was found in 6 (27.2%) de novo patients, and 5 (29.4%) recurrent patients. Most patients required only observation, topical or systemic corticosteroids. Amongst vaccinated patients, 12.3% of new uveitis referrals during the study period were related to COVID-19 vaccination. Among patients with a history of quiescent uveitis, only 0.85% experienced a flare following vaccination.

Conclusion: The majority of inflammation thought to be secondary to COVID-19 vaccination achieved quiescence with observation or steroids, and the overall incidence is low. Anterior uveitis was the most common. HLA-B27 positivity occurred at a higher rate than reported in the baseline population.