Ophthalmic manifestations and optic nerve functions in COVID-19: a prospective case series in Pakistani population.

Objective: Information on the ocular and neuro-ophthalmological manifestations of COVID-19 is relatively sparse. This study was conducted to identify optic nerve dysfunction and ocular involvement in COVID-19 patients.

Methods: This prospective case series was conducted from April 2021 to December 2022 at the Ophthalmology Department of a public sector tertiary care hospital in Islamabad, Pakistan. We selected 50 patients with COVID-19 by nonprobability convenience sampling. Detailed systemic/ocular history, ocular examination and optic nerve functions were assessed. Best corrected Snellen's acuity, color vision, contrast sensitivity, light brightness appreciation and Humphrey visual field assessments were done. Detailed slit lamp examination of anterior and posterior segment was also performed.

Results: Ocular symptoms were significantly common in patients with severe systemic disease (n=50, 34% patients, p value0.013). The most common complaint was blurred vision (n=6, 12%). Follicular conjunctivitis was found in 60% patients. Optic nerve functions were documented for one hundred eyes of 50 patients. Seventeen eyes had color vision defects (blue yellow) and four eyes had reduced light brightness appreciation. Twenty-nine eyes had visual field defects i.e. paracentral ring scotomas, superior/inferior arcuate defects, or general reduction in sensitivity.

Conclusions: One third of our study population had ocular or neuro-ophthalmic involvement. Although severity of ophthalmic involvement was related to severity of systemic COVID-19 illness and concomitant comorbid disease, ocular involvement was also reported in patients with mild systemic disease or in vaccinated patients. Prolong follow up of these patients should be considered to prevent visual complications.