Non-Arteritic Anterior Ischaemic Optic Neuropathy with Progressive Macular Ganglion Cell Atrophy due to COVID-19

ABSTRACT A 72-year-old man with type II diabetes mellitus presented with sudden painless vision loss and an inferior visual field defect in his right eye. He had previously tested positive for COVID-19 disease with the symptoms starting 13 days before the onset of vision loss. His decimal visual acuity, 55 days after the onset of visual symptoms, was 0.3 and this decreased over the following week to counting fingers. 24–2 visual field analysis revealed an inferior altitudinal defect. Dilated fundus examination revealed mild optic disc swelling in the right eye. The left eye was normal. He was diagnosed with non-artertic anterior ischaemic optic neuropathy (NAION). On spectral domain optical coherence tomography there was retinal thinning in the supero-temporal foveal area. Macular ganglion cell layer – inner plexiform retinal layer complex analysis showed progressive atrophy that developed from the supero-temporal to the infero-nasal fovea. COVID-19 infection may lead to NAION.