Retinal complications after COVID shots

This post highlights people who developed eye complications after mRNA (Pfizer, Moderna) or adenoviral-vectored COVID-19 vaccines. (AstraZeneca, Janssen, J&J).

The case series were peer-reviewed and in the Vaccines and the Journal of Ophthalmic & Vision Research.

The retina is at the back of the eye and receives visual stimuli. The image below represents an eye as seen from the side. Note the retinal blood vessels. They supply different types of nerve cells needed to catch visual stimuli.

The macula is responsible for central, high-resolution color vision.

Normal vision requires a healthy blood supply. The photo below shows what an eye doctor sees when they look inside an eye. The macula is the fuzzy dark red circle in the middle. The blood vessels are the branching objects coming from the white spot. The veins are larger than the arteries. The white area where the blood vessels come from is the optic disk.

The optic disk is where all the nerves from the retina exit to go to the brain. All blood vessels come from the optic disk. That is why anything that affects the optic disk will affect the vision.

The following are brief histories of patients with eye complications after getting COVID shots. Don’t be intimidated by the medical terms. All eye complications in this post are due to retinal blood-supply damage.

branched retinal arterial occlusion

A 38-year-old, otherwise healthy male patient presented with a two-day-old painless visual field loss of the inferior hemisphere in his right eye. Testing revealed branch retinal arterial occlusion. It happened four days after receiving his second SARS-CoV-2 vaccination with Comirnaty^® (BioNTech^®, Mainz, Germany; Pfizer^®, New York City, NY, USA).

Branch retinal arterial occlusion results from obstruction of one of the branches of the central retinal artery. The most common cause is a blood clot from somewhere else (emboli) secondary to either carotid plaques or from the heart. Less common, nonembolic causes include vasospasm and inflammatory and hypercoagulable disorders.

combined arterial and venous occlusion

An 81-year-old female patient developed unsteadiness and blurred vision in her right eye, which increased over the last couple of days. The visual symptoms started twelve days after the second SARS-CoV-2 vaccination with Comirnaty^®.She was diagnosed with combined arterial and venous occlusion in her right eye. The condition is “very rare,” based on another case report.

The nerve cells that process visual stimuli use plenty of energy and adequate oxygenation. The nerves will not work well without blood, and blurry vision happens.

venous stasis retinopathy

A 40-year-old male patient noticed blurry vision five days after his first dose of SARS-CoV-2 vaccination with Comirnaty^® and was diagnosed with venous stasis retinopathy in his left eye.

Venous stasis is a condition where the blood flow is stagnant. Stasis builds up pressure in the veins and prevents fresh blood from the arteries from coming in.

nerve fiber infarction (eye stroke)

A 32-year-old man presented with a sudden onset of a scotoma two days after receiving the second dose of SARS-CoV-2 vaccination with Spikevax^® (Moderna, Cambridge, UK).

He was diagnosed with a circumscribed nerve fiber infarction. An infarction happens when blood supply is lost; if not corrected, the nerve fiber will die, and blindness can result. Another name for this condition is an eye stroke.

Wikipedia describes a scotoma as an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by an area of a well-preserved image.

Note the blurry grass and trees on the right side of the image below. That is a scotoma.

acute bilateral macular neuroretinopathy

A 21-year-old female patient presented with a circumscribed scotoma in her left eye. She developed an acute bilateral macular neuroretinopathy three days after receiving the first SARS-CoV2-vaccine Vaxzevria^® (AstraZeneca^®, Cambridge, UK). She also presented with a scotoma.

This condition is another rare disorder that affects the center for high-resolution and color vision, the macula.

non-arteritic anterior ischemic optic neuropathy

A 67-year-old male went to the ophthalmological emergency service with decreased vision and scotomata in his right eye, which he had been experiencing for two days. He was diagnosed with non-arteritic anterior ischemic optic neuropathy (NAION) in his right eye four days after receiving the first dose of Vaxzevria^® (AstraZeneca^®, Cambridge, UK).

Brigham and Women’s Hospital describes NAION as “the loss of blood flow to the optic nerve (which is the nerve that carries visual signals from the eye to the brain). This condition typically causes sudden vision loss in one eye without any pain. In many cases, the patient notices a significant loss of vision in one eye immediately upon waking up.

Fundus photography (A, B) showed an elevated and congested optic nerve head in the right eye (A) and was normal in the left eye (B). Late fundus fluorescein angiography (C, D) revealed staining at the optic nerve head in the right eye (C) and was unremarkable in the left eye (D).

bilateral arteritic anterior ischemic optic neuropathy

A 79-year-old female had a sudden bilateral vision loss two days after receiving the second recombinant mRNA vaccine (Pfizer) injection. She was diagnosed with bilateral arteritic anterior ischemic optic neuropathy (AAION).

The American College of Ophthalmology describes AAION as,

Arteritic Anterior Ischemic Optic Neuropathy (AAION) is an acute, often painful optic neuropathy that occurs predominantly in elderly patients over age 50 but with increasing incidence each decade thereafter and can cause permanent loss of vision.

Ischemia (loss of blood) occurs at the head of the optic nerve in relation with structural crowding of the nerve fibers, impairing perfusion and leading to optic disc edema

Manifestations include rapid onset of unilateral visual loss accompanied by decreased visual acuity (typically severe: <20/200 in over 60% of the patients), visual field (altitudinal field defect is most common) or both.

bilateral acute zonal occult outer retinopathy

A 33-year-old healthy female with a progressive nasal field defect in her left eye and flashes in both eyes. Her symptoms started ten days after receiving the second recombinant mRNA vaccine (Moderna) injection. She was diagnosed with bilateral acute zonal occult outer retinopathy (AZOOR).

The National Institute of Health describes Acute Zonal Occult Outer Retinopathy (AZOOR) as a rare condition that affects the eyes. People with this condition may experience a sudden onset of photopsia (the presence of perceived light flashes) and an area of partial vision loss (a blindspot). Other symptoms may include “whitening of vision” or blurred vision.

My thoughts

In summary, this article describes eight eye conditions after COVID vaccinations.

The retinal blood vessels reflect the condition of the smallest blood vessels in the body. The small sizes of the blood vessels in the retina and the high number of nerves that depend on them give an early warning of what else may be happening throughout the body. That’s because diseases that affect blood vessels don’t pick and choose what they will damage.

Most of the conditions mentioned above are rare. The proximity of the COVID injections should make any physician establish cause and effect.

Several studies by Zheng et al. and Rue et al. have established that the SARS-CoV-2 spike proteins can cause inflammation and blood clot formation, damaging blood vessels and the organ they supply.

If you are considering getting a booster shot, remember this post.

Don’t Get Sick!

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Vaccine-induced clot articles:

References:

Girbardt et al. Retinal Vascular Events after mRNA and Adenoviral-Vectored COVID-19 Vaccines-A Case Series. Vaccines (Basel). 2021 Nov 17;9(11):1349. Doi: 10.3390/vaccines9111349. PMID: 34835280; PMCID: PMC8625395.
Maleki A, Look-Why S, Manhapra A, Foster CS. COVID-19 Recombinant mRNA Vaccines and Serious Ocular Inflammatory Side Effects: Real or Coincidence? J Ophthalmic Vis Res. 2021;16(3):490-501. Published 2021 Jul 29. doi:10.18502/jovr.v16i3.9443

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