Retinal Vascular Findings Common in Severe COVID-19

A medic makes an intubation for a mechanical ventilation to a patient suffering from Covid-19 at the emergency unit of La Timone hospital in Marseille, southeastern France, on September 11, 2020. (Photo by Christophe SIMON / AFP) (Photo by CHRISTOPHE SIMON/AFP via Getty Images)
Optic nerve inflammation and microvasculature occlusion were the most common findings among patients admitted to an ICU with SARS-CoV-2.

More than one-third of patients admitted to an intensive care unit (ICU) with severe COVID-19 had ophthalmological manifestations, according to a report published in Retina. Frequent fundoscopic findings in these patients include optic nerve inflammation, microvasculature occlusion, and major vascular occlusions, the report shows. The cross-sectional single-center study looks at patients admitted to the ICU in the largest third-level referral center for COVID-19 in Mexico City. 

Consecutive patients admitted to the ICU with a diagnosis of COVID-19 were examined with an indirect ophthalmoscope and a posterior-pole camera was utilized to take clinical photographs. Of the 117 patients (median age 54 years, range 45-63 years, 74 men 42 patients had ophthalmological manifestations (unilateral in 23 and bilateral in 19), and 10 of these patients had more than 1 ophthalmological manifestation. Ocular findings included papillitis (n=13), cotton wool spots (n=12), retinal hemorrhages (n=5), retinal nerve fiber layer edema (n=8), macular whitening (n=5), retinal vascular tortuosity (n=4), papillophlebitis (n=3), central retinal vein occlusion (n=1), and branch retinal vein occlusion (n=1). 

While the most common ocular finding was optic nerve inflammation, including papillitis and papillophlebitis, the classic triad of optic neuritis (vision loss, periocular pain, and dyschromatopsia) could not be confirmed due to the critically ill nature of the patients. 

Study limitations include the cross-sectional design, the inclusion of patients with severe COVID-19, and the timing of ocular fundus examinations within a period of 8 days after admission to the ICU. “Clinical assumptions were based on ophthalmological examination but could not be confirmed by paraclinical studies (e.g., fluorescein retinal angiography, optical coherence tomography, optical coherence tomography angiography, and visual fields), given the difficulty of performing these procedures in critically ill patients” according to the study.

Ocular fundus manifestations were not associated with demographic characteristics, inflammatory markers, hemodynamic factors, or comorbidities. 

“The presence of retinal hemorrhages may support the hypothesis that SARS-CoV-2 retinal tropism is associated with disruption of the blood–retinal barrier,” note researchers. 


Romero-Castro R, Ruiz-Cruz, M, Alvarado-de la Barrera, C, et al. Posterior segment ocular findings in critically ill patients with COVID-19. Retina. 2022;42(4):628-633. doi:10.1097/IAE.0000000000003457