Bilateral Orbital Inflammation Associated with COVID-19 Infection: A Case Report and Brief Review of the Literature
Abstract
A 31-year-old woman with no history of systemic autoimmune disease developed bilateral pain, redness, periorbital edema, and proptosis while being hospitalized for mild coronavirus disease 2019 (COVID-19) pneumonia. The onset of ocular symptoms occurred six days after systemic COVID-19 symptoms. Computed tomography examination of the orbit revealed diffuse inflammation involving multiple orbital structures. A complete systemic workup was performed to exclude other systemic inflammatory diseases. She was initially diagnosed with probable orbital cellulitis secondary to sinusitis. However, she did not improve with antibiotic therapy. Empirical administration of systemic corticosteroids led to a dramatic clinical response. The patient has been maintained on a gradual steroid taper without inflammation relapse. This article describes a potential causal association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and orbital inflammation. Ophthalmologists should be aware of this presentation when assessing patients with COVID-19 who present with orbital inflammatory symptoms.
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Ulhaq ZS, Soraya GV. The prevalence of ophthalmic manifestations in COVID-19 and the diagnostic value of ocular tissue/fluid. Graefes Arch Clin Exp Ophthalmol 2020;258:1351- 2.
Nasiri N, Sharifi H, Bazrafshan A, Noori A, Karamouzian M, Sharifi A. Ocular manifestations of COVID-19: a systematic review and meta-analysis. J Ophthalmic Vis Res 2021;16:103- 12.
Dave TV, Nair AG, Hegde R, Vithalani N, Desai S, Adulkar N, et al. Clinical presentations, management and outcomes of rhino-orbital-cerebral mucormycosis (ROCM) following COVID-19: a multi-centric study. Ophthalmic Plast Reconstr Surg 2021;37:488-95.
Dinkin M, Feinberg E, Oliveira C, Tsai J. Orbital inflammation with optic perineuritis in association with COVID-19. J Neuroophthalmol 2022;42:e300-1.
Eleiwa T, Abdelrahman SN, ElSheikh RH, Elhusseiny AM. Orbital inflammatory disease associated with COVID-19 infection. J AAPOS 2021;25:232-4.
Armstrong BK, Murchison AP, Bilyk JR. Suspected orbital myositis associated with COVID-19. Orbit 2021;40:532-5.
Martinez Diaz M, Copete Piqueras S, Blanco Marchite C, Vahdani K. Acute dacryoadenitis in a patient with SARS-CoV-2 infection. Orbit 2021;41:374-7.
Mangan MS, Yildiz E. New onset of unilateral orbital myositis following mild COVID-19 infection. Ocul Immunol Inflamm 2021;29:669-70.
Dermarkarian CR, Chilakapati M, Hussein M, Chevez-Barrios P, Allen RC. Bilateral orbital inflammation in a 6-month old with SARS-CoV-2 infection. Orbit 2021;1-4.
Ho D, Low R, Tong L, Gupta V, Veeraraghavan A, Agrawal R. COVID-19 and the ocular surface: a review of transmission and manifestations. Ocul Immunol Inflamm 2020;28:726-34.
Neri P, Pichi F. COVID-19 and the eye immunity: lesson learned from the past and possible new therapeutic insights. Int Ophthalmol 2020;40:1057-60.
Yeşiltaş YS, Gündüz AK. Idiopathic orbital inflammation: review of literature and new advances. Middle East Afr J Ophthalmol 2018;25:71-80.
Dotan A, Muller S, Kanduc D, David P, Halpert G, Shoenfeld Y. The SARS-CoV-2 as an instrumental trigger of autoimmunity. Autoimmun Rev 2021;20:102792.
Eleiwa TK, Elmaghrabi A, Helal HG, Abdelrahman SN, ElSheikh RH, Elhusseiny AM. Phlyctenular keratoconjunctivitis in a patient with COVID-19 infection. Cornea 2021;40:1502–4.
Vlachoyiannopoulos PG, Magira E, Alexopoulos H, Jahaj E, Theophilopoulou K, Kotanidou A, et al. Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19. Ann Rheum Dis 2020;79:1661-3.
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