• Comprehensive Ophthalmology

    Review of: Ocular adverse events after COVID-19 vaccination

    Ng X, Betzler B, Testi I, et al. Ocular Immunology and Inflammation, September 2021

    A narrative literature review of studies was conducted to provide an overview of the adverse ocular effects reported with the 4 types of COVID-19 vaccines currently available: mRNA , protein subunit, vector, and whole virus.

    Study design

    A total of 23 English-language articles reporting ocular findings associated with COVID-19 vaccinations were included in the review.

    Outcomes

    Cumulatively, ocular side effects were reported in 74 individuals and included facial nerve palsy, abducens nerve palsy, corneal graft rejection, acute macular neuroretinopathy, uveitis, superior ophthalmic vein thrombosis, central serous chorioretinopathy, Vogt-Koyanagi-Harada reactivation, and onset of Graves orbitopathy (thyroid eye disease). These reported side effects are similar to ocular manifestations reported with the COVID-19 infection, so there may be a common pathway between the immune-mediated response to the vaccine and the virus itself.

    Limitations

    The reporting of side effects within a temporal relationship with the vaccine does not prove causality. The speculated association is considered rare given the millions of people who have received 1 or more vaccines. These ocular side effects may be related to the maladaptive immune response in susceptible individuals. Vaccines have added adjuvants within them to boost their efficacy; these adjuvants potentiate the innate and adaptive immune response further, possibly leading to autoimmune or inflammatory conditions in some individuals. Also, the reported side effects were published in the form of case series or reports, and drawing a clear conclusion from anecdote alone is often limited.

    Clinical significance

    While an abnormal immune response may be triggered by the COVID-19 vaccine, the ocular manifestations reported in the literature had a good prognosis with appropriate management. It is important to note that the benefits of receiving the vaccine far outweigh the rare ocular risks.