Coronavirus disease 2019 (COVID-19) has had a wide-ranging public health impact, contributing to at least 5 million deaths globally at the time of this report. Although thromboembolic events following COVID-19 vaccination have been an ongoing concern, only a limited number of ophthalmic manifestations have been reported to date.
We obtained a detailed history, hypercoagulable workup, best-corrected visual acuity (BCVA), Humphrey visual field (HVF), dilated fundus exam (DFE), and multimodal imaging including optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and fundus photography.
A 27-year-old female was diagnosed with central retinal vein occlusion (CRVO) a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on DFE. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement of her CRVO.
Given the chronology of the patient’s condition, we believe that the CRVO which occurred due to the first dose was exacerbated by an intense immunological reaction after the second dose. The severity of this complication, despite its rarity, must be emphasized and weighed in but should not preclude the extensive benefits of vaccination.