Eye-melting risk from COVID complication

“Anterior scleritis should be considered by all clinicians when a patient presents with ocular pain and erythema following or during COVID-19 infection”

Hawke’s Bay clinicians have treated a man with a rare and serious eye condition triggered by COVID-19.

The condition can cause the whites of the eyes effectively to melt away.

They say it is the first reported case of bilateral anterior necrotising scleritis in a patient who was double-vaccinated against the virus.

The 24-year-old man is also the first reported case of that condition co-presenting with the ulcer-causing condition called reactive infectious mucocutaneous eruption (RIME).

“There have only been three prior reported cases of COVID-associated scleritis, none of which had severe systemic manifestations or associated RIME.”

The case report by clinicians including Cornia Chilibeck, a doctor at Te Whatu Ora Te Matau a Māui Hawke’s Bay and researcher at the University of Auckland, is published in today’s New Zealand Medical Journal.

The website of the College of Optometrists in the UK says scleritis is a rare but potentially severe sight-threatening inflammatory disease. In necrotising scleritis, “the scleral tissue melts away”.

The man was admitted to hospital nine days after testing positive for COVID on a RAT test. At day five, he developed oral ulceration, swallowing became painful and his eyes were painful and red. He was started on oral amoxicillin for a possible abscess in the vicinity of his tonsils and was screened for numerous potential causes.

Worsening pain and eye redness prompted an ophthalmology review, whose findings included normal visual acuity and intraocular pressure.

The redness remained in the sclera despite topical application of phenylephrine 10 per cent. Conjunctival viral swabs were negative.

He was treated with 1g intravenous methylprednisolone daily for three days followed by 1mg/kg oral prednisone tapered off over eight weeks.

“Improvement in pain, mucosal ulceration and necrotising scleritis was observed at 36 hours after the initiation of IV methylprednisolone, followed by rapid improvement over the following four days.

“He was discharged from hospital and regularly monitored during his outpatient follow-up with dental and ophthalmology. At his last ophthalmology follow-up 10 weeks after discharge, there were no signs of rebound RIME or scleritis.”

Dr Chilibeck and her colleagues write that eye complications of COVID occur in between 4 and 11 per cent of patients, most commonly dry eyes and conjunctivitis.

They say the case in their report shows severe eye complications of COVID can occur even in someone who is double-vaccinated.

“In this case, the investigation findings implicate COVID-19 as the trigger for RIME and bilateral anterior necrotising scleritis.”

“Anterior scleritis should be considered by all clinicians when a patient presents with ocular pain and erythema following or during COVID-19 infection. Careful consideration must be taken to avoid automatically dismissing such cases as conjunctivitis.”

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