COVID-19 vaccine may be linked to bilateral cornea melting

A 48-year-old male patient presented to an ophthalmic emergency department with what was described as progressive bilateral corneal melting 5 weeks after he received the first dose of a COVID-19 vaccine.

Physicians in New Delhi reported a rare case of bilateral immune-mediated keratolysis (corneal melting) after administration of 1 dose of the ChAdOx1 nCoV-19 (Covishield, AstraZeneca) vaccination.1

This case may demonstrate a temporal association between this severe ocular adverse event after 1 dose of any of the available SARS-CoV-19 vaccines, according to first author Tanveer Alam Khan, MD, and colleagues from the Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

The patient was a 48-year-old man who presented to the ophthalmic emergency department with what was described as progressive bilateral corneal melting 5 weeks after he received the first dose of the COVID-19 vaccine.

The patient reported having experienced fever, diarrhea, and vomiting during the first 2 weeks following the vaccination, which then subsided before the ocular symptoms began 3 weeks after he received the vaccination.

Ocular examination showed a visual acuity of light perception bilaterally with features of bilateral corneal melting with choroidal detachment on ultrasonography. Culturing was negative for microorganisms.

The patient underwent tectonic penetrating keratoplasty and the host corneal tissue was sent for analysis that included histopathology, bacterial and fungal cultures, polymerase chain reaction for herpes simplex virus, varicella zoster virus, cytomegalovirus, adenovirus, and SARS-CoV-2.

“Microbial culture was sterile, and viral polymerase chain reaction reports were negative. Histopathological examination revealed dense inflammatory cell infiltration,” the investigators wrote.

According to investigators, a detailed systemic workup revealed no underlying systemic or autoimmune pathology.

“Immune-mediated keratolysis after the ChAdOx1 nCoV-19 (Covishield) vaccination is a rare entity, and we believe that this is the first report of a temporal association between a serious ocular adverse event after a single dose of any SARS-CoV-19 vaccine,” investigators concluded. “It may be included as a possible adverse event associated with this vaccine.”

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Reference

Khan TA, Navneet S, Livia K, et al.* Bilateral immune-mediated keratolysis after immunization with SARS-CoV-2 recombinant viral vector vaccine. Cornea published online September 4, 2021; doi: 10.1097/ICO.0000000000002844