COVID-19 Vaccine-Associated Optic Neuropathy: A Systematic Review of 45 Patients

“Abstract: We provide a systematic review of published cases of optic neuropathy following COVID-19 vaccination. We used Ovid MEDLINE, PubMed, and Google Scholar. Search terms included: ‘COVID-19 vaccination’,’ optic neuropathy’, ‘optic neuritis’, and ‘ischemic optic neuropathy’. The titles and abstracts were screened, then the full texts were reviewed…

“Discussion: In this systematic review of published cases of optic neuropathy following COVID-19 vaccination, we found that COVID-19 vaccination was associated with several forms of optic neuropathy, most commonly AION [anterior ischemic optic neuropathy] and optic neuritis. All subtypes of COVID-19 vaccines, including mRNA, viral vector, and inactivated viral vaccines were associated with optic neuropathy. However, protein subunit vaccines, such as the Novavax vaccine, were not reported as a cause of optic neuropathy in the current review. The temporal association between vaccine administration and the development of optic neuropathies in these cases makes a causal link plausible, with a mean time from vaccination to the development of ocular symptoms of 9.6 ± 8.7 days. Cases with a late onset of optic neuropathy, however, are less likely to be related to vaccination and could be coincidental. Vaccines and their adjuvants are meant to robustly activate the innate immune system, and adaptive immunity then follows. Overactivation of this response, however, may occur in some patients and lead to rare immune-mediated complications…

Conclusions: In conclusion, several cases of optic neuropathy were reported following the administration of COVID-19 vaccines, suggesting an association and perhaps a cause–effect relationship, with at least one case reporting a positive rechallenge phenomenon following the second dose of vaccination.”