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People with severe COVID-19 may be at risk for developing eye abnormalities. Morsa Images/Getty Images
  • A new study finds that people with severe COVID-19 may be at risk for certain eye abnormalities.
  • COVID-19 has been linked to cases of conjunctivitis, but this is the first time researchers have noticed nodules on the back of patients’ eyes.
  • Experts say the viral infection may affect blood vessels, which could lead to nodules.

New research shows that patients with severe COVID-19 may be at risk for certain eye abnormalities, according to a study published today in the medical journal Radiology.

The study, initiated by the French Society of Neuroradiology, used MRI scans to find significant abnormalities in the eyes of some people with severe COVID-19.

It looked at 129 patients, all of whom underwent a brain MRI. Of the 129 patients, 9 (7 percent) had abnormal MRI findings of the eyeball. Eight of these patients had spent time in the ICU for COVID-19. The scans revealed one or more nodules on the back of the eye.

COVID-19 has been linked to conjunctivitis cases, but this is the first time researchers have noticed major abnormalities. In this case, the nodules on the back of the patients’ eyes.

The researcher’s theory is that the nodules could be related to inflammation triggered by the virus and inadequate drainage of the veins around the eyes due to patients remaining in the prone position for a significant amount of time.

Seven of the nine patients with nodules had spent time in the prone position in the ICU or were intubated.

Of the nine patients, many had underlying conditions as well. Two had diabetes, six were obese, and two had hypertension.

These conditions and staying in the ICU can all take a toll on eye health.

For those who are hospitalized for COVID-19, simply being in bed can be a risk. Staying in a supine position for an extended period of time could affect these blood vessels’ drainage.

Dr. Claudia F.E. Kirsch, division chief, neuroradiology at Northwell Health in New York, said the infection could also set off a response that can begin to damage the eye.

“When you have a virus going into the bloodstream, blood vessels get blocked, which causes an inflammatory response, which could be affecting the eye orbit,” Kirsch explained.

As with other newly discovered potential side effects of COVID-19, the long-term risks are still being assessed. Because such a small sample group has been studied, more tests are needed to determine the long-term risks.

There may be many other patients of severe COVID-19 who have these nodules. Because the focus was keeping their vitals in check while in the ICU, these patients were not subjected to these other precise tests.

“When these patients come in, they are very sick. The goal is to keep them alive. In the ICU, we are focused on just keeping them able to breathe,” said Kirsch, explaining why these nodules may not have been previously caught.

She also noted that nodules might be forming in other parts of the body, but doctors have not known to screen for them.

One reason to be mindful of eye nodules is that they could potentially lead to blindness if left untreated.

“The first goal is to get patients to breathe on their own and reduce the viral load,” said Kirsch. “Prevention would be the ideal so that patients don’t contract the disease at all. Handwashing and all the basics are also important, but we are still learning about what happens to the eye.”

The study suggests that eye screening should be considered in all patients with severe COVID-19. Screenings could include an MRI and a fundoscopy, which uses a magnifying lens and light to check the back of the eye.

Doctors are still discovering and learning about this potential side effect. The virus primarily attacks the lungs, but it has been previously linked with eye abnormalities such as conjunctivitis.

Still, eye abnormalities remain largely unstudied with respect to COVID-19.

“We have not seen a lot of COVID-19 complications from an ocular standpoint,” said Dr. Mark Fromer, ophthalmologist at Lenox Hill Hospital in New York.

“We have seen some conjunctivitis associated with COVID-19, but generally it has cleared on its own without intervention. It’s pretty easy to check the back of the eye without an MRI,” he said. “What the study suggests makes sense, which is an ocular examination where the pupil is dilated and the macula can be checked with a magnifying lens.”