Disclosures: Giorgio A. Negron: No financial relationships or conflicts of interest

Case Diagnosis: Development of sub-acute blindness and vascular retinopathy after COVID-19 infection

Case Description: A 68-year-old female with history of hypertension and insulin-dependent diabetes presented to the ED for 1-week history of cough, fevers, fatigue, and general weakness. On arrival, patient was found altered and hypoxic requiring intubation and transfer to MICU service. Imaging/labs tests were concerning for ARDS secondary to COVID-19 viral pneumonia. Hospital course was complicated by prolonged hospitalization (45 days), intubation, prone ventilation, and tracheostomy placement. Patient was eventually decannulated and weaned to nasal cannula supplementation. On arrival to inpatient rehabilitation, she reported painless bilateral vision loss that started sometime during her ICU stay and was evident during therapy. Exam: Normal sclera, PERRLA, and poor visual acuity in all quadrants with finger counting. Neuro-ophthalmology was consulted.

Setting: Inpatient Rehabilitation HospitalAssessment/

Results: Ophthalmology examination noted significant vision loss (OD 20/300, OS 20/200), nuclear sclerosis of the lenses, and bilateral scattered retinal hemorrhages and macular edema on ophthalmoscopic view. These findings were concerning for COVID-19 induced Purtscher-like retinopathy and central renal vein occlusion (CRVO).

Discussion: In the absence of trauma, Purtscher-like retinopathy is a rare syndrome that presents with retinal hemorrhages and vision loss associated with microembolizations secondary to an induced hypercoagulable state such as in COVID-19 infection. Intermittent hypoxia and ventilation proning can further promote vascular occlusions through the release of tissue factors and increased intraocular pressure, respectively. Anticoagulation prophylaxis and intra-ocular injections of anti-VEGF have been indicated to reduce further hemorrhage burden; however, permanent vision loss is usually seen.

Conclusion: During the end of her rehabilitation stay, patient reported slight improvement in vision acuity. She fulfilled her rehabilitation goals for supervision for all ADLs and ambulation with a rolling walker (>300 ft). She was discharged home to family with driving restrictions and close follow up with outpatient ophthalmology to discuss prognosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/development-of-sub-acute-blindness-and-retinal-hemorrhages-after-covid-19-infection-a-case-report/