Introduction:
COVID-19 is a highly contagious that spreads from person to person
primarily by affected person’s respiratory droplets and contamination
objects or bodily limbs via the nostrils, mouth, and ocular route (1,
2). COVID-19 may affects multiple organ system (cardiovascular diseases,
respiratory failure, renal failure, liver damage, ocular adverse effect)
but it is difficult to monitor all the system (3). The nasolacrimal
system allows pulmonary virus spreads through the eye. As a result,
virus-infected nanoparticles interacted with the ocular surface and can
then infiltrate the lung tissue through the nasolacrimal channel. The
angiotensin converting enzyme 2 (ACE2) binding site is present in the
retina as a facilitator for virus entry into human host which may leads
to retinal involvement by SARS-CoV-2 (4-6). Conjunctivitis, conjunctival
erythema, chemosis, epiphora, cotton wool spots (CWS), and
microhemorrhages have been confirmed on fundus assessment.
Hyperreflective abnormalities at the point of the ganglion cell and
internal plexiform layer at the papillomacular region can be detected
through spectral-domain optical coherence tomography (SD-OCT)(7, 8). In
Germany, SARS-CoV-2 virus RNA was found in the retinas where three of
the 14 number COVID-19 patients who died (4) and another study conducted
in Italy found additional papillary focal retinal hemorrhage in the
post-COVID-19 group(9). Severe capillary lesions such as cotton wool
spots, retinal hemorrhages, sectoral retinal infarction have
subsequently been reported in admitted, severe COVID-19 patients which
suggests a new SARS-CoV-2 association (10). The generation of cytokines,
which are responsible for the activation of a procoagulant prothrombotic
response, is causing concern about these retinal microvascular
observations, which could be a symptom of COVID-19’s intravascular
coagulopathies and endothelial damage (11). As COVID-19 vaccinations
become more common, the might be a increases concern of ophthalmic
consequence due to vaccination (12), however a microvascular anomaly in
the deep capillary plexus of the retina is suspected, the pathogenesis
is unexplained (13, 14). In one case series, eye adverse events take
place immediately after getting an inactivated COVID-19 vaccination were
observed (12) and according to an interim analysis of four randomized
controlled studies based on vaccine safety data, ocular consequences are
uncommon with Live-virus vaccinations (AstraZeneca vaccine) (15, 16). In
this report, we present a patient with secondary retinal hemorrhage who
had recovered back from COVID-19 and had also received COVID-19
vaccination.