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.