Katherine Wei, MD1, Juliana Thong, DO1, Julia Kang, MD, MPH2, Mariam Mostamandy, MD1 and Kimberly Cockerham, MD, FACS3*

The novel Coronavirus Disease 2019 (COVID-19) is known to present with a broad range of clinical manifestations. While symptoms such as fever, cough, dyspnea, myalgias, diarrhea, anosmia, and ageusia predominate, less common manifestations involving multiple systems have also been described. Some reported ocular manifestations include symptoms associated with keratoconjunctivitis, such as chemosis, ocular pain, photophobia, dry eye and tearing [1]. Neurological symptoms in addition to smell and taste dysfunction have been commonly described as well, and include headache, ataxia, dizziness, altered level of consciousness, and stroke [2]. Whether these neuro-ophthalmologic findings reflect direct involvement of these systems or a more generalized response to SARS-CoV-2 infection remains uncertain. Many other neurologic, rheumatologic, and infectious diseases also present with similar clinical findings as those described in COVID-19, further complicating the diagnostic picture. In this case series, we examine several patients presenting with unusual neuro-ophthalmological manifestations and discuss similarities of these findings with those seen in SARS-CoV-2 infection, and review current literature describing possible mechanisms underlying similar findings in patients with confirmed COVID-19.

Keywords: COVID-19, episcleritis, giant cell arteritis, idiopathic intracranial hypertension, infectious disease, inflammatory response, neuro-ophthalmology, neurology, novel Coronavirus Disease 2019, orbital apex-sphenoid syndrome, ophthalmology, optic neuritis, pseudotumor cerebri, rheumatology, SARS-CoV-2, scleritis, Takayasu arteritis, vasculitis, vision loss

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