In a new study, researchers found strong abnormalities in the eyes of some people with severe COVID-19.
The results support the need for eye screening in these patients to provide appropriate treatment and management of severe COVID-19.
The research was conducted by a team at the French Society of Neuroradiology.
The COVID-19 pandemic has affected more than 100 million people since it began early in 2020.
While the virus primarily attacks the lungs, it has been linked with eye abnormalities like conjunctivitis, also known as pink eye, and retinopathy, a disease of the retina that can result in a loss of vision.
Eye abnormalities visible on MRI exams have been reported but there is limited research on the nature and frequency of these abnormalities.
In the study, the team examined 129 patients with severe COVID-19 who underwent brain MRI.
Of the 129 patients, nine (7%) had abnormal MRI findings of the globe, or eyeball.
The MRI scans showed one or more nodules in the back part, or posterior pole, of the eyeball. Eight of the nine patients had spent time in the intensive care unit (ICU) for COVID-19.
All nine patients had nodules in the macular region, the area in the back of the eye responsible for our central vision. Eight had nodules in both eyes.
The results suggest that screening should be considered in all patients with severe COVID-19 to detect these nodules.
In clinical practice, this screening could include dedicated exploration of the eyes with high-resolution MRI.
Additional recommended exams include fundoscopy, which uses a magnifying lens and a light to check the back of the inside of the eye, and optical coherence tomography, a noninvasive test that provides a 3D picture of the structure of the eye.
The team says that severe eye problems might largely go unnoticed in the clinic, as COVID-19 patients hospitalized in the ICU are often being treated for much more severe, life-threatening conditions.
They advocate for the screening of all patients hospitalized in the ICU for severe COVID-19. They believe those patients should receive specific eye-protective treatments.
The mechanism behind nodule formation remains unknown, although it could be related to inflammation triggered by the virus.
Inadequate drainage of the veins of the eyes, a problem found in patients who spend time in the ICU in the prone position or intubated, may also be a factor.
Seven of the nine patients with eye abnormalities in the study had been placed in a prone position in the ICU for an extended time.
The findings support previous research that showed COVID-19 exacts a greater toll on people with existing health problems. Of the nine patients with eye nodules, two had diabetes, six were obese and two had high blood pressure.