A new study from Mexico presented at the American Society of Retina Specialists (ASRS) 2021 annual meeting has described the various ocular manifestations of SARS-CoV-2 infection in newborns.

The study included 15 newborns who tested positive for SARS-CoV-2 on RT-PCR using nasopharyngeal swabs and were isolated in a dedicated NICU. The mean gestational age of 35.2 weeks and the mean birth weight was 2.2kg. While 10 mothers were also Covid-positive, the infection was in newborns not due to vertical transmission, say the authors. The infection was possibly acquired through close contact with the infected mother and other family members after birth, as was the practice earlier when the pandemic first began. All the newborns underwent complete eye examination including portable slit-lamp examination, fundus examination, color fundus photography, red-free imaging and fluorescein angiography using a contact wide-angle imaging system.

All the 15 newborns had periorbital edema; out of the 15, 11 had chemosis and hemorrhagic conjunctivitis and 8 had ciliary injection. Six had corneal edema and one full-term newborn had rubeosis and posterior synechiae.

Seven newborns had normal fundus, whereas in the remaining newborns, the fundus findings included cotton wool spots, vitreous hemorrhage, oxygen-induced retinopathy and retinopathy of prematurity.

Fluorescein angiography revealed microvascular damage evident as patchy choroidal filling, peripapillary hyperfluorescence, blocked hypofluorescence in vitreous hemorrhage, venous laminar flow and boxcarring. Changes related to oxygen-induced retinopathy and retinopathy of prematurity were also seen.

Presenting the findings Maria Ana Martinez-Castellanos, MD, professor of pediatric retina at the Association to Prevent Blindness of the National Autonomous University of Mexico in Toluca, Mexico said, “If you have a child with COVID, please perform angiograms because we may be missing retinal diseases that may give us problems later.”

These findings are also published in the Journal of AAPOS, the journal of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS).

Once thought to be a respiratory disease, Covid-19 is now known to have extra-pulmonary presentations too. Ocular manifestations of the infection have been reported in adult patients with Covid-19. Current evidence shows that Covid-19 is uncommon in neonates. The long-term impact of the infection, including on the eyes, is still unknown. In this study, all the study subjects had some ocular manifestations and are under regular follow-up to detect any long-term complications.

It is important that ophthalmologists are aware of the various presentations of ocular eye disease in SARS-CoV-2 infection for timely diagnosis and treatment.

References

1. Pérez-Chimal LG, et al. Ophthalmic manifestations associated with SARS-CoV-2 in newborn infants: a preliminary report. J AAPOS. 2021 Apr;25(2):102-104. doi: 10.1016/j.jaapos.2020.11.007.
2. Newborns with SARS-CoV-2 show ocular injury - Medscape - Oct 12, 2021.