Abstract
In this case study, the authors describe peculiar bilateral cotton wool-like
retinal lesions associated with macular edema in a patient with COVID-19 who was
vaccinated with a single dose of AstraZeneca one month earlier. This patient had
no pulmonary or systemic cardiovascular complications from COVID-19, as reported
in other papers that found retinal lesions. However, the patient was diagnosed
with idiopathic myopathy when discovering the SARS-CoV-2 infection. The patient
was a 22-year-old white female with no previous history of morbidity,
complaining of blurred vision in both eyes seven days after testing positive for
SARS-CoV-2 by PCR (using nasal and oral swab) and confirmed through ELISA blood
test (IgM positive). There was no ancillary test revealing diabetes mellitus.
The patient presented with scattered whitish cotton wool-like lesions and a few
hemorrhages on the posterior pole in fundus examination. On spectral domain
optical coherence tomography (SD-OCT), there were hyperreflective lesions in the
nerve fiber layer, ganglion cell layer, inner nuclear layer, and inner and outer
plexiform layers at the site corresponding to the whitish cotton wool-like
lesions in the posterior fundus photos. Moreover, the macula of both eyes had
intraretinal and subretinal fluid, reversible with corticosteroid therapy. In
conclusion, COVID-19 has been associated with capillary disorders at different
target sites such as retina, lungs, and central nervous system. Similarly,
vaccination against SARS-CoV-2 has been linked to retinal complications in the
literature; however, cotton wool-like lesions have not yet been reported. There
are many questions yet to be answered about the implications of COVID-19
infection and its vaccines.
