COVID-19 and sudden-onset ocular neurogenic palsy in prior healthy patients: a systematic review.

Publication date: Jul 13, 2023

The aim of this systematic review is to identify cases of neurogenic ocular palsy in the presence of COVID-19 and to document patient characteristics, type of palsy and possible aetiologies. A systematic search of PubMed, Medline and CINAHL databases was conducted on the 6th of January 2023 to identify cases of neurogenic ocular palsy in patients with current or previous COVID-19 infection. Data were pooled to summarise the neurogenic palsy, patient clinical characteristics and proposed palsy mechanisms. The combined database search yielded 1197 articles. Of these, 23 publications consisting of 25 patients met the inclusion criteria. Most patients were male (68%) and ranged in age from 2 to 71 years (median=32. 7, SD=21. 4). Seven patients (28%) were children aged 2 to 10 years old. Abducens palsies were most common (68%) and the most common ocular presentation was diplopia (76%) with an average time of onset 15 days from testing positive to COVID-19 or having symptoms of the virus. Proposed mechanism of development of a neurogenic palsy secondary to COVID-19 infection was classified into one of three categories: vascular/thrombotic, a viral neuro-invasive or inflammatory virus-mediated immune response. This study suggests that COVID-19 infection may be linked to oculomotor, trochlear and abducens nerve palsies and the underlying mechanisms may vary but are difficult to definitively establish. Further studies investigating the onset of neurogenic palsy secondary to COVID-19 infection is required.

Concepts Keywords
Covid Abducens nerve palsy
January COVID-19
Medline diplopia
Old neuro-ophthalmological complications
Viral oculomotor nerve disease
oculomotor nerve palsy
ophthalmoplegia
SARS-CoV-2 infection
trochlear nerve palsy

Semantics

Type Source Name
disease MESH COVID-19
disease VO document
disease MESH infection
drug DRUGBANK Methionine
disease MESH Abducens palsies
disease MESH diplopia
disease VO time
disease IDO immune response
disease MESH complications
disease MESH oculomotor nerve disease
disease MESH ophthalmoplegia
pathway REACTOME SARS-CoV-2 Infection
disease MESH trochlear nerve palsy

Original Article

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