Possible endophthalmitis and COVID-19 link found

Researchers are investigating a possible link between coronavirus disease 2019 (COVID-19) and endophthalmitis. In just 2 months, 3 COVID-19 patients at New York’s Northwell Health Hospital developed profound vision loss as a result of keratitis that developed into endophthalmitis. In the course of treatment, 1 patient’s eye had to be removed.

Results of the retrospective review were released at the American Academy of Ophthalmology (AAO) 2020 Virtual conference. Researchers hope findings will encourage more support from within the medical community for eye evaluations when assessing the role of anti-infectious treatments.

The occurrence of keratits leading to rapid perforation and endophthalmitis is exceeding rare, and the appearance of 3 cases over the course of 2 months in New York, a coronavirus epicenter, has caused many to take note and investigate, researchers say in a statement.¹

Typically, in the rare instances where keratitis leads to endophthalmitis, it is associated with surgery or trauma.

Amilia Schrier, MD, reports all 3 endophthalmitis patients were in their 60s; hail from Manhattan, Brooklyn, and Long Island; and presented to the Northwell Health Ophthalmology Department within the same 2-month period, positive with COVID-19. Of the 3, 2 were outpatients and 1 was in the hospital at the time of the keratitis diagnosis. One of the outpatients later died at a hospital. Each patient’s culture results came back with a different organism: Streptococcus pneumoniae, Serratia marcescens, and Candida parapsilosis.

“The incidence of keratitis progressing to endophthalmitis is extremely low,” Dr. Schrier says. “A 2012 study reported only 27 out of 9,934 eyes in a 15-year period experienced endophthalmitis caused by keratitis.² Seeing 3 of these cases in a 2-month period with COVID-19 positivity suggests that there may be an association between COVID-19 infection and severe eye disease.”

Sonal S. Tuli, MD, offers a different perspective, suggesting further research and caution be taken when interpreting the results.

“The findings do not suggest that COVID-19 causes endophthalmitis but that there is some relationship between the 2,” Tuli says in a statement. “It is possible that some aspect of the health of these individuals made them more liable to get infected with COVID-19 as well as a severe infection in their eye, such as a poor immune system or nutritional deficiencies. It is also possible that these findings are incidental because of the large numbers of COVID positive patients presenting to New York hospitals during the peak of the pandemic in New York.”¹

References

1.Newswire.New Study Finds Possible Link Between Sight-Threatening Eye Infection and Coronavirus. 2021 February 8;Available at:https://www.newswise.com/coronavirus/new-study-finds-possible-link-between-sight-threatening-eye-infection-and-coronavirus. Accessed 2/2/21.

2. Henry CR, Flynn HW Jr, Miller D, Forster RK, Alfonso EC. Infectious keratitis progressing to endophthalmitis: a 15-year study of microbiology, associated factors, and clinical outcomes. Ophthalmology. 2012;119(12):2443-2449.