Ocular findings of Multisystem Inflammotary Syndrome in children with COVID-19

Author: Semra Tiryaki Demir (Turkey)

Co-authors: İmran Arkan

Purpose

Severe acute respiratory syndrome coronavirus 2 continues to spread worldwide. Although children typically have a mild course of coronavirus disease 2019 (COVID-19) symptoms compared to adults, a multisystem inflammatory syndrome in children (MIS-C) with a more severe course has been shown to be associated with COVID-19. Gastrointestinal, cardiovascular, hematologic, mucocutaneous and respiratory symptoms are more common in patients with MIS-C. It has also been reported that MIS-C patients may develop conjunctivitis in their eyes. Apart from conjunctivitis, it is not known exactly which pathologies MIS-C can cause in the eye. In this study, the ocular findings of two cases diagnosed with MIS-C in the Pediatric Infectious Diseases Department were examined.

Setting/Venue

Case Series

Methods

Case 1, 8 years-old male patient presented with a complaint of floaters in the right eye. Fundus examination revealed a splinter retinal hemorrhage around the optic nerve in the right eye, and there was no pathology in the fundus of the left eye. Optical coherence tomography (OCT) imaging revealed several vitritis-like hyperreflective dots in the posterior vitreous the right eye. At the follow-up three weeks later, the splinter retinal hemorrhage around the optic nerve in the right eye regressed, and that there was regression in the vitritis-like hyperreflective dots detected by OCT. Case 2, 10 years-old female patient presented with the complaint of conjunctival hyperemia and periorbital rash in both eyes. Biomicroscopic examination revealed non-purulent conjunctivitis in both eyes. Fundus examination revealed dilatation and minimal tortuous increase in the retinal arteries and veins in both eyes. OCT imaging revealed several vitritis-like hyperreflective spots in the posterior vitreous in both eyes. It was found that conjunctivitis regressed spontaneously in the follow-up three days later. In the follow-up after 2 weeks, it was found that dilatation and tortuosity in the retinal arteries and veins decreased in both eyes, and that there was minimal regression in the vitritis-like hyperreflective dots detected by OCT.

Results

While no pathology was observed in the anterior segment examination in Case 1, non-purulent conjunctivitis and resemble Kawasaki disease periorbital rash on the eyelids were detected in Case 2. Fundus examination revealed a splinter retinal hemorrhage around the optic nerve in only one eye in Case 1, and dilatation and minimal tortuous increase in the retinal arteries and veins in both eyes in Case 2. In the OCT imaging of both cases revealed vitritis-like hyperreflective dots in the posterior vitreous. In the short-term follow-up of the cases, it was found that the vitritis-like hyperreflective dots detected with OCT continued despite the decrease in only case 2, and other ocular findings regressed in both cases.

Conlusions

Various eye findings affecting both the anterior and posterior segments of the eye may develop in patients with MIS-C. Although most ocular findings regress in a short time, their long-term effects are unknown. Future studies with larger sample sizes will be needed.

Financial Disclosure

None

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