Location
Suwanee, GA
Start Date
10-5-2021 12:00 AM
End Date
13-5-2021 12:00 AM
Description
A 27-year-old female presents to the emergency room with acute onset horizontal binocular diplopia and a history of COVID-19 infection two weeks prior. She has a history of longstanding intermittent right esotropia. Before her COVID-19 infection she only had diplopia after extended reading and typically sees clearly. After the infection, she has constant double vision which started acutely and worsened over several hours. Her only other symptom at the time was increased fatigue. During examination of eye tracking, there was a left esotropia when looking left and a right esotropia when looking right. She was discharged with a Medrol Dosepak for 6th nerve palsy with follow up as needed. Around 3 weeks later, she presented to the optometrist with horizontal diplopia. Diplopia has been stable and constant since her visit to the emergency department 3 weeks prior. On physical examination, an alternating esotropia greater than 45 prism diopters in primary gaze was found with the cover-uncover test. She was diagnosed with alternating esotropia after decompensation of an intermittent esotropia in the right eye. Three weeks later during follow up, she reports a gradual and small improvement of the diplopia in her near vision with little to no improvement of the diplopia for her distance vision.
Conclusion and significance: COVID-19 has neurotropic effects which can result in decompensation for patients with strabismus. Understanding the neurological manifestations of the disease may help in the recognition and diagnosis while promoting the need for targeted therapeutics. This is the first reported case we are aware of with decompensated strabismus due to COVID-19.
Embargo Period
6-3-2021
Strabismus decompensation as a possible neurological manifestation of COVID-19: A case report
Suwanee, GA
A 27-year-old female presents to the emergency room with acute onset horizontal binocular diplopia and a history of COVID-19 infection two weeks prior. She has a history of longstanding intermittent right esotropia. Before her COVID-19 infection she only had diplopia after extended reading and typically sees clearly. After the infection, she has constant double vision which started acutely and worsened over several hours. Her only other symptom at the time was increased fatigue. During examination of eye tracking, there was a left esotropia when looking left and a right esotropia when looking right. She was discharged with a Medrol Dosepak for 6th nerve palsy with follow up as needed. Around 3 weeks later, she presented to the optometrist with horizontal diplopia. Diplopia has been stable and constant since her visit to the emergency department 3 weeks prior. On physical examination, an alternating esotropia greater than 45 prism diopters in primary gaze was found with the cover-uncover test. She was diagnosed with alternating esotropia after decompensation of an intermittent esotropia in the right eye. Three weeks later during follow up, she reports a gradual and small improvement of the diplopia in her near vision with little to no improvement of the diplopia for her distance vision.
Conclusion and significance: COVID-19 has neurotropic effects which can result in decompensation for patients with strabismus. Understanding the neurological manifestations of the disease may help in the recognition and diagnosis while promoting the need for targeted therapeutics. This is the first reported case we are aware of with decompensated strabismus due to COVID-19.