Patients more severely affected by COVID-19 have been reported to be more at-risk of developing ocular manifestations. Researchers in Paris recently shared their work in Radiology on globe MRI abnormalities in these patients. Previously, the literature had only analyzed orbital MRI abnormalities.

The study assessed nine patients (one woman and eight men, mean age 56) with globe MRI abnormalities obtained from a multicenter cohort of 129 patients presenting with more severe cases of COVID-19. Eight of the nine patients were hospitalized in the ICU. Compared with this larger cohort, the researchers noted that the nine patients under review had one or several hyperintense nodules of the posterior pole of the globe on FLAIR-WI MRI. Five patients had bilateral fluid filling of the mastoid cells. The researchers highlighted that no patient had optic nerve, optic chiasm or optic tract abnormalities.

All nine patients had nodules in the macular region, eight had bilateral nodules and two had nodules outside the macular region. “These extra-macular nodules were not visible in the three patients who underwent ophthalmological examination,” the researchers noted. “This might be due to a lack of sensitivity of the clinical examination, which was difficult to perform in patients with severe COVID-19 or to the delay between the completion of the MRI examination and the ophthalmological examination.”

Severe eye problems might largely go unnoticed as patients with COVID-19 are often treated in ICUs for much more severe, life-threatening conditions. The researchers advocate for screening and follow-up of these patients to provide appropriate treatment and improve the management of potentially severe ophthalmological manifestations.

Lecler A, Cotton F, Lersy F, et al. Ocular MRI findings in patients with severe COVID-19: a retrospective multicenter observational study. Radiology. February 16, 2021. [Epub ahead of print].