Update on coronavirus disease and retinal artery occlusion

Background: The novel coronavirus disease 2019 (COVID-19) is significant not only for its life-threatening impact, but also for its association with serious eye disorders, including retinal artery occlusion. This language-inclusive narrative review analyzed the available clinical literature on retinal artery occlusion linked to COVID-19, highlighting it as a serious vision-threatening complication of this disease during the recent pandemic. Methods: A targeted literature search was conducted in the PubMed / MEDLINE and Google Scholar databases from January 1, 2020, to January 1, 2025, to gather the most recent evidence. Studies were identified through various combinations of the following search terms: “eye diseases in COVID-19,” “ocular findings,” “ocular manifestations in COVID-19,” “posterior segment alterations in COVID-19,” and “retinal artery occlusion in COVID-19.” Articles with relevant clinical significance were selected for review. The reference lists of these papers also manually checked for other relevant papers. We included case reports, case series, and both prospective and retrospective studies that reported cases of central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) in patients of any age, sex, and race with confirmed COVID-19. Results: We found 27 records, of which 21 reported cases of CRAO in patients with COVID-19. The mean (standard deviation) age of these patients was 54.1 (13.4) years (range: 30–77 years). Off the 21 patients, 18 (86%) were men and three (14%) were women. In three cases, bilateral involvement was noted; in one such instance, CRAO was diagnosed sequentially: in the left eye while the patient had COVID-19, and in the right eye 1.5 months later. Among the cases of unilateral CRAO, the left eye was the most frequently affected. Additionally, four cases of BRAO were reported in patients with COVID-19, with most of these patients being women. Most of these cases were diagnosed in the left eye within 1 month of a COVID-19 diagnosis. Notably, in the majority of cases involving CRAO or BRAO, vascular thromboembolic events were not reported. Additionally, two case series reported a total of 17 patients with COVID-19 who were diagnosed with CRAO. Conclusions: Although strong evidence of a causal relationship is lacking, healthcare specialists should be aware that CRAO or BRAO may be ocular complications of COVID-19. This is particularly important with the emergence of new subvariants of SARS-CoV-2 and in asymptomatic patients, and considering the availability of rapid viral antigen tests will make it easier to check if the patient with CRAO or BRAO actually have asymptomatic COVID-19.