Ocular and optic nerve complications following SARS-CoV-2 infection and vaccination

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affects the respiratory system but can also involve multiple organs, including the often-overlooked ocular system. An increasing number of population-based and retrospective case series studies have reported that ocular and neuro-ophthalmic complications are temporally associated with COVID-19 infection and vaccination. Furthermore, some data suggest a modest increase in ocular adverse events (OAEs) following infection or vaccination, particularly among individuals with autoimmune or pre-existing ocular conditions. The proposed immune-mediated mechanisms include immune responses following vaccination that may contribute to demyelination through molecular mimicry, a phenomenon in which antigens share structural or functional similarities with host self-antigens. In this review, we summarize studies published between 2019 and June 2025, retrieved from PubMed and Google Scholar databases. Studies were selected based on their clinical relevance and contribution to the understanding of OAEs in the context of SARS-CoV-2 infection and COVID-19 vaccination. Thematic tables highlight the clinical spectrum of reported ocular manifestations, ranging from common conditions such as uveitis, optic neuritis, retinal vascular occlusions, and cranial nerve palsies to rarer entities, including acute macular neuroretinopathy, thyroid eye disease, and papillophlebitis. This review presents recent evidence on the proposed pathophysiological mechanisms and risk profiles of COVID-19-related OAEs, with the aim of improving awareness, promoting timely ophthalmic evaluation, and supporting surveillance and future research to clarify causality and inform preventive strategies.