Table 4.

Review of literature of neuro-ophthalmic manifestations of COVID-19

Study	Type	Location	Age (years)	Sex	Duration between COVID-19 symptoms/diagnosis and ophthalmic symptoms (days)	Covid illness	Signs	Diagnosis	Management	Outcome
Insausti- Garcia et al.[52]	Case	Spain	40	M	42	Mild	Va- 20/200. Dilated tortuous retinal vessels, disc edema, superficial retinal hemorrhages, cotton wool spot, macular edema	Papillophelbitis	Intravitreal dexamethasone implant	Decreased disc and macular edema, Va- 20/40
Sawalha[54]	Case	USA	44	M	7	Mild	OD 20/200, OS 20/20, OD RAPD, superior arcuate VF defect	OU optic neuritis	IVMP 1 g daily for 5 days, followed by oral in tapering doses	Remarkable improvement in Va in OD, complete recovery in OS
Zhou[55]	Case	USA	26	M	Concurrent	Mild	OU vision loss, OD HM, OS 20/250, disc edema, retinal haemorrhage	MOG-Ab associated ON in the setting of COVID19- parainfectious demyelinating	IVMP, oral steroids	3 weeksdramatic improvement in vision, resolution of disc edema
Mendez Guerrero et al.[56]	Case	Spain	58	M	36	Severe	Roving eye movements, opsoclonus, ‘round the house’ sign	Acute hypokinetic rigid syndrome	Nil	Spontaneous improvement
Ortiz-Seller et al.[57]	Case	Spain	51	F	2	Mild	OU- 20/25, OU poorly reactive pupil. Pupillary dilatation in bright illumination, light near dissociation. OU hypersensitive response with pupillary constriction to 0.1% pilocarpine. Fundus- multiple, white yellowish placoid lesions in posterior pole and mid peripheral retina.	OU inflammary chorioretinal disease with Adie’s syndrome possibly associated with COVID-19	Oral prednisolone	Full visual, anatomical and functional recovery in first week. 3 months- BCVA- 20/20
Dinkin et al.[59]	Case	USA	36	M	4	Mild	OS partial 3rd nerve palsy, lower limb hyporeflexia, gait ataxia, right abduction defect, lower limb paraesthesia, areflexia	MFS	IVIG	Significant improvement
Gutierrez- Ortiz[60]	Case	Spain	50	M	5	Mild	Vertical diplopia, broad based gait, absent deep tendon reflexes, right hypertropia, limitation of ocular movements, right internuclear ophthalmoplegia, right fascicular oculomotor nerve palsy	MFS	IVIG	Significant improvement
Greer[61]	Case	USA	43	F	3	Mild	Horizontal diplopia	6th nerve palsy
Greer et al.[61]	Study	USA	52	M	Concurrent	Mild	Horizontal diplopia	6th nerve palsy		Resolved in 6 days
Dinkin et al.[59]	Case	USA	71	F	Concurrent	Moderate, hospital admission	Abduction limitation of OD	Cranial nerve palsy	HCQ	2 weeks- gradual improvement
Gutierrez-Ortiz et al.[60]	case	Spain	39	M	3	Mild	OU 6th nerve palsy, absent deep tendon reflexes	Multiple cranial nerve palsy		2 weeks- recovered
Falcone et al.[62]	case	USA	32	M	3	Severe	Horizontal diplopia	6th nerve palsy	HCQ	Persistent limitation of abduction
Belghmaidi et al.[63]	case	Morocco	24	F	1	Mild	Diplopia, OS restricted upgaze, adduction and downgaze	Incomplete 3rd nerve palsy, pupil sparing	HCQ, azithromycin	6th day- complete recovery
Theophanous et al.[64]	Case	USA	6	M	Initial	Mild	Lagophthalmos	Bell’s palsy	IV acyclovir, IVIG, lubricating eye drops, oral steroids	3 weeks- improvement
Assini et al.[65]	Letter to editor	Italy	55	M	20	Severe	Bilateral ptosis, dysphagia, dysphonia, bilateral paralysis of 12th nerve, hyporeflexia	Bilateral ptosis with GBS	IVIG	5th day onwards- complete remission
Huber et al.[66]	Case	Germany	21	F	21	Mild	Intermittent diplopia, OD ptosis, limited upgaze, Cogan’s lid twitch. ice test negative, Tensilon positive	Ocular MG	IVIG, oral pyridostigmine	Improvement
Cyr et al.[67]	Case	USA	61	M	5	Mild	OU no PL	Acute OU occipital territorial ischemic infarct		Expired- 3 days
			34		7	Severe	PL+, OU pallor of optic disc	Occlusion of right MCA, CVA
Yang et al.[68]	Case	UK	60	M	Not specified, delayed	Mildmoderate	OD HMCF. Diplopia, vertical gaze palsy central and superior field loss, vertigo, unsteady gait	Bilateral supranuclear gaze palsy, left paramedian midbrain infarct, OD BRAO	High dose aspirin, apixaban, antibiotic for bacterial endocarditis	Gradual improvement

anti-MOG: anti-myelin oligodendrocyte glycoprotein, BCVA: best corrected visual acuity, BRAO: branch retinal artery occlusion, CKD: chronic kidney disease, COPD: chronic obstructive pulmonary disease, CVAcerebrovascular accident, F: female, FC: finger counting, GBS: Guillain-Barré syndrome, HM: hand movement, IVIG- intravenous immunoglobulin, IVMP: intravenous methylprednisolone, M: male, MCA: middle cerebral artery infarct, MFS: Miller Fischer syndrome, MG: myasthenia gravis, OD: Right eye, OPL: outer plexiform layer, OS: Left eye, OU: bilateral, PL: perception of light, RAPD: relative afferent pupillary defect, SLE: systemic lupus erythematosus, Va: visual acuity, VF: visual fields