Dear Editor,
We read the interesting letter by Ish et al.[1] on facial nerve palsy after the COVID-19 vaccination. However, we have a few important observations and suggestions to make which we feel will be beneficial for all the ophthalmologists.
First, the authors have associated facial nerve palsy directly with the COVID-19 vaccination in a patient with no systemic features. The important question is whether the authors performed MRI/CT[2] to rule out other causes of facial nerve palsy as imaging is mandated in idiopathic Bell’s palsy patients before reaching a definitive etiological diagnosis for the same. Moreover, introspecting the images closely, lagophthalmos, ectropion, and congestion were not evident. A better image would have provided more clinical clues.
Second, the patient was referred to an ENT specialist, who ruled out auditory involvement. However, did the authors rule out other cranial nerves involvement as these patients can also present with multiple cranial nerve palsy features?[3] It is also important to rule out the involvement of 5th nerve by examining corneal sensations in this patient.
Third, we feel that before labeling it as a COVID-19 vaccination adverse effect, the COVID-19 test should have been performed as it could have been a subclinical COVID-19 manifestation[4]. Moreover, the patient did not present with any of the prodromal features, such as fever, myalgia, and fatigue after the COVID-19 vaccine as has been noticed in the majority of the subjects taking the vaccine.
Lastly, before starting steroids, the patient’s blood sugar, pressure, and other systemic parameters should have been documented. In addition, as other viral causes (HSV, HZV, and EBV) were not ruled out, the antiviral cover could have been started. Shemer et al.[5] in their case-control analysis of 37 patients concluded that there was no association of facial nerve palsy with COVID-19 vaccination, but this cannot be generalized. As per the majority of reports, it appears to be more of a coincidence. Once again, we congratulate the authors for enlightening us with this rare clinical presentation after the COVID-19 vaccination.
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Conflicts of interest
There are no conflicts of interest
Acknowledgements
Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry.
References
- 1.Ish S, Ish P. Facial nerve palsy after COVID-19 vaccination-A rare association or a coincidence. Indian J Ophthalmol. 2021;69:2550–2. doi: 10.4103/ijo.IJO_1658_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 5.Shemer A, Pras E, Einan-Lifshitz A. Association of COVID-19 vaccination and facial nerve palsy:A case-control study. JAMA Otolaryngol Head Neck Surg. 2021;147:739–43. doi: 10.1001/jamaoto.2021.1259. [DOI] [PMC free article] [PubMed] [Google Scholar]