Herpetic anterior uveitis following COVID-19 vaccines: a case series

Muriel Ott; Thanoosha Nagamany; Souska Zandi; Francesco Pichi; Aniruddha Agarwal; Ester Carreño; Vishali Gupta; Dilraj S Grewal; Emmett T Cunningham; Marion R Munk

doi:10.3389/fmed.2023.1242225

Herpetic anterior uveitis following COVID-19 vaccines: a case series

Front Med (Lausanne). 2023 Sep 22:10:1242225. doi: 10.3389/fmed.2023.1242225. eCollection 2023.

Authors

Muriel Ott¹, Thanoosha Nagamany¹, Souska Zandi¹, Francesco Pichi^{2

3}, Aniruddha Agarwal^{2

3

4}, Ester Carreño⁵, Vishali Gupta⁶, Dilraj S Grewal⁷, Emmett T Cunningham^{8

9

10}, Marion R Munk^{1

11

12}

Affiliations

¹ Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States.
³ Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates.
⁴ Department of Ophthalmology, Maastricht University Medical Center, Maastricht, Netherlands.
⁵ Department of Ophthalmology, University Hospital Fundación Jimenez Diaz, Madrid, Spain.
⁶ Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁷ Department of Ophthalmology, Duke University, Durham, NC, United States.
⁸ Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, United States.
⁹ Department of Ophthalmology, School of Medicine, Stanford University, Palo Atlo, CA, United States.
¹⁰ The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, United States.
¹¹ Augenarzt-Praxisgemeinschaft Gutblick AG, Pfäffikon, Switzerland.
¹² Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.

Abstract

Purpose: To report a case series of herpetic uveitis following COVID-19 vaccinations.

Methods: Demographic, clinical and treatment-related data of herpetic anterior uveitis cases was collected at five tertiary eye hospitals between January 2021 and June 2022. A retrospective database review at one of the centers comparing the number of cases of herpetic eye disease before and after the introduction of COVID-19 vaccination was performed as well.

Results: Twenty-four patients (9 female, 15 male) with a mean age of 54 years (range 28-83 years) were diagnosed with herpetic uveitis, reporting an onset of symptoms 3-42 days after the first, second or third dose of COVID-19 vaccination. Median time between vaccination and onset of herpetic eye disease was 10 days (mean 12.7 ± 10.15 days) days. The administered vaccines were BNT162b2, mRNA-1273, BBIBP-CorV and Ad26.COV2.S. The cases included 11 HSV, 10 VZV and 1 CMV anterior uveitis, 2 were not further specified. There was an equal number of first episodes (n = 12, 50%) and recurrent episodes (n = 12, 50%). Response to established regimens was generally good. The retrospective database review revealed the exact same incidence of herpetic uveitis during the pandemic and ongoing vaccination compared to prior SARS-CoV-2.

Conclusion: This report includes 24 cases of herpetic anterior uveitis in a temporal relationship to various COVID-19 vaccines. This study supports the potential risk of herpetic eye disease following COVID-19 vaccines, but proof of a direct, causal relationship is missing.

Keywords: COVID-19 vaccines; SARS-CoV-2 vaccination; herpes zoster ophthalmicus; herpetic eye disease; keratitis; mRNA vaccination; ocular herpes simplex; uveitis.