Researchers in New Zealand have reported a rare case of a woman who experienced white dot syndrome post COVID-19 vaccination and had subsequent infection from the virus.

Both the conditions have, so far, occurred separately in 15 cases worldwide, according to the team at the University of Auckland in New Zealand.

In the report, published in the Journal of Ophthalmic Inflammation and Infection, they report the case of a 28-year-old healthy woman who was diagnosed with multiple evanescent white dot syndrome (MEWDS) after complaining of vision problems just two days after receiving her second dose of the Pfizer-BioNTech vaccine.

MEWDS, first described in 1984, is an idiopathic inflammatory disease of the outer retina that is thought to be a transient, viral-induced autoimmune reaction.

Though the pathogenesis is not fully understood, it has been associated with a flu-like prodrome and has also been reported following a number of vaccinations including hepatitis A, B, human papillomavirus (HPV), influenza, measles-mumps-rubella, varicella virus, rabies, yellow fever in addition to the COVID-19 vaccine.

The woman’s symptoms included dark blind spots, phantom light flashes, and overall decreased vision all specific to her right eye, said the researchers in the paper.

The team noted that the woman started showing symptoms in her right eye two days after receiving the second dose of COVID vaccination.

Symptoms included right central scotoma (blind spot in the middle of your visual field), photopsia ( floaters, flashes, or flickering lights in the eye and decreased vision.

Upon testing the doctors discovered that the vision in her right eye went from 20/20 to 20/50, meaning she could see something at 20 feet that someone with average eyesight could see at 50 feet.

In addition, her eye tissue was torn, optic nerves were swollen, and multiple pale-coloured lesions were scattered throughout the back of her eye. But, her symptoms resolved without treatment over a three month period with a final visual acuity of 20/20 in the affected eye.

She had no ocular manifestations following the first or third COVID-19 vaccination. Routine blood workup at the time of infection including full blood count, renal function, CRP, HbA1c was negative, the researchers said.

However, a year later, the patient again represented with similar symptoms, but in the left eye and was again diagnosed with MEWDS. 

Interestingly, seven days following symptom onset, the patient tested positive for COVID infection, after developing mild coryzal symptoms and two days of fever.

Her lab test which included full blood count, renal function, CRP, HbA1c, serum ACE, HLA-B27 cell surface marker, hepatitis screen and HIV were all negative. Furthermore, an MRI brain also turned out to be normal.

No hospitalisation or treatment was required, and the symptoms resolved over a 9 month period, with a final visual acuity of 20/25 in the affected eye. She has not had further recurrences, despite receiving the annual influenza vaccination, the researchers said.

“There have been 15 reported cases of MEWDS following COVID vaccination and at least 3 following COVID infection. However, to the best of our knowledge, this is the first case of recurrent MEWDS following both COVID-19 vaccination and subsequent infection,” said Hannah W. Ng, from the varsity,.

“It would be prudent for clinicians to monitor susceptible patients, especially those who have had uveitis following COVID-19 vaccine, to be monitored for ocular disease in the event of subsequent COVID-19 infection,” she added.