Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy.
Exam and biomarker models accurately predict persistent eye symptoms after COVID-19.
Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy.
COVID-19 does not require hospitalization in most cases, but post-acute sequelae can persist and are a public health concern.
In a prospective cross-sectional study, we examine persistent ocular symptoms (persistent ocular symptoms) emerging in non-hospitalized individuals after COVID-19, with individuals without persistent ocular symptoms post-recovery as controls.
Using symptom and quality of life data, clinical examinations and biofluid proteomics, we document ocular symptoms persisting from 3 months up to 3 years post-infection.
Persistent ocular symptoms lead to significant vision disability and are linked to clinical findings not detectable in routine exams but only with specialized tests.
We report a tear film proteomic profile consistent with severe COVID-19, chronic dysregulation of CD4 + T cell regulatory activity, upregulation of ITGB6, NFASC, CTGF, TPSAB1 and CKMT1A-CKMT1B, pupil dysfunction correlating with elevated JUN, and dendritic/T cell dysregulation correlating with elevated ANGPTL2, SKAP2 and DAPP1 levels.
Diagnostic models based on clinical examinations with or without biomarkers predict persistent ocular symptoms with 77-91% accuracy and implicate chronic T cell-mediated neuroinflammation in the pathogenesis of persistent ocular symptoms, a debilitating syndrome arising after COVID-19 recovery and characterized by strabismus, ocular dysautonomia and peripheral ocular neuropathy.