An eye to the future: Acute and long‐term neuro‐ophthalmological and neurological complications of COVID‐19

Abstract

AbstractCOVID‐19 has had a significant impact on the global population and has produced compelling evidence of non‐pulmonary organ dysfunction, including the nervous system. It is vital that specialists in ophthalmology and neurology are informed of the potential complications of COVID‐19 and gain a deeper understanding of how COVID‐19 can cause diseases of the nervous system. In this review we detail four possible mechanisms by which COVID‐19 infection may result in neurological or neuro‐ophthalmological complications: (1) Toxic and metabolic effects of severe pulmonary COVID‐19 disease on the neural axis including hypoxia and the systemic hyper‐inflammatory state, (2) endothelial dysfunction, (3) dysimmune responses directed again the neuroaxis, and (4) direct neuro‐invasion and injury by the virus itself. We explore the pathological evidence for each of these and how they may link to neuro‐ophthalmological disorders. Finally, we explore the evidence for long‐term neurological and neuro‐ophthalmological complications of COVID‐19, with a focus on neurodegeneration.