Central Retinal Vein Occlusion in COVID-19

Central retinal vein occlusion (CRVO) secondary to severe acute respiratory syndrome coronavirus 2–induced coagulation abnormalities is rare. A 32-year-old man presented with bilateral CRVO. He had a history of retinal migraine with occasional floaters and received 2 primary and a booster dose of the BNT162b2 vaccine 7 months prior. Four months before presentation, he developed acute blurring of vision in the left eye and was diagnosed with a nonischemic CRVO with dot-blot hemorrhages. He was managed conservatively with aspirin. Three weeks later, he contracted COVID-19 and received 5 days of nirmatrelvir/ritonavir. Four weeks after his COVID infection, repeat fundoscopic evaluation demonstrated resolving hemorrhages in the left eye but a new CRVO in the right eye. Antivascular endothelial growth factor injections were deferred because of normal visual acuity. He had a normal magnetic resonance imaging of the brain and a normal bilateral carotid duplex and was planned for close follow-up with ophthalmology. COVID-19 patients presenting with visual symptoms should be screened for CRVO.