Features of primary and recurrent herpetic keratitis after vaccination against COVID-19 infection

Abstract

Purpose

To evaluate the features of primary and recurrent herpetic keratitis (HK) after vaccination against COVID-19

Setting

State Institution "The Filatov Institute of eye diseases and tissue theraphy NAMS of Ukraine†, Odessa

Methods

34 eyes of 31 patients with HK developed after vaccination against COVID-19 infection were analysed. Patients were divided into two groups: 1 - with primary HK (9 eyes, 9 patients) and 2 - with recurrent HK after vaccination (25 eyes, 22 patients). According to the medical records, the following vaccines were received: CoronaVac - 9 patients, Pfizer - 11, AstraZeneca - 8, Sinovac - 2, Moderna - 1. In the venous blood of patients the levels of IgG antibodies to coronavirus spike protein; herpes virus type 1/2, Herpes Zoster virus, Cytomegalovirus, Epstein-Barr virus, and total vitamin D were determined.

Results

In both groups, stromal non-necrotizing keratitis was the most common (in primary HK in 62.5% of cases and in recurrent HK in 84% of cases, p=0.01). 6 patients (24%) had bilateral form of recurrent HK. In 84.2% of all patients the vitamin D level was reduced and averaged (24.4 ± 8.5) ng/ml. The increased levels of IgG to HSV1-2 was detected in 86.5% , to Epstein-Barr virus - in 96.4% , to Herpes Zoster- in 92% , to cytomegalovirus - in 88.8% of patients. S-protein levels were higher than normal in all 100% of the examined patients in both groups.

Conclusions

Vaccination against COVID-19 with various vaccines can be a trigger for activation of the herpes virus with the development of both primary and recurrent HK, including bilateral eye lesions. Especially for patients with a history of HK, ophthalmologists should warn about possible ocular side effects of vaccination and advise to monitor changes in the eyes after vaccination. Patients may be advised to self-manage their vision and ocular symptoms for weeks after vaccination and report any changes immediately.