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Uvéites associées au COVID-19 : Profils cliniques, défis diagnostiques et prise en charge

The aim of the study is to evaluate the clinical presentation, prevalence, and management outcomes of uveitis associated with COVID-19, highlighting diagnostic challenges in a real-world setting.

A retrospective review of patients diagnosed with COVID-19-associated uveitis at the S.V. Malayan Eye Center's Cornea and Uveitis Department, Yerevan, Armenia, from May 2020 to December 2023. Inclusion criteria included confirmed SARS-CoV-2 infection (RT-PCR/serology) and ocular findings consistent with uveitis. Ophthalmic evaluations included slit-lamp biomicroscopy and funduscopy. Due to patients’ financial limitations, OCT was selectively performed, meanwhile fluorescein angiography (FA) was unavailable. Diagnostic workups ruled out other causes. Treatment responses and visual outcomes were analyzed.

Of 27 patients (mean age 43; range 28–72), 81% were female, with all having confirmed COVID-19 infection. The mean time from SARS-CoV-2 diagnosis to uveitis onset was 5.1 weeks. All cases presented with bilateral anterior nongranulomatous uveitis. Ocular symptoms included eye pain, redness, photophobia, and blurred vision. Fine pigmented keratic precipitates and pigmented cells resembling a pigment storm in 67% of patients. Two patients showed sectoral iris 

Patients were treated with topical corticosteroids and cycloplegics; no systemic steroids were needed. Visual acuity improved to 20/20 in 90% of patients within 4 weeks, with no recurrences during 6-month follow-up. COVID-19-associated uveitis accounted for 12.5% of all uveitis cases seen during this period.

COVID-19-associated uveitis predominantly presents as bilateral anterior nongranulomatous uveitis with unique findings, emphasizing the importance of a detailed clinical history for diagnosis. Timely treatment with topical corticosteroids leads to excellent outcomes. Further research is needed to clarify mechanisms and optimize management.