Uveitis following mRNA COVID-19 vaccination: Is it real?

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Uveitis is a rare adverse effect of vaccines. Awareness of potential reactions to vaccines is important, as is reporting occurrences to adverse drug reaction registries. Case reports on drug interaction are the first indication that a drug is causing an adverse reaction. However, these reports have limitations in providing information on the clinical features, clinical course, outcome, the existence of concomitant systemic disease, and other potential contributing factors. Unfortunately, the interval between vaccination and the onset of uveitis has a wide range in the reported cases, from a few days to a number of years. At present, based on the evolution of COVID-19 vaccines and the evolving data on their adverse reactions, no casualties have been reported till date. With the massive rollout of COVID-19 vaccines worldwide, there is a very low incidence of its adverse effects. Till date, there is no evidence that suggests that individuals should avoid COVID-19 vaccines due to ocular inflammation.[1] Various hypotheses have been proposed for vaccine-associated uveitis. This includes molecular mimicry secondary to a resemblance between vaccine peptide fragments and uveal self-peptides, delayed-type hypersensitivity with deposition of immune complexes, and an immune reaction to vaccination adjuvants.[2,3] Adjuvants are often added to the vaccines to potentiate their effect on innate and adaptive immune systems. Though it is safe and effective, in a small section of the population, the administration of these adjuvants can lead to an autoimmune or inflammatory syndrome. In COVID-19 mRNA vaccines, the adjuvants stimulate innate immunity through endosolic or cytoplasmic nucleic acid receptors.[4] Due to an altered nucleic acid metabolism and processing, several connective tissue diseases may trigger an immune response following immunization. Leibowitz et al.[5] have reported that uveitis and autoimmune diseases have a systemic overlap. Thus, the development of uveitis following vaccination may indicate an undiagnosed autoimmune disease. This also indicates that there is a need for evaluation of inflammatory disease in individuals who develop ocular inflammation following COVID vaccination. Though local injection site reactions are common after vaccinations, systemic adverse effects can occur after the administration of mRNA COVID-19 vaccines. These include fatigue, fever, chills, headache, and myalgias. Serious adverse effects like anaphylaxis have been reported after m RNA COVID-19 vaccine administration.[6] Also, myocarditis and pericarditis after mRNA COVID-19 vaccination have been reported in the Vaccine Adverse Event Reporting System. Most cases are in male adolescents, typically within several days of COVID-19 vaccination and, more commonly, after the second dose.[7] Gulia Renisi et al.[8] have reported a case of anterior uveitis in a 23-year-old male. Symptoms occurred 14 days after the second dose of BNT162b2 COVID-19 vaccine. Initial symptoms were pain, photophobia, and red eye. Visual acuity was completely restored, and the ocular inflammation resolved after a 10-day treatment course of topical steroids and cycloplegic eye drops. Testi et al.[9] have reported in their multinational study that there was a short duration following vaccination and the onset of ocular inflammation. Seventy patients presented with ocular inflammatory events within 14 days following COVID-19 vaccination. The most common were anterior uveitis (58.6%), posterior uveitis (12.9%), and anterior scleritis (10.0%). The number of ocular events following mRNA COVID-19 vaccination was higher.[9] Treatment of the ocular inflammation included topical corticosteroids (55.7%), systemic corticosteroids (18.6%), antivirals (8.6%), and topical corticosteroids with oral nonsteroidal anti-inflammatory drugs (2.8%). Ten patients (14.3%) did not require any treatment.[9] Finally, if there are systemic adverse events after COVID-19 vaccination, physicians should be aware of the possibility of eye inflammation following vaccination.[10] Even if there is a possibility of a causal association, most of the ocular events are mild and have a good visual outcome. There is no evidence to suggest that individuals should avoid getting m RNA COVID vaccination because of ocular-related adverse events. However, curtailing the COVID-19 vaccination is not required, but awareness among physicians and patients about rare but potential ocular inflammatory events after the COVID-19 vaccination is required.

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