Oculomotor paralyses as a clinical expression of COVID-19

Abstract

Purpose: To analyze the importance of oculomotor paralyses (OMP) as an isolated diagnostic criterion and screening for SARS-CoV-2 infection.
Materials and methods: Based on the protocol, patients presenting to the clinical and ophthalmology emergency departments of “Hospital Interzonal General de Agudos Dr. Rodolfo Rossi” of La Plata, were studied for two months because they had signs and/or symptoms consistent with OMP associated or not with another diagnostic criterion for COVID-19. Tests performed included anamnesis, ophthalmic examination, extrinsic ocular motility (EOM), pupillary reflexes and color vision, laboratory tests, polymerase chain reaction (PCR) from throat/nose swab sampling and serology for detection of IgG antibodies if PCR was negative. In addition, neuroimaging studies of the brain and orbit were carried out.
Results: A total of 20 patients with pictures consistent with OMP presented to the emergency department; 17 were included because they met the inclusion criteria. Of this total, 12 patients (70.6%) tested positive for SARS-CoV-2, either by PCR or IgG. Of these, 66% had one or more associated symptoms, while the remaining 33% were asymptomatic. Neuroimaging results were normal in 94% of the sample. No patient required hospitalization and all of them improved until complete resolution of the picture.
Conclusions: The finding of a high rate of positivity for COVID-19 by PCR or serology tests should be stressed. This form of presentation by oculomotor paralysis should be considered to suspect the presence of a probable SARS-CoV-2 infection and thus order pertinent tests for its detection. Continuous study of diagnostic and treatment algorithms is essential to update and adjust these approaches as the pandemic progresses.