Retinal imaging study diagnoses a case of COVID-19

Background: Hyper-reflective lesions at the level of ganglion cell (GCL) and inner plexiform retinal layers (IPL) by Optical Coherence Tomography (OCT) and cotton wool spots in the examination of the eye fundus have recently been described as findings in patients with COVID-19 infection.Case report: We report a case of a 42-year-old male anesthetist who treated COVID patients during the previous five weeks and suddenly debuted with a temporal relative scotoma in his left eye (OS); three weeks before, he presented with ageusia for several days. Best corrected visual acuity was 20/20 for OS; no discromatopsy or afferent pupillary defect were present. Visual field was performed, with no significant findings associated to the focal loss of sensitivity referred by the patient. The anterior segment was unremarkable on slit lamp examination in both eyes. Fundus examination of the left eye showed no significant findings. A placoid, hyperreflective band at the level of GCL and IPL was visible in the temporal and nasal side of the fovea on OCT which spared the outer retina, at the time of diagnosis and at one month. A propharyngeal swab test for SARS-CoV-2 RNA, IgG and IgM ELISA determinations were performed. Real-time reverse-transcriptase polymerase chain reaction (RT‐PCR) was negative. ELISA testing and a third rapid antibody detection test performed 7 days after the onset of symptoms were positive.Conclusions: Ocular signs and symptoms in COVID cases are rarely reported, but may be underestimated, especially those that affect the retina and occur in asymptomatic or paucisymptomatic cases. We present the first case of diagnosis of COVID-19 based on retinal ophthalmic examination.