Abstract
Background: Vaccine-associated intraocular inflammation has been reported with several vaccines, including the Pfizer-BioNTech mRNA COVID-19 (BNT162b2) vaccine. While rare, these ocular adverse events warrant further investigation to better understand their clinical course, ideal management, and long-term outcomes. Anterior uveitis has been the most commonly reported manifestation following mRNA COVID-19 vaccination, but optimal treatment strategies and risk of recurrence remain unclear.
Aims: To report three cases of acute anterior uveitis occurring within weeks of COVID-19 vaccination, assess their response to treatment and follow up course, and review existing literature on vaccine-associated uveitis.
Methods: This case report analyzes three patients who developed acute anterior uveitis following COVID-19 vaccination. All patients underwent a comprehensive ophthalmic evaluation at presentation, including best-corrected visual acuity, slit-lamp examination, intraocular pressure measurement, and dilated fundus exam. These patients were managed with topical corticosteroids and were followed over the course of 30 months to assess response to treatment as well as any recurrence or complications.
Results: Each case of uveitis was successfully treated with topical corticosteroids, leading to complete resolution of inflammation without requiring systemic immunosuppressants. One patient experienced a mild recurrence eight weeks after the second vaccine dose, which was controlled with a second course of topical corticosteroids. No further recurrences were observed with long-term follow-up extending up to 30 months. Laboratory and imaging evaluations were negative for systemic inflammatory or infectious causes.
Conclusion: All three cases of acute anterior uveitis after COVID-19 vaccination responded well to topical corticosteroids, with no evidence of persistent or recurrent inflammation or long-term complications. These findings suggest that, in the absence of previously documented systemic autoimmune disease or other concerning features, COVID-19 vaccine associated acute anterior uveitis can be effectively managed with topical therapy alone, without the need for extensive systemic workup. Larger studies are needed to further investigate these findings and management strategies.