Multifocal ocular haemorrhages secondary to COVID-19-related immune thrombocytopenia—Report of a rare case

Abstract

We report a rare case of subconjunctival, optic nerve head and retinal haemorrhages secondary to immune thrombocytopenia (ITP) associated with coronavirus disease 2019 (COVID-19). A previously healthy 17-year-old male presented with a 2-day history of generalized rash, dysphagia and redness of right eye. Physical examination revealed diffuse petechiae, peritonsillar mucosal bleeding and subconjunctival haemorrhage in right eye. Investigations revealed anaemia with severe thrombocytopenia, and patient was COVID-19 positive. Ophthalmic evaluation during hospital course revealed subconjunctival haemorrhage in right eye and extensive haemorrhages over the optic nerve head and retinal nerve fibre layer in both eyes. A diagnosis of subconjunctival and retinal haemorrhages secondary to COVID-19-induced immune thrombocytopenia was made. Patient was managed conservatively, and spontaneous resolution was noted at follow-up. COVID-19-induced ITP can rarely present with ocular manifestations. Systemic treatment and correction of hematologic parameters lead to resolution and a successful outcome.

Keywords

• covid-19
• haemorrhage
• immune thrombocytopenic purpura
• retinal