Bilateral ciliochoroidal detachment: Drug- or COVID-19-related? A case report and literature review

Abstract

Background: This report describes a case of bilateral transient myopia with a shallow anterior chamber and ciliochoroidal detachment following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and indapamide intake. Case presentation: A 37-year-old man with coronavirus disease 2019 (COVID-19) was referred to our department due to bilateral blurred vision. The patient had been treated with ibuprofen for fever and indapamide for uncontrolled blood pressure. After four days of indapamide intake, the patient complained of bilateral visual blurring. On ocular examination, his uncorrected visual acuity was 20/400 in both eyes. Slit-lamp examination revealed shallow anterior chambers. The following day, the patient experienced pain and redness in both eyes, which began the previous night. Ocular examination revealed a significant decrease in intraocular pressure (IOP) compared to the previous day: 11 mmHg and 12 mmHg in the right eye (OD) and left eye (OS), respectively. Slit-lamp examination revealed conjunctival injection and the presence of inflammatory cells (2+) in the shallow anterior chambers of both eyes. Ultrasound biomicroscopy revealed ciliary body detachment and B-scan ultrasonography showed peripheral shallow choroidal detachment in both eyes. Discontinuing indapamide and initiating treatment with oral prednisolone, topical tobramycin dexamethasone and tropicamide phenylephrine eye drops resulted in the rapid recovery of signs and symptoms after three days. Discussion and conclusions: Indapamide intake may contribute to bilateral ciliochoroidal detachment, with SARS-CoV-2 infection possibly increasing susceptibility to drug-induced side effects. Timely drug withdrawal and symptomatic treatment can result in a good prognosis.