J Korean Med Sci.  2023 Mar;38(12):e95. 10.3346/jkms.2023.38.e95.

Non-Arteritic Ischemic Optic Neuropathy Following COVID-19 Vaccination in Korea: A Case Series

  • 1Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 2Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
  • 4Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 5Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 6Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
  • 7Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
  • 8Department of Ophthalmology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
  • 9Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Korea
  • 10Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 11Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea


To report the clinical manifestations of non-arteritic anterior ischemic optic neuropathy (NAION) cases after coronavirus disease 2019 (COVID-19) vaccination in Korea.
This multicenter retrospective study included patients diagnosed with NAION within 42 days of COVID-19 vaccination. We collected data on vaccinations, demographic features, presence of vascular risk factors, ocular findings, and visual outcomes of patients with NAION.
The study included 16 eyes of 14 patients (6 men, 8 women) with a mean age of 63.5 ± 9.1 (range, 43–77) years. The most common underlying disease was hypertension, accounting for 28.6% of patients with NAION. Seven patients (50.0%) had no vascular risk factors for NAION. The mean time from vaccination to onset was 13.8 ± 14.2 (range, 1–41) days. All 16 eyes had disc swelling at initial presentation, and 3 of them (18.8%) had peripapillary intraretinal and/or subretinal fluid with severe disc swelling. Peripapillary hemorrhage was found in 50% of the patients, and one (6.3%) patient had peripapillary cotton-wool spots. In eight fellow eyes for which we were able to review the fundus photographs, the horizontal cup/ disc ratio was less than 0.25 in four eyes (50.0%). The mean visual acuity was logMAR 0.6 ± 0.7 at the initial presentation and logMAR 0.7 ± 0.8 at the final visit.
Only 64% of patients with NAION after COVID-19 vaccination have known vascular and ocular risk factors relevant to ischemic optic neuropathy. This suggests that COVID-19 vaccination may increase the risk of NAION. However, overall clinical features and visual outcomes of the NAION patients after COVID-19 vaccination were similar to those of typical NAION.


Coronavirus Disease 2019 (COVID-19); Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2); Vaccination; Non-Arteritic Anterior Ischemic Optic Neuropathy


  • Fig. 1 Images of the fundus and visual field maps. (A) Fundus photograph and corresponding horizontal cross-sectional optical coherence tomography scan in a patient with non-arteritic anterior ischemic optic neuropathy following coronavirus disease 2019 vaccination. Severe optic disc edema and peripapillary sub-retinal fluid (white arrow) are seen. (B) Visual field test results (grayscale map, total deviation probability map, and pattern deviation probability map) of the patients show the inferior altitudinal defect.

  • Fig. 2 Line chart showing the changes of visual acuity.NLP = no light perception, LP = light perception, HM = hand motion, CF = count finger.aTwo eyes showed the same changes.


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