Neurogenic palsy due to COVID-19
Reviewed by Fiona Rowe

The authors aimed to identify cases of neurogenic palsy in the presence of Covid-19 and document the patient characteristics, type of palsy and possible aetiologies. Case reports and case series were included in the search. Twenty-three articles were included with data for 25 patients; 17 male and eight female. Mean age was 32 years (SD 21.4; range 2––71). Seven children were aged 2–10 years. All had a history of Covid-19 and 16 were symptomatic for this. Sixth nerve palsy was present in 17 cases, third nerve palsy in seven and one case of fourth nerve palsy. Common presentation was with diplopia (16 cases), diplopia with blurred vision (two cases) and one with diplopia and eye pain. Time for Covid-19 onset or positive test, to ocular symptoms, was 14.9 days (SD 4.2). Time to improved symptoms was 41.1 days (SD 59.7). Proposed causes of the nerve palsy were vascular / thrombotic, viral neuro invasion or inflammatory virus-mediated immune response – the latter being the most proposed mechanism. The findings of this study were that most patients were male, most had sixth nerve palsy and onset was within 15 days of virus onset.

COVID-19 and sudden-onset ocular neurogenic palsy in prior healthy patients: a systematic review.
Spiteri R, Barakat S, Vukicevic M.
STRABISMUS
2023;31(2):145–51.