Case Report: COVID-19 Related Double Vision

A 53-year-old male contracted a mild case of COVID-19 in April of 2020. His symptoms included a fever, loss of smell, and fatigue, which he stated resolved within a few days. Approximately three weeks later, he began to experience a wide range of neurological symptoms, including numbness in the extremities and difficulty swallowing. He consulted a neurologist who started a workup for MS. All scans were negative, and the only abnormal findings were inflammatory markers in his blood tests. 

In early August, the patient started to experience double vision. He stated that his left eye could not move past the midline. He had no previous vision problems. He was immediately sent to the emergency room. An MRI of the brain and orbits were unremarkable. Over the next few days, his diplopia improved but did not fully resolve.

His doctor referred him to us for evaluation in early September. We discovered a left 6^th nerve palsy of 14 PD.  The 6^th cranial nerve controls one of the eye muscles called the lateral rectus. This muscle moves the eye out or abducts the eye. In this case, the patient’s left eye could not fully abduct. This will cause double vision in the horizontal direction.  Prismatic aligning lenses were prescribed to resolve the double vision. 

Thankfully, the patient’s other neurological symptoms have decreased significantly. This gives us hope that as time passes, his eye muscle restriction will be reduced.  However, because COVID-19 is a new disease, we are unsure what the future will hold for this very nice gentleman.