E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Ocular Symptoms in Long COVID: A Cross-Sectional Study.
Kaleem, Shayaan, Sawano, Mitsuaki, Arun, Adith S et al. · Clinical ophthalmology (Auckland, N.Z.) · 2026 · DOI
Quick Summary
This study looked at eye problems in people with long COVID, comparing those who developed new eye symptoms (like blurred vision, dry eyes, or floaters) after infection with those who didn't. About 57% of the 595 participants reported new eye symptoms. People with eye symptoms had worse overall health, more financial struggles, and were more likely to have dysautonomia (problems with blood pressure and heart rate control) and ME/CFS.
Why It Matters
Many ME/CFS and long COVID patients report eye problems but this symptom receives limited clinical attention. This study demonstrates that ocular symptoms may mark a more severe disease subtype with greater autonomic dysfunction, suggesting eye problems warrant systematic evaluation and may serve as clinical indicators of disease severity.
Observed Findings
- 57% (341/595) of long COVID participants reported new-onset ocular symptoms
- Participants with ocular symptoms had median health scores of 40 vs 51 in those without symptoms (p<0.001)
- 38% of those with ocular symptoms had dysautonomia compared to 15% without ocular symptoms (p<0.001)
- 21% with ocular symptoms had ME/CFS compared to 9.1% without ocular symptoms (p=0.005)
- Dizziness, cold intolerance, and pressure at the base of the head were top differentiating symptoms in those with ocular involvement
Inferred Conclusions
- Individuals with long COVID and new-onset ocular symptoms represent a more clinically severe phenotype with worse health outcomes
- Ocular symptoms in long COVID are associated with dysautonomia and ME/CFS diagnosis, suggesting possible shared pathophysiologic mechanisms
- Ocular symptoms correlate with greater socioeconomic challenges, indicating this population may require targeted support
Remaining Questions
- What is the underlying pathophysiology linking ocular symptoms to dysautonomia in long COVID?
- Would objective ophthalmologic findings (imaging, visual testing) differ between those with and without self-reported ocular symptoms?
What This Study Does Not Prove
This cross-sectional study cannot establish causation or determine whether ocular symptoms are directly caused by viral infection, dysautonomia, or other mechanisms. The study relied entirely on self-reported symptoms without objective eye examination or imaging, so the actual prevalence and nature of underlying ocular pathology remain unknown. Correlation between ocular symptoms and dysautonomia does not prove one causes the other.
Tags
Symptom:Orthostatic IntoleranceFatigueSensory SensitivityTemperature DysregulationPain
Phenotype:Infection-TriggeredSevereLong COVID Overlap
Method Flag:PEM Not DefinedSmall SampleMixed CohortWeak Case DefinitionExploratory Only
Metadata
- DOI
- 10.2147/OPTH.S565596
- PMID
- 41907807
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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