A new study finds a high risk of inflammatory eye diseases following the administration of the anti-Covid vaccine

People with a history of uveitis may have a recurrence of the ocular inflammatory disorder following the administration of the COVID-19 vaccine, especially in the first post-vaccination period.

A recent study published in JAMA Ophthalmology found that about 17 percent of nearly 474,000 vaccinated people with a history of uveitis experienced a recurrence within a year of vaccination.

Uveitis (inflammation of the vascular tunic of the eye called the uvea or choroid) occurs when the immune system fights an infection or attacks healthy tissue in the eye. This can cause symptoms including pain, redness and loss of vision as it affects the uvea and other parts of the eye.

Researchers collected data on all people diagnosed with uveitis in South Korea between January 2015 and February 2021 to determine the risk of recurrence after receiving the COVID-19 vaccine. The data were taken from the databases of the Korea National Health Insurance Service and the Korea Disease Control and Prevention Agency. The incidence of uveitis was analyzed from February 26, 2021 to December 31, 2022. Cases were classified according to onset at three months, six months, and one year, type of uveitis, and type of vaccine.

Individuals included in the study received at least one dose of the COVID-19 vaccine from Pfizer, Moderna, AstraZeneca, or Johnson & Johnson and did not test positive for SARS-CoV-2 during the study period.

Study findings

Among the 473,934 people included in the study, the cumulative incidence of post-vaccination uveitis was 8.6% at three months, 12.5% ​​at six months and 16.8% at one year – mainly of the anterior type, affecting the iris from the front of the eye. Moreover, the risk of uveitis recurrence was highest in the first 30 days after vaccination, reached a maximum between the first and second vaccine doses, and decreased with subsequent vaccinations.

According to the researchers, the first dose of the vaccine can activate the inflammatory pathways that lead to initial inflammation in people prone to autoimmune reactions or who have a history of uveitis. However, there is a decrease in risk with repeated vaccination, which may be due to adaptation of the immune system to the vaccine antigen, although further studies are needed to confirm this hypothesis.

In addition, the risk of experiencing the condition increased among those who received all four types of vaccines, especially among those who received Pfizer’s COVID-19 vaccine. These patients were more likely to experience uveitis recurrence during the onset period. Also, those who received the Moderna vaccine presented a higher risk of facing uveitis after the first vaccine and during the premature onset period.

Notably, there were variations in the types of uveitis observed in the pre- and post-vaccination periods. Among patients with infectious uveitis before receiving a COVID-19 vaccine, nearly 54% had noninfectious uveitis after being vaccinated, while the majority of people with noninfectious uveitis before vaccination had a recurrence of the same type after vaccination .

Most patients with uveitis were between 60 and 79 years old, followed by those between 40 and 59 years old. Among those with comorbidities, hypertension, diabetes and rheumatic diseases were the most common.

“Although uveitis following vaccination is rare, our findings support an increased risk after anti-COVID vaccination, especially in the early post-vaccination period,” the authors wrote. “These results emphasize the importance of vigilance and monitoring of uveitis in the context of vaccinations, including anti-COVID vaccinations, especially in people with a history of uveitis.”

Other studies on vaccine-associated uveitis

Other studies have found an association between uveitis and the COVID-19 vaccination, including a February 2023 study published in the journal Ophthalmology. The study provided information on a possible temporal association between reported vaccine-associated events and Covid vaccines from Pfizer, Moderna and Johnson & Johnson.

Furthermore, adverse ocular reactions have been reported following COVID-19 vaccination in addition to uveitis, including facial nerve palsy, retinal vascular occlusion, acute macular neuroretinopathy, thrombosis, and Graves’ disease.

In an article published in June 2022 in the journal Vaccines, researchers analyzed ocular adverse reactions reported to the Adverse Vaccine Event Reporting System (Vaccine Adverse Event Reporting System /VAERS) to provide doctors and researchers with a broader picture of the ocular side effects of the COVID-19 vaccinations.

VAERS is a voluntary reporting system co-administered by the US Food and Drug Administration (Food and Drug Administration / FDA) and the Center for Disease Control and Prevention (CDC). It is designed to detect vaccine safety signals, although it is estimated to account for less than 1% of actual adverse events.

During the analysis period from December 2020 to December 2021, VAERS received 55,313 reports of ocular adverse events, of which 6,688 met inclusion criteria. Of these reports, 2,229 were related to eyelid swelling, ocular hyperemia (eye redness), and conjunctivitis, 1,785 were reports of blurred vision, and 1,322 were reports of visual impairment.

Women accounted for 74 percent of the reports, and the eye conditions occurred primarily in people ages 40 to 59 who received either the Johnson & Johnson or Moderna vaccine.

Of the patients who reported eye complications, 50% received the anti-COVID-19 vaccine from Pfizer, 38% from Moderna, and 12% from Johnson & Johnson.

Although the study’s authors said they could not determine whether the vaccines were associated with an increased risk of adverse reactions, their data suggest a “possible association between COVID-19 vaccines and ocular adverse events.”

“Physicians are cautioned not only to be aware of this potential problem, but also to screen for any underlying medical conditions in patients and carefully document in VAERS within several weeks of vaccination,” they wrote.

According to current VAERS data, 734 cases of uveitis, 539 cases of ocular inflammation, 2,781 cases of retinal disorders, 11,641 cases of facial nerve disorders, and 3,909 reports of eyelid swelling, ocular hyperemia, and conjunctivitis were reported following vaccination with the anti-COVID vaccines between December 14, 2020 and March 29.

Potential associations between uveitis and other vaccines have been reported, including influenza, human papillomavirus, and varicella-zoster vaccines. However, these studies did not necessarily establish a causal relationship.