62 | Ocular and neurological sequelae in long covid: dry eye, asthenopia, sleep disorders, asthenia, and restless legs syndrome – a case report with literature review

M. Troisi¹, S. Troisi², L. Vitiello³, D. Strianese¹, C. Bellucci⁴, M. Rinaldi¹, L. D'Andrea¹, C. Costagliola¹ | ¹Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II; ²Ophthalmologic Unit, Salerno Hospital University; ³Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, Polla; ⁴Ophthalmology Unit, Department of Medicine and Surgery, University Hospital of Parma.

Introduction. Coronavirus disease 2019 is a pandemic disease caused by the severe acute respiratory syndrome coronavirus 2. Gambino et al. performed an evaluation of the ocular surfaces of post-COVID-19 patients compared to a control group of healthy subjects, and a statistically significant increase in dry eye disease emerged in both subjective and objective assessments. Fatigue and sleep disturbances have also been reported as long-term manifestations after acute infection.

Objectives. In this case report, the authors describe the management of a patient with a history of acute SARS-CoV-2 infection who subsequently developed persistent dry eye and systemic symptoms.

Materials and Methods. A 59-year-old Caucasian male patient was evaluated for the presence of about six weeks’ ocular burning in both eyes, which was associated with foreign body sensation, and symptoms of asthenopia. The patient was started on an oral therapy with a multivitamin product including Vitamins B, Choline, Reishi, Coenzyme Q10, and SOD. He also continued the instillation of a tear substitute and oral melatonin.

Results. After 6 weeks of treatment, the patient reported a significant improvement in ocular symptoms. A reduction in asthenia and insomnia was also reported.

Conclusions. Given the positive response to this combination therapy (tear substitutes, choline, vitamins, melatonin), it seems that these systemic treatments can address not only ocular symptoms but also the broader manifestations of Long Covid. The near-simultaneous presentation of dry eye, asthenopia, fatigue, and sleep disturbances, as well as the positive outcome of all clinical manifestations after six weeks of treatment, suggests a correlation between the various symptoms. Therapeutic strategies that combine nutritional support for ocular surface health with neuroprotective agents such as choline and vitamin complexes may promote symptom resolution by targeting both peripheral and central nervous system alterations.