Evaluation of an Association between COVID-19 and Retinal Hemorrhage in Children.

PURPOSE: To evaluate the association of retinal hemorrhage with coronavirus disease 2019 (COVID-19) in children.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Inpatients and outpatients at Children's Hospital of Philadelphia 1 month to 18 years of age who underwent a dilated fundus examination by an ophthalmologist within 1 month of a COVID-19 test between January 2020 and October 2023.

METHODS

Medical records were reviewed for the results of COVID-19 testing and retinal findings. Primary outcome was the association between COVID-19 and retinal hemorrhage assessed across 4 periods: retinal examination within 7 days, 14 days, 21 days, or 28 days of COVID-19 testing. Generalized estimating equations were used to determine statistical significance and to control for age and multiple COVID-19 tests.

MAIN OUTCOME MEASURES: Association between COVID-19 and presence of retinal hemorrhage.

RESULTS

Among 6952 children (mean age, 6.1 years) studied, 3496, 4758, 5887, and 6952 children underwent a fundus examination within 1, 2, 3, and 4 weeks of a COVID-19 test, respectively. No associations were found between COVID-19 and the presence of retinal hemorrhage in any of the periods: 7 days (odds ratio, 0.80; 95% confidence interval [CI], 0.20-3.32; P = 0.76), 14 days (odds ratio, 0.75; 95% CI, 0.24-2.00; P = 0.63), 21 days (odds ratio, 0.79; 95% CI, 0.29-2.15; P = 0.64), or 28 days (odds ratio, 0.63; 95% CI, 0.23-1.72; P = 0.37). All 4 children with positive COVID-19 testing and retinal hemorrhage had alternative plausible causes with hemorrhage patterns consistent with those other causes.

CONCLUSIONS

Coronavirus disease 2019 is not associated with retinal hemorrhage in children. Coronavirus disease 2019 should not be considered as a potential cause of retinal hemorrhage in children, and this unsupported theory should not be accepted clinically or in legal proceedings.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.