Ocular Symptoms in Long COVID: A Cross-Sectional Study

Introduction: This study compared demographics, socioeconomic characteristics, pre-pandemic health conditions, newly diagnosed health conditions, and long COVID symptoms between participants with and without self-reported new-onset ocular symptoms after COVID-19 infection. Material and Methods: We performed a cross-sectional analysis of the Listen to Immune, Symptom, and Treatment Experiences Now (LISTEN) study. Adults who self-reported long COVID, completed surveys between May 2022 and October 2023, and did not report post-vaccination syndrome were included. Ocular symptoms were defined as self-reported new-onset blurring or loss of vision, dry eyes, or floaters/flashes of light attributed to long COVID. Group comparisons used percentages for categorical variables and median and interquartile range (IQR) for continuous variables as well as Bonferroni-adjusted P-values. A gradient-boosted tree model was used to identify symptoms that differentiated groups. Results: Among 595 participants (median age 46 years [IQR 38-56]; 73% female), 341 (57%) reported ocular symptoms. Pre-pandemic comorbidities were similar between groups. Participants with ocular symptoms had lower EuroQoL visual analogue scale health scores (median 40 [IQR 30-59] vs 51 [IQR 39-70], P < 0.001), greater financial difficulties (20% vs 8.8%, P < 0.001), increased worry about housing stability (16% vs 5.4%, P < 0.001), and higher rates of new-onset dysautonomia (38% vs 15%, P < 0.001) and myalgic encephalomyelitis/chronic fatigue syndrome (21% vs 9.1%, P = 0.005). Key differentiating symptoms included dizziness, cold intolerance, pressure at the base of the head, tinnitus, and tremors. Conclusion: Individuals with long COVID with self-reported new-onset ocular symptoms after infection may represent a more severe phenotype, with poorer health status and greater socioeconomic challenges despite similar pre-pandemic health profiles.