Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy, 2026, Moustardas et al.

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Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy

Moustardas, Petros; Setterud, Helen; Meijer, Helena; Andersson, Gunnel; Roth, Jenny; Dashti, Ava; Johansson, Björn; Macedo, António Filipe; Lagali, Neil

Abstract
Abstract COVID-19 does not require hospitalization in most cases, but post-acute sequelae can persist and are a public health concern.
In a prospective cross-sectional study, we examine persistent ocular symptoms (POS) emerging in non-hospitalized individuals after COVID-19, with individuals without POS post-recovery as controls.
Using symptom and quality of life data, clinical examinations and biofluid proteomics, we document ocular symptoms persisting from 3 months up to 3 years post-infection.
POS lead to significant vision disability and are linked to clinical findings not detectable in routine exams but only with specialized tests. POS include near vision disturbances, strabismus, weakened autonomic pupillary reflexes, corneal neurodegeneration and chronic activation of ocular surface dendritic/T cells.
We report a tear film proteomic profile consistent with severe COVID-19, chronic dysregulation of CD4 + T cell regulatory activity, upregulation of ITGB6, NFASC, CTGF, TPSAB1 and CKMT1A-CKMT1B, pupil dysfunction correlating with elevated JUN, and dendritic/T cell dysregulation correlating with elevated ANGPTL2, SKAP2 and DAPP1 levels.
Diagnostic models based on clinical examinations with or without biomarkers predict POS with 77-91% accuracy and implicate chronic T cell-mediated neuroinflammation in the pathogenesis of POS, a debilitating syndrome arising after COVID-19 recovery and characterized by strabismus, ocular dysautonomia and peripheral ocular neuropathy.

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www.eurekalert.org

Eye problems after COVID-19 can now be explained

Mild COVID-19 can cause severe and long-lasting eye problems, according to a study from Linköping University, Sweden. The study also explains why it has been difficult for sufferers to get help: the abnormal eye behaviour cannot be detected by standard methods. The researchers have developed a...
www.eurekalert.org

News Release 8-Jul-2026

Eye problems after COVID-19 can now be explained​

Peer-Reviewed Publication
Linköping University


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Neil Lagali
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Neil Lagali, professor of experimental ophthalmology at Linköping University.

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Credit: Theresa Lagali

Mild COVID-19 can cause severe and long-lasting eye problems, according to a study from Linköping University, Sweden. The study also explains why it has been difficult for sufferers to get help: the abnormal eye behaviour cannot be detected by standard methods. The researchers have developed a diagnostic model to detect COVID-related eye problems.

“I think it’s very important that the problem is recognised and that we show that it can be measured by objective testing. Patients don’t have access to that today. We’ve studied people in Sweden, but believe that many people around the world are experiencing these problems,” says Neil Lagali, professor of experimental ophthalmology at Linköping University, who led the study published in Nature Communications.

The study originated with people seeking care for eye problems following a mild COVID-19 infection. They were experiencing a lot of discomfort, sensitivity to light and in many cases severe eye pain, difficulty reading and focusing their gaze.

Following examination of those affected, the research team realised that the problem was substantial, not only in terms of prevalence but also in impact on quality of life. Among those affected were people who wanted to continue their studies or work but were unable to do so, as they could no longer read text and were suffering from pain and extreme eye fatigue. Healthcare professionals could not find anything wrong with their eyes, nor provide any explanation for their symptoms, let alone a diagnosis.

In the current study, the researchers examined 100 people with eye problems following COVID-19 who had not been hospitalised. They had suffered from eye problems for 3 months up to 3 years, and one in three were on full or part-time sick leave. The researchers compared the affected group with a control group of 32 people, who had also had mild COVID-19 but without eye problems.

“We found that the problems experienced by those affected were not detectable by standard tests. We had to perform specialised examinations to detect deviations. The puzzle pieces then fell into place, and we found explanations for the symptoms,” says Neil Lagali.

In their study, the researchers found long-term inflammation and deterioration of several eye functions controlled by the nerves in the brain.

One of the advanced tests involved proteomics, where a variety of proteins in the tear fluid are analysed. In those with eye problems, the researchers found an abnormal pattern of proteins regulating nerves and immune cells, so-called T cells. The findings were consistent with advanced eye microscopy that they used to measure the T cells and nerves in the eye. Strikingly, the same protein pattern has been found in blood and tissue in cases of severe and fatal COVID in other studies.

“Our findings suggest that these people have suffered a severe reaction to COVID-19 manifested in the eyes, with long-term inflammation and an impact on the nerves that control multiple eye functions,” says Petros Moustardas, senior research associate at Linköping University and lead author of the study, who performed the proteomics analyses.

Many of those affected became highly sensitive to light. The researchers can now provide an explanation: their pupils let too much light into the eye. The impaired pupil function was furthermore linked to headaches, difficulty reading text and in focusing the eyes.

Another finding was that both eyes could not cooperatively function in a normal way. Known as strabismus, or crossed-eyes, this occurs almost exclusively in young children. This type of adult-onset strabismus is unusual. According to Neil Lagali, it can be explained by the fact that the nerves that control the eye muscles have been affected.

The various abnormalities discovered by the researchers point to an eye syndrome that occurs following COVID-19. To develop diagnostic criteria, which do not exist today, the researchers came up with two diagnostic models. One model uses only measurements from instruments usually found in eye clinics in larger academic hospitals. In the second model, a few tear fluid protein values are added, making it even more accurate.

“These people are really struggling in their daily lives. Now we know what’s wrong with their eyes, and have several clues as to how COVID-19 may have caused these problems. We hope that the findings can lead to effective treatment and that in the long run their problems will ease, but unfortunately we don’t know yet,” says Neil Lagali.

The study was conducted in collaboration with Helen Setterud and Björn Johansson at the Linköping University Hospital Eye Clinic, and partners at Linnaeus University in Kalmar. The study was financed by the Swedish Research Council.

Article: Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy. Petros Moustardas, Helen Setterud, Helena Meijer, Gunnel Andersson, Jenny Roth, Ava Dashti, Björn Johansson, António Felipe Macedo and Neil Lagali, (2026), Nature Communications, published 8 July 2026, doi: 10.1038/s41467-026-74858-4

Journal​

Nature Communications

DOI​

10.1038/s41467-026-74858-4

Method of Research​

Observational study

Subject of Research​

People

Article Title​

Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy

Article Publication Date​

8-Jul-2026

COI Statement​

The authors declare no competing interests.
 
This is interesting and tracks my experience. I had loss of focus and loss of muscle control in my eyes on day 1 of acute covid. I went on to develop pretty severe neuro long covid about 3 weeks late with all kinds of vision problems. Now, 3 years later, my eyes are a lot better, but my tear film and close range vision are still significantly impacted. My eyes didn’t improve much until a few months after i started Baricitinib.
 
Stuart79 said:
This is interesting and tracks my experience. I had loss of focus and loss of muscle control in my eyes on day 1 of acute covid. I went on to develop pretty severe neuro long covid about 3 weeks late with all kinds of vision problems. Now, 3 years later, my eyes are a lot better, but my tear film and close range vision are still significantly impacted. My eyes didn’t improve much until a few months after i started Baricitinib.
Click to expand...
Covid has completely busted my vision as well. Can't focus both eyes on the same thing at a couple of metres, severe problems with looking at screens and pretty bad dry eyes. Did not have this issue with my moderate ME/CFS prior to the Long Covid decline.
 
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