Ocular Microbiology and Immunology Group
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2025 OMIG Abstract

Dysautonomia and Ocular Symptoms in Long-COVID Patients

Sakina Qazi^1,2,3, Chloe Shields^1,2,3, Kimberly Cabrera², Jane Nguyen³, Pragnya Rao Donthineni¹,
Normila Barthelemy^1,2,3, Araliya Gunawardene^1,2, Paula Sepulveda-Beltran^1,2, Leonardo Tamariz²,
Anat Galor<sup>1,2

1</sup>Bascom Palmer Eye Institute, University of Miami, Miami, Florida; ²Surgical and Research Services,
Miami Veterans Administration Medical Center, Miami, Florida; ³University of Miami Miller School of Medicine, Miami, Florida

Purpose: To examine relationships between dysautonomia and ocular symptoms in long-COVID.

Methods: Cross-sectional study of 162 long-COVID patients (59±14 years; 77% male). Dry eye disease (DED) symptoms were captured with the 5 Item Dry Eye Questionnaire (DEQ5) and Ocular Surface Disease Index (OSDI) and neuropathic ocular pain symptoms with questions regarding burning pain and evoked pain to wind, light, and temperature. The Composite Autonomic Symptom Score-31 (COMPASS-31) assessed dysautonomia symptoms (n=162), and the NASA lean test and heart rate variability metrics (n=75) captured dysautonomia signs.

Results: Individuals with versus without DED symptoms (DEQ5≥6) had a higher autonomic symptom burden (37.7±18 vs 20.9±15, p<0.001), with most COMPASS-31 domains associating with symptoms. Of the autonomic signs, the strongest associations were between eye pain evoked by hot/cold temperatures and change in diastolic blood pressure (DBP) from baseline to 8 minutes (r=-0.48, p<0.01 for both). On linear regression analyses, pupillomotor and secretomotor symptoms remained closely associated with most ocular symptoms, while autonomic signs most closely aligned with ocular pain metrics.

Conclusions: Ocular symptoms relate to autonomic symptoms in a long-COVID cohort. Associations with autonomic signs were less consistent but overall, the data suggest a relationship between an imbalance in sympathetic-to-parasympathetic activity and ocular pain in this population.