COVID-19 and the eye: how much do we really know? A best evidence review (original) (raw)

Ophthalmology-focused publications and findings on COVID-19: A systematic review

European Journal of Ophthalmology, 2021

To summarize COVID-19 research endeavors by ophthalmologists/researchers in terms of publication numbers, journals and author countries, and to detail key findings. Methods: The LitCovid database was systematically reviewed for ophthalmology-focused COVID-19 articles. The quality of the evidence was assessed for articles investigating conjunctivitis in COVID-19 patients. Results: There were 21,364 articles in LitCovid on June 12, 2020, of which 215 (1%) were ophthalmology-focused. Of articles on COVID-19 transmission, 3.3% were ophthalmology-focused. Ophthalmology-focused articles were published in 68 journals and originated from 25 countries. The top five countries publishing ophthalmology-focused articles (China, India, United States of America, Italy, and United Kingdom) produced 145/215 (67%) articles. A total of 16 case reports/ series from eight countries reported that conjunctivitis can be the initial or the only symptom of COVID-19 infection. Conjunctivitis may occur in the middle phase of COVID-19 illness. A total of 10 hospital-based cross-sectional studies reported that between 0% and 31.6% of COVID-19 patients have conjunctivitis or other ocular conditions, with a pooled prevalence of 5.5% reported in a meta-analysis. Viral RNA was detected in conjunctival swabs of patients with and without ocular manifestations, after resolution of conjunctivitis, after nasopharyngeal swabs turned negative and in retina of deceased COVID-19 patients. Conclusion: Within 3 months of declaring the COVID-19 pandemic, 215 ophthalmology-focused articles were published in PubMed, concentrating on disease manifestations and transmission. The reported presence of conjunctivitis or other ocular conditions in COVID-19 patients is varied. Clinicians should be alert for ocular involvement in COVID-19 infections and possible ocular transmission even in patients without ocular symptoms.

COVID-19 and the eye: a review

COVID-19 and the eye: a review , 2021

ABSTRACT Background: To provide a review for general practitioners and medical specialists about the most common eye complaints and ocular manifestations in a COVID-19 patient. Methods: Reviewed 50 articles referenced in 4 databases from 20 December 2019 to 16 September 2020. Results: Of the 50 articles reviewed, 26 met the criteria for analysis and were included in the study. Among them were 5 reviews, 6 case series, 7 case reports, 4 cross-sectional studies, 2 systematic reviews, 1 cohort study and 1 correspondence. We found that the prevalence of ocular manifestations in patients during the course of COVID-19 varied between 0.8% and 31.6%, depending on the study design. Symptoms of acute conjunctivitis were the most frequent clinical findings. Acute phase reactants were also correlated to ocular manifestations and the severity of the systemic disease in many reports. Conclusions: Ocular manifestations are not uncommon in COVID-19 patients and have been associated with higher levels of acute phase reactants as well as a higher degree of severity of the systemic disease. We recommend that all physicians consider COVID-19 as a differential diagnosis in the presence of acute conjunctivitis with or without systemic symptoms.

Eye in COVID-19: A Brief Review

Pakistan Journal of Ophthalmology

This is a brief review covering the currently available literature on ocular manifestations of COVID-19, andprevention strategies for ophthalmologists. A literature search was carried out of Pubmed, Google Scholar andWHO database of publications on COVID. Keywords used in the search were eye, ocular manifestations,ophthalmology, COVID-19, nCoV-2019, and coronavirus disease. All available articles were reviewed and thosepertinent to the study topic were included. Considering the dearth of information available, ophthalmology journals were also searched separately for relevant articles. Major ocular manifestation of COVID reported in literature is red eye, which usually presents before the onset of respiratory symptoms. Since the eye can be a possible transmission route for SARS-CoV-2, infection control measures should be undertaken by ophthalmologists, including use of personal protection equipment and eye/face covering. A framework for structuring ophthalmological services during th...

Are eyes the windows to COVID-19? Systematic review and meta-analysis

BMJ Open Ophthalmology, 2020

ObjectiveTo review and critically appraise the ocular manifestation and the presence of SARS-CoV-2 through PCR positivity from ocular samples in COVID-19-related patients. Moreover, to evaluate the time and severity association of ocular manifestation to systemic disease of COVID-19.Methods and analysisA systematic literature search from PubMed, ScienceDirect and Google Scholar databases was performed using standardised Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Selected keywords were related to COVID-19, ocular manifestation and PCR testing of SARS-CoV-2. Studies were assessed for their validity, and the data were extracted by two independent reviewers. Observational, case series and case report studies were included if they met the selection criteria. Meta-analysis was performed to estimate the pooled prevalence of ocular manifestations and PCR positivity from tears.ResultsThirty-one articles were qualitatively reviewed, and 14 studies were inclu...

Survey of Direct and Indirect Effects of COVID-19 on Eyes and the Common Ocular Manifestations

2021

PurposeOcular manifestations were reported in many recent observations that studied either the effect of COVID-19 directly on eyes or of face mask use. Hence, this study aimed to investigate the effect of COVID-19 on the eyes and make a clear comparison of its direct and indirect effect from face mask-wearing.MethodsThis was a cross-sectional study of both written and web-based questionnaires, distributed among a group of COVID-19 patients and a matched control group, the questionnaire consisted of common demographic data, COVID-19 infection history and its symptoms, focusing on ocular symptoms and the presence of conditions related to or cause eye symptoms. As well as the use of face masks that were assessed in terms of the complained ocular manifestationResultsOf 618 participants, 252 had COVID-19 and 366 never had COVID-19. Ocular manifestation among COVID-19 incidence was 44%, significantly higher than non-infected participants’ incidence (35.8%), adjusted odds ratio, 95% confid...

COVID-19 eye infection: recommendations for ophthalmologist and patients

Journal of Community Empowerment for Health, 2020

Coronavirus disease (COVID-19) is a public health emergency of international concern as declared by the World Health Organization on 30 January 2020. Currently, COVID-19 is spreading rapidly worldwide, with no proven treatment nor vaccination, thus infection control measures are paramount. The severity of the majority of COVID-19 cases is mild to moderate, with fever as its most common symptoms, followed by dry cough and fatigue. COVID-19 initially reported to be transmitted from bats but then evolved into human-to-human via droplets. Coronavirus has been detected in tears and conjunctival secretions, but there is still a controversy about whether the virus can be transmitted through tears. However, the ocular transmission might be transported through a lacrimal duct to nasopharyngeal mucosa and then cause an infection. Because the nature of close contact in doctor-patient interaction during ophthalmologic practice, strict measures must be taken to minimize the impact both on the pa...

COVID-19 and ocular implications: an update

Journal of Ophthalmic Inflammation and Infection

Background COronaVIrus Disease 19 (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. The purpose of this review is to highlight the possible ocular presentation of COVID-19 infection and the consequence of the pandemic in the daily ophthalmology routine. A total of 9 articles was included by searching PubMed database for articles published between December 2019 and April 2020. Main body Conjunctivitis (and keratoconjunctivitis) can be the first symptom in infected patients. The virus can be present in tear and conjunctival secretions, requiring maximum attention. It’s important to understand if COVID-19 could spread through the ocular route or present as the primary infected site. Ocular implications should also be considered for therapy. In fact, one potential treatment is chloroquine and its derivatives, including hydroxychloroquine. Hydroxychloroquine, in fact, can induced retinal toxicity. The exponential increase in lthe numbe...

Unfolding COVID-19: Lessons-in-Learning in Ophthalmology

Clinical Ophthalmology

Importance: An observant Chinese doctor Li Wenliang became the first physician to alert the world about COVID-19. Being an ophthalmologist himself, he has put the additional onus on us. The fact that the ocular manifestation could be the first presenting feature of novel coronavirus pneumonia should not be ignored and the possibility of spread of SARS-CoV-2 through the ocular secretions cannot be ruled out. However, with breakthroughs still evolving about this disease, the calls are now louder for closer examination on the pathogenesis of conjunctivitis associated with it. Hence, we conducted a scoping review of all available literature till date to fill in the "potential" gaps in currently available knowledge on ocular manifestations of SARS-CoV-2 infection in an attempt to establish continuity in the "chain of information" from December 2019 till April 2020. We also summarize a possible hypothesis on much less understood and highly debated topics on regard to the etiopathogenesis of ocular involvement in SARS-CoV-2 based on either presence or absence of ACE2 receptor in the ocular surface. Methods: We conducted a scoping review search of published and unpublished SARS-CoV-2-related English language articles from December 2019 till mid of April 2020 from the online databases. The findings were summarized using text, tables, diagrams, and flowcharts. Results: The commonest ocular manifestation in SARS-CoV-2 infection is follicular conjunctivitis and has been the first manifestation of SARS-CoV-2 infection in 3 reported cases till date. The ocular surface inoculated with the SARS-CoV-2 leads to the facilitation of the virus to the respiratory system via the lacrimal passage. RT-PCR analysis of the ocular secretions has shown the presence of the SARS-CoV-2 nucleotides indicating the possibility of infection of ocular secretions. ACE2 receptors and its expression on the ocular mucosal surface are linked behind the etiopathogenesis of conjunctivitis. Conclusion: Conjunctivitis can be the presenting manifestation but may go unnoticed due to its mild nature. The ocular surface could serve as the entry gateway for the virus and ocular secretions could play a role in virus shed. The eye care personnel, as well as the general people, need to be more vigilant and adopt protective eye measures.

COVID-19 and ophthalmology- Challenges and mitigation of disease

Indian Journal of Clinical and Experimental Ophthalmology

The SARS-CoV-2 infection has become a global health crisis with an uprising trend of infection and death in the world. Considering the contagious nature and the human to human transmission of the disease, it is utmost important to follow the infection control measures in the ophthalmic practice. The pink eye or conjunctivitis is the associated symptom reported along with the respiratory illness and fever in patients of COVID-19. So the triage policy, using noncontact procedures, understanding the risk factors of the disease, postponement of routine ophthalmic patient’s visit, following respiratory hygiene, hand hygiene, using personal protective equipment (PPE) are some of the measures to keep the infection in control are explained in this article. The surface disinfection, equipment disinfection are also important considering the environmental contamination nature of the disease. So in order to minimize the infection every ophthalmologist should work as per the guidelines and measu...

COVID-19 and Ophthalmology: A New Chapter in an Old Story

Medical Hypothesis, Discovery and Innovation in Ophthalmology, 2020

1 Instituto de la Vision Cerro de las Rosas, Sanatorio Allende – Sede Cerro, Cordoba, Argentina 2 Facultad de Ciencias de la Salud, Universidad Catolica de Cordoba, Cordoba, Argentina 3 Department of Ophthalmology, Hospital de Clinicas, School of Medicine, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina 4 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA 5 Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, FL, USA Epub: March 4, 2020