Are eyes the windows to COVID-19? Systematic review and meta-analysis (original) (raw)
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Iranian Journal of Medical Sciences, 2022
Background: There are reports of ocular tropism due to respiratory viruses such as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Various studies have shown ocular manifestation in coronavirus disease-2019 (COVID-19) patients. We aimed to identify ophthalmic manifestations in COVID-19 patients and establish an association between ocular symptoms and SARS-CoV-2 infection. Methods: A systematic search of Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted for publications from December 2019 to April 2021. The search included MeSH terms such as SARS-CoV-2 and ocular manifestations. The pooled prevalence estimate (PPE) with 95% confidence interval (CI) was calculated using binomial distribution and random effects. The meta-regression method was used to examine factors affecting heterogeneity between studies. Results: Of the 412 retrieved articles, 23 studies with a total of 3,650 COVID-19 patients were analyzed. The PPE for any ocular manifestation...
COVID-19 and the eye: how much do we really know? A best evidence review
Arquivos brasileiros de oftalmologia, 2020
To identify and classify available information regarding COVID-19 and eye care according to the level of evidence, within four main topics of interest: evidence of the virus in tears and the ocular surface, infection via the conjunctival route, ocular manifestations, and best practice recommendations. A structured review was conducted in PubMed, ScienceDirect, LILACS, SciELO, the Cochrane Library and Google Scholar on COVID-19 and ophthalmology. The Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence worksheet was used for quality assessments. 1018 items were identified in the search; 26 records were included in the qualitative synthesis, which encompassed 6 literature reviews, 10 case series or cross-sectional studies, 4 case reports, and 6 intervention descriptions. Seventeen out of 26 records (65%) were categorized as level 5 within the Oxford CBME methodology grading system, the rest were level 4. The evidence generated on COVID-19 and ophthalmology to date is limi...
PLOS ONE, 2020
PurposeThis study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).MethodsA systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible.ResultsA total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens...
Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis
Journal of Ophthalmic and Vision Research
Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed randomeffects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71–17.72). In the studies that reported...
Ocular manifestations in SARS-CoV-2 positive patients: a systematic review
Expert Review of Ophthalmology, 2020
Objective: Investigate the importance of optical symptoms within SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) patients. Design: Systematic review Methods: Databases searched included Medline, EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, ProQuest. As well, meeting abstracts from American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology and Canadian Ophthalmological Society were also considered. Articles underwent two rounds of screening before risk of bias assessment and data extraction. Results: In total, 582 studies were identified. A total of 2064 unique SARS-CoV-2 positive patients are included in this review from 13 different studies that met the inclusion criteria. We observed that the most common ocular symptoms in patients with SARS-CoV-2 were dry eyes, chemosis, epiphora, and blurred vision. The least common symptoms included hyperemia, conjunctivitis and photophobia. Additionally, we observed a unique relationship between patients with ocular manifestations and the severity of the systemic symptoms. Conclusion: Ocular symptoms do not occur commonly among SARS-CoV-2 positive patients; however, this study displays that there is an occurrence of common ocular manifestations such as dry eyes, chemosis, epiphora, and blurred vision. Therefore, increased ocular examinations may aid in diagnosis of SARS-CoV-2 infections. ABBREVIATIONS: COVID-19 (coronavirus disease 2019), SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) ARTICLE HISTORY
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.
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.
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...