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The outbreak of the new coronavirus (COVID-19) that started in Wuhan, China, has spread all over the world and has had a great impact on eye care. 1 It is a ribonucleic acid (RNA) virus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may have ocular manifestations in some patients. 2 This is a single-stranded RNA virus with a genome of about 30 kb in length. The RNA genome encodes its proteins. The proteins are spike protein S, membrane protein M, envelope protein E and nucleocapsid protein N. Protein S is responsible for attachment to host receptors; protein M helps to shape virus particles and their binding to the nucleocapsid; protein E acts in the assembly of particle release; and protein N acts on genome binding and replication. 3 The new coronavirus shows 96% genetic similarity to the bat-type coronavirus SARS BatCovRaTG13, and its spike surface protein (S) binds to angiotensin-converting enzyme 2 (ACE2) on the cell surface. ACE2 expression can be found in respiratory, intestinal, renal, cardiac and immune cells. Its main transmission routes are through respiratory droplets, fomites and fecal-oral routes. Some patients have had an episode of conjunctivitis before pneumonia, thus raising the hypothesis that the ocular mucosa is a possible transmission route for SARS-CoV-2, since the cornea and conjunctiva show expression of the ACE2 receptor, which is responsible for entry of the virus cells. 4 Presence of the ACE2 infection receptor in the aqueous humor of humans has also been described. 5 ACE2 is a crucial receptor for SARS-CoV-2 in vivo: in an experiment on mice, an injection of SARS-CoV spike worsened acute lung failure in vivo, which was then attenuated by blocking the renin-angiotensin pathway. 6,7 OBJECTIVEThe objective of this narrative review was to summarize the currently available evidence on COVID-19 with regard to its implications for ophthalmology.

Ligneous conjunctivitis is a rare form of chronic and recurrent bilateral conjunctivitis, in which thick membranes develop on the tarsal conjunctiva and on other mucosae. We report the case of a 55-year old female patient with bilateral ligneous conjunctivitis who was successfully treated with 50% heterologous serum. There was no recurrence or side effects after one-year follow-up. We suggest the use of 50% heterologous serum should be further studied to better determine its efficacy as a treatment option for ligneous conjunctivitis.

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