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

Abstract

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 included in the meta-analysis. The pooled prevalence of ocular manifestation among COVID-19-related patients was 0.05 (95% CI 0.02% to 0.08). The overall PCR from tears samples positivity rate from COVID-19-related patients presenting with ocular manifestation was 0.38 (95% CI 0.14% to 0.65). Ocular manifestation could precede systemic manifestation in about 0.28 (95% CI 0.05% to 0.58) of COVID-19-related patients with ocular manifestations. Besides, ocular manifestation was not associated with a severe form of COVID-19.ConclusionAlthough the overall number of ocular manifestation and SARS-CoV-2 PCR positivity rate from ocular samples was very low, around a quarter of COVID-19-related patients with ocular manifestation presented their ocular manifestation earlier than the systemic manifestation regardless of the severity. Interestingly, SARS-CoV-2 PCR was positive from one-third of ocular samples, which could potentially be the source of infection to the respiratory tract and the environment, although the infectivity is yet to be determined.

Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients

“…We have reported here the results of 74 consecutive patients characterized for the presence of SARS-CoV-2 in NP and ocular swabs. These results add more knowledge to the limited number of similar studies published so far, in the majority of which an even smaller number of patients (17 to 45) were included [58,59]. In conclusion, and in agreement with these reports, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not a frequent occurrence, and that there is no evident correlation between eye infection by SARS-CoV-2 and respiratory symptoms.…”

Automated Direct Selective Laser Trabeculoplasty: First Prospective Clinical Trial

“…33 Another advantage of the system in the era of the coronavirus disease 2019 (COVID-19) pandemic is the lack of contact with the treated eye and the potential for increasing the distance between the patient and operator, who does not have to use the gonioscope. Although the severe acute respiratory syndrome coronavirus 2 viral particles could be present in the tear film in one-third of ocular samples among patients with ocular manifestation, which in turn represents only 5% of the COVID-19-related patients, 34 we do not consider the laser plume effect could result in the release and dispersion of significant particulate matter into the atmosphere. In DSLT, the laser first passes through relatively transparent conjunctiva/epithelium above the limbus.…”

Diagnostic accuracy of infrared thermal imaging for detecting COVID‐19 infection in minimally symptomatic patients

“…Furthermore, the eye possesses an independent ocular renin‐angiotensin‐aldosterone system with abundant expression of ACE receptors in the conjunctiva and cornea 35 . Additionally, SARS‐CoV‐2 viral invasion can also be mediated through attachment to the CD147 receptor, which is expressed in tears and different ocular tissues, including conjunctiva, corneal epithelium and endothelium, stromal keratocytes, and retinal pigment epithelium 34,36 . Taken together, these facts strongly suggest that the eye's tissues are actively involved in COVID‐19 infection and progression, and that thermal imaging of these structures offers an insight into the infectious process.…”