Coronavirus disease 2019 (SARS-CoV-2) and colonization of ocular tissues and secretions: a systematic review

Abstract

Coronavirus disease 19 (COVID-19) has been described to potentially be complicated by ocular involvement. However, scant information is available regarding severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and ocular structures tropism. We conducted a systematic review of articles referenced in PubMed, Cochrane Library, Web of Science and Chinese Clinical Trial Register (ChiCTR) from December 20, 2019 to April 6, 2020, providing information on the presence of SARS-CoV-2 in cornea, conjunctiva, lacrimal sac, and tears. We excluded ongoing clinical studies as for unobtainable conclusive results. Of 2422 articles, 11 met the inclusion criteria for analysis and were included in the study. None of the studies were multinational. Among the 11 selected papers there were three original articles, one review, four letters, two editorials, and one correspondence letter. Globally, 252 SARS-CoV-2 infected patients were included in our review. The prevalence of ocular conjunctivitis complicating the course of COVID-19 was demonstrated to be as high as 32% in one study only. Globally, three patients had conjunctivitis with a positive tear-PCR, 8 patients had positive tear-PCR in the absence of conjunctivitis, and 14 had conjunctivitis with negative tear-PCR. The majority of the available data regarding SARS-CoV-2 colonization of ocular and periocular tissues and secretions have to be considered controversial. However, it cannot be excluded that SARS-CoV-2 could both infect the eye and the surrounding structures. SARS-CoV-2 may use ocular structure as an additional transmission route, as demonstrated by the COVID-19 patients' conjunctival secretion and tears positivity to reverse transcriptase-PCR SARS-CoV-2-RNA assay.

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

“…Our findings were in accordance with the previous systematic review by Aiello et al 26 that available earlier. Most of the studies included in their review were also included in our current study.…”

Retinal involvement and ocular findings in COVID‐19 pneumonia patients 

“…All available evidence in humans is focused on the ocular surface, where almost only conjunctivitis has been described, and most data come from case reports or ndings from human conjunctival samples. 17,30,31 In our patients, of whom we carefully considered baseline anamnestic, the results of fundus examination seem to demonstrate that neither the retina nor retinal vessels are involved in the active phase of COVID-19 infection.…”

Ocular findings and retinal involvement in COVID-19 pneumonia patients: A cross-sectional study in an Italian referral centre

“…All available evidence in humans is focused on the ocular surface -where almost only conjunctivitis has been described -and most data comes from case reports or ndings from human conjunctival samples. 17,30,31 In our patients, of whom we carefully considered baseline anamnestic, results of fundus examination seem to demonstrate that neither the retina nor retinal vessels are involved in the active phase of COVID-19 infection.…”