Impact of SARS-CoV-2 on Ocular Surface Pathology and Treatment Practices: a Review

Bal, Sila; Chodosh, James; Venkateswaran, Nandini

doi:10.1007/s40135-021-00271-3

Cited by 7 publications

(7 citation statements)

References 35 publications

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“…It was unclear if any of these patients subsequently developed respiratory symptoms or had a poor visual outcome. However, previous studies have shown that most SARS-CoV-2 associated outpatient conjunctivitis cases appeared mild [1] and the majority of patients’ symptoms resolved within 3 weeks [5] . Similar to many places around the world, clinical studies were placed on hold during the surge, as was the case at the Aravind Eye Center.…”

Section: Limitationsmentioning

confidence: 89%

“…SARS-CoV-2 RNA has been detected in the conjunctiva and tears of patients hospitalized with moderate to severe COVID-19 disease. [1] , [2] Conjunctivitis associated with COVID-19 disease is documented in both the outpatient and hospitalized populations, although the prevalence varies dependent on the study and population investigated and it remains a debate whether infection with SARS-CoV-2 can present as a primary conjunctivitis [ 1 , [3] , [4] , [5] , [6] ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outpatient human coronavirus associated conjunctivitis in India

Prajna¹,

Lalitha²,

Teja³

et al. 2022

Journal of Clinical Virology

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Section: Limitationsmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Outpatient human coronavirus associated conjunctivitis in India

Prajna¹,

Lalitha²,

Teja³

et al. 2022

Journal of Clinical Virology

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“…Bal et al suggest that ocular manifestations can appear at any stage of the disease, with conjunctivitis often being an early sign, while later ocular pathology may be linked to more severe COVID-19. Although the evidence for direct transmission through eye mucosa is currently lacking, early detection of COVID-related ocular symptoms could potentially limit disease spread [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Ophthalmic Manifestations of COVID-19: A Retrospective Study on Prevalence, Characteristics, and Clinical Implications

Patel,

Gandhi,

Satapara

et al. 2024

Cureus

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Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, has had far-reaching implications beyond the respiratory system. Mounting evidence suggests that COVID-19 can impact various organ systems, including the eyes. This study aimed to elucidate the prevalence, characteristics, and clinical implications of ophthalmic manifestations in patients diagnosed with COVID-19. Methods: This retrospective study analyzed data from electronic medical records of adult patients hospitalized with COVID-19 between March 1, 2020, and December 31, 2020, at a large tertiary academic medical center. Ophthalmic manifestations, including conjunctivitis, dry eye symptoms, ocular pain, epiphora, ocular redness, and visual disturbances, were identified and examined for their prevalence, onset, duration, and associations with COVID-19 severity and systemic symptoms. Results: Among 342 patients included in the study, 106 (31.0%) experienced at least one ophthalmic manifestation during their COVID-19 illness. Conjunctivitis was the most common manifestation in 62 patients (18.1%), followed by dry eye symptoms in 38 patients (11.1%), ocular pain/discomfort in 27 patients (7.9%), epiphora in 19 patients (5.6%), ocular redness in 14 patients (4.1%), and visual disturbances in nine patients (2.6%). Ophthalmic manifestations were significantly associated with severe COVID-19 illness (42.9% vs. 26.7%, p = 0.003) and the presence of systemic symptoms such as fever, cough, and dyspnea. The median time of onset was six days, and the median duration was 10 days. Conclusions: Ophthalmic manifestations are prevalent in COVID-19 patients, particularly in those with severe illness and systemic symptoms. The study highlights the importance of recognizing and managing ocular symptoms in affected individuals and underscores the multifaceted nature of COVID-19, necessitating interdisciplinary collaboration for comprehensive patient care.

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“…Positivity rate in ocular surface samples of COVID-19 patients is likely dependent on the stage of the disease at the time of corneal retrieval and the retrieval technique [ 10 ]. Likewise, highly variable prevalence of ocular lesions in patients affected by SARS-CoV-2 are also reported, ranging from 0.8% to 31.6% [ 11 – 12 ]. Thus, the available data provide only limited and conflicting evidence to support a possible SARS-CoV-2 infection via the corneal or conjunctival route.…”

Section: Introductionmentioning

confidence: 99%

Exploration of the ocular surface infection by SARS-CoV-2 and implications for corneal donation: An ex vivo study

et al. 2022

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Background The risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission through corneal graft is an ongoing debate and leads to strict restrictions in corneas procurement, leading to a major decrease in eye banking activity. The aims of this study are to specifically assess the capacity of human cornea to be infected by SARS-CoV-2 and promote its replication ex vivo, and to evaluate the real-life risk of corneal contamination by detecting SARS-CoV-2 RNA in corneas retrieved in donors diagnosed with Coronavirus Disease 2019 (COVID-19) and nonaffected donors. Methods and findings To assess the capacity of human cornea to be infected by SARS-CoV-2, the expression pattern of SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE-2) and activators TMPRSS2 and Cathepsins B and L in ocular surface tissues from nonaffected donors was explored by immunohistochemistry (n = 10 corneas, 78 ± 11 years, 40% female) and qPCR (n = 5 corneas, 80 ± 12 years, 40% female). Additionally, 5 freshly excised corneas (80 ± 12 years, 40% female) were infected ex vivo with highly concentrated SARS-CoV-2 solution (106 median tissue culture infectious dose (TCID50)/mL). Viral RNA was extracted from tissues and culture media and quantified by reverse transcription quantitative PCR (RT-qPCR) (viral RNA copies) 30 minutes (H0) and 24 hours (H24) after infection. To assess the risk of corneal contamination by SARS-CoV-2, viral RNA was tested by RT-qPCR (Ct value) in both corneas and organ culture media from 14 donors diagnosed with COVID-19 (74 ± 10 years, 29% female) and 26 healthy donors (79 ± 13 years, 57% female), and in organ culture media only from 133 consecutive nonaffected donors from 2 eye banks (73 ± 13 years, 29% female). The expression of receptor and activators was variable among samples at both protein and mRNA level. Based on immunohistochemistry findings, ACE-2 was localized mainly in the most superficial epithelial cells of peripheral cornea, limbus, and conjunctiva, whereas TMPRSS2 was mostly expressed in all layers of bulbar conjunctiva. A significant increase in total and positive strands of IP4 RNA sequence (RdRp viral gene) was observed from 30 minutes to 24 hours postinfection in central cornea (1.1 × 108 [95% CI: 6.4 × 107 to 2.4 × 108] to 3.0 × 109 [1.4 × 109 to 5.3 × 109], p = 0.0039 and 2.2 × 107 [1.4 × 107 to 3.6 × 107] to 5.1 × 107 [2.9 × 107 to 7.5 × 107], p = 0.0117, respectively) and in corneoscleral rim (4.5 × 109 [2.7 × 109 to 9.6 × 109] to 3.9 × 1010 [2.6 × 1010 to 4.4 × 1010], p = 0.0039 and 3.1 × 108 [1.2 × 108 to 5.3 × 108] to 7.8 × 108 [3.9 × 108 to 9.9 × 108], p = 0.0391, respectively). Viral RNA copies in ex vivo corneas were highly variable from one donor to another. Finally, viral RNA was detected in 3 out of 28 corneas (11%) from donors diagnosed with COVID-19. All samples from the 159 nonaffected donors were negative for SARS-CoV-2 RNA. The main limitation of this study relates to the limited sample size, due to limited access to donors diagnosed with COVID-19 and concomitant decrease in the procurement corneas from nonaffected donors. Conclusions In this study, we observed the expression of SARS-CoV-2 receptors and activators at the human ocular surface and a variable increase in viral RNA copies 24 hours after experimental infection of freshly excised human corneas. We also found viral RNA only in a very limited percentage of donors with positive nasopharyngeal PCR. The low rate of positivity in donors diagnosed with COVID-19 calls into question the utility of donor selection algorithms. Trial registration Agence de la Biomédecine, PFS-20-011 https://www.agence-biomedecine.fr/.

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Impact of SARS-CoV-2 on Ocular Surface Pathology and Treatment Practices: a Review

Cited by 7 publications

References 35 publications

Outpatient human coronavirus associated conjunctivitis in India

Outpatient human coronavirus associated conjunctivitis in India

Ophthalmic Manifestations of COVID-19: A Retrospective Study on Prevalence, Characteristics, and Clinical Implications

Exploration of the ocular surface infection by SARS-CoV-2 and implications for corneal donation: An ex vivo study

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