<p>A Review of Neuro-Ophthalmological Manifestations of Human Coronavirus Infection</p>

Abstract

Introduction Human coronavirus (HCoVs) are a group of viruses with recognized neurotropic and neuroinvasive capabilities. The reports on the neurological and ocular findings are increasing day after day and several central and peripheral neurological manifestations are already described. However, none specifically describes the neuro-ophthalmological manifestation of HCoVs. This is the first article specifically reviewing neuro-ophthalmological manifestations of HCoVs infection. Methods PubMed and Google Scholar databases were searched using the keywords: coronaviridae, coronavirus, COVID-19, SARS-CoV-2, SARS-CoV-1, MERS, ocular, ophthalmology, ophthalmological, neuro-ophthalmology, neurological, manifestations. A manual search through the reference lists of relevant articles was also performed. There were no restrictions concerning language or study type and publications not yet printed but available online were considered. Results Coronavirus eye involvement is not frequent and includes mostly a typical viral follicular conjunctivitis. Recently, retinal anatomical alterations were described using optic coherence tomography. Neuro-ophthalmological symptoms and signs can appear isolated or associated with neurological syndromes. The manifestations include headache, ocular pain, visual impairment, diplopia, and cranial nerve palsies secondary to Miller Fisher syndrome, Guillain-Barré syndrome, or encephalitis, and nystagmus. Conclusion Neurological and neuro-ophthalmological syndromes, symptoms, and signs should not be neglected and a complete ophthalmological examination of these patients should be performed to fully describe ocular manifestations related to HCoVs. We believe that major ocular and neuro-ophthalmological manifestations reports lack due to safety issues concerning detailed ophthalmological examination; on the other hand, in a large number of cases, the presence of life-threatening coronavirus disease hinders ocular examination and ophthalmologist’s visit to the intensive care unit.

Ophthalmic Screening in Patients with Coronavirus Disease 2019: A Prospective Cohort Study

“…Median best corrected visual acuity (BCVA) was 0.1 (0-1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) in the right eye (oculus dexter; OD) as well as in the left eye (oculus sinister; OS) (mean BCVA 0.198 ± 0.32 (±standard deviation) LogMAR OD; mean BCVA 0.19 ± 0.34 LogMAR OS). Median intraocular pressure (IOP) was 16 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) mmHg OD and 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) mmHg OS (mean IOP 15.8 ± 3.12 mmHg OD; 16.1 ± 2.74 mmHg OS).…”

“…A number of anecdotal reports suggest possible neuro-ophthalmic involvement in COVID-19 including ocular motility dysfunction, diplopia, and ptosis [ 10 ]. Intraocular, especially posterior segment examination, require ophthalmological expertise and technical equipment that is usually not available in an infectious disease unit.…”

“…Hence, evidence on intraocular involvement in COVID-19 is scarce, originating mainly from a few letters to the editor, case reports, and small case series [ 11 ]. Concerns have been expressed that major neuro-ophthalmological and intraocular manifestations are underreported as a result of limited diagnostic capabilities [ 10 ]. In addition, the sparse reports on intraocular findings in COVID-19 are conflicting and highly controversial [ 11 ].…”

Internuclear ophthalmoplegia as a presenting feature in a COVID-19-positive patient

“…12 Reports of neuro-ophthalmic findings such as cranial nerve paresis, optic neuritis, gaze palsy, vision loss and so on are being increasingly described in the literature. [6][7][8][9][10][11][12][13][14][15][16] Multiple mechanisms in the aetiopathogenesis of neuroophthalmic manifestations in COVID-19 have been proposed, and these include postviral inflammatory syndrome, sequelae of a proinflammatory state and as a consequence of systemic conditions, such as cardiovascular disease or uncontrolled hypertension. 14 Haematological spread and direct viral invasion have also been suggested.…”

Opportunities, Challenges and Pitfalls of Using Cannabidiol as an Adjuvant Drug in COVID-19

“…In addition, pathological changes in the renal [ 1 , 16 , 27 , 33 , 37 , 38 ], gastrointestinal, hepatic, pancreatic [ 1 , 16 , 27 , 31 , 39 , 40 ] and nervous systems [ 1 , 27 , 41 , 42 , 43 ] have been described. Disturbances of the eyes [ 1 , 44 ], endocrine [ 45 , 46 ] and reproductive functions [ 31 , 45 , 46 , 47 ], skeletal muscles [ 1 , 33 , 48 ] and skin [ 1 , 49 , 50 ] occur as well (for details, see Figure 2 ).…”