Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctival Secretions: A Review

Abstract

SARS-CoV-2 is a highly transmissible virus that spreads mainly via person-to-person contact through respiratory droplets, or through contact with contaminated objects or surfaces from an infected person. At present we are passing through a phase of slow and painful understanding of the origin, epidemiological profile, clinical spectrum, and risk profile of the virus. To the best of our knowledge there is only limited and contradictory evidence concerning SARS-CoV-2 transmission through other routes. Importantly, the eye may constitute not only a potential site of virus replication but also an alternative transmission route of the virus from the ocular surface to the respiratory and gastrointestinal tract. It is therefore imperative to gain a better insight into the potential ophthalmological transmission route of the virus and establish directions on best practice and future models of care for ophthalmological patients. This review article critically evaluates available evidence on the ophthalmological mode of viral transmission and the value of earlier identification of the virus on the eye. More evidence is urgently needed to better evaluate the need for protective measures and reliable ocular diagnostic tests to diminish further pandemic spread.

Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era of COVID‐19

“…Reassuringly, spatter did not extend above the neckline of the surgeons' scrub gown; sparing the surgeons' head, surgical mask and eyewear nor did spatter contaminate the assistant or equipment table. We therefore conjecture through our observed locally‐limited microdroplet spatter and in the context of a lack of convincing evidence of viable SARS‐CoV‐2 in the tear film, 19,24,25 that the risk of contamination is relatively low and only standard PPE equipment is required for the operating surgeon, assistant and the circulating theatre staff.…”

“…Despite this, previous pilot studies and experiments have demonstrated that piezosurgical procedures can and do produce both microdroplets and aerosolized particles 10,12,27 . By the nature of clinical and surgical practice, ophthalmologists may be at risk of exposure to SARS‐CoV‐2 5,19,24,28 . However, while both microdroplets and exhaled aerosol have been identified as potential routes for SARS‐CoV‐2 transmission, the risk of viable viral contamination via ocular fluid, through the generation of microdroplets and aerosol during phacoemulsification surgery, appears to be low but is still under investigation 4,23,25,26,29 …”

“…Furthermore, knowledge of ocular tropism of viral agents is well‐recognized, with several existing viruses (including SARS‐CoV‐1) isolated in the tear film, cornea, aqueous humour and crystalline lens 6,15‐19 . As SARS‐CoV‐2 has demonstrated both an extended incubation period between 2 and 14 days in patients, high rates of asymptomatic carriers and extended surface stability with a half‐life >5 hours on steel and plastic, there appear to be multiple opportunities for virus transmission within health settings 14,20‐23 .…”

Mechanisms of COVID-19-induced heart failure: a short review

“…The virus that causes COVID-19 is transmitted through respiratory aerosols or physical contact with contaminated droplets [4]. SARS-CoV-2 virus then finds its way into the respiratory system, where they induce a cascade of inflammatory reactions [4]. SARS-CoV-2-induced COVID-19 has caused a large variety of complications resulting in high morbidity and mortality.…”

“…SARS-CoV-2-induced COVID-19 has caused a large variety of complications resulting in high morbidity and mortality. COVID-19-induced pathologies are not limited to the respiratory system alone, but they are also seen in other body systems and organs such as the brain [5], eye [4], gastrointestinal tract [6], renal and urinary structures [7], hemopoietic [8], and cardiovascular [9] system. Recent reports show that COVID-19 causes several cardiovascular complications including myocardial infarction (MI), myocarditis, heart failure (HF), cardiogenic shock, and sudden cardiac death (SCD) [10].…”