Ocular manifestation, comorbidities, and detection of severe acute respiratory syndrome-coronavirus 2 from conjunctiva in coronavirus disease 2019: A systematic review and meta-analysis

Abstract

The coronavirus disease 2019 (COVID 19) pandemic has presented major challenges to ophthalmologists. Reports have shown that ocular manifestations can be the first presenting symptoms of COVID 19 infection and conjunctiva may be a portal of entry for the severe acute respiratory syndrome (SARS) associated coronavirus 2 (SARS CoV 2). The purpose of this article is to provide general guidance for ophthalmologists to understand the prevalence of ocular presentation in COVID 19 patients and to reduce the risk of transmission during practice. Relevant studies published in the period of November 1, 2019, and July 15, 2020, regarding ocular manifestations of COVID 19 and detection of SARS CoV 2 in the eye were included in this systematic review and meta analysis. The pooled prevalence of the ocular manifestations has been estimated at 7% (95% confidence interval [CI]: 0.03–0.10) among COVID 19 patients. The pooled detection rate of SARS CoV 2 from conjunctiva was low (1%, 95% CI: 0.00–0.03). Conjunctival symptoms were the most common ocular manifestations in COVID 19, but the positive detection rate of the SARS CoV 2 virus by reverse transcription–polymerase chain reaction of conjunctival tears or secretions remained low. No study has shown a definite transmission of COVID 19 through ocular mucosa or secretions. In summary, ocular manifestations in COVID 19 patients commonly comprise ocular surface symptoms. Although a low prevalence of ocular symptoms was encountered among patients infected by SARS CoV 2, it is imperative for all ophthalmologists to understand the full spectrum of COVID 19 symptoms or signs including those of the eyes as well as to adopt appropriate protective measures during clinical practice.

Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study

“…COVID-19 has been reported to be associated with ophthalmological abnormalities, such as conjunctivitis, chemosis, retinopathy or optic neuritis (3)(4)(5)(6)(7). MRI orbital abnormalities have been reported but no MRI studies have been published about globe abnormalities to the best of our knowledge (8)(9)(10).…”

Imaging in the COVID-19 era: Lessons learned during a pandemic

“…As a mucosal surface, the conjunctiva can be exposed to respiratory droplets and act as a potential port of entry for SARS-CoV-2. Ocular manifestations occur in up to 7% of COVID-19 patients, with conjunctivitis being the most prevalent[ 150 ]. Less frequently, retinal abnormalities may occur as a result of the microangiopathic damage caused by the virus, which can lead to ischemia[ 151 ].…”

Abnormal MRI findings of the orbital or visual pathways in patients with severe COVID-19: Observations from the French multicenter COVID-19 cohort

“…COVID-19 has been reported to be associated with ophthalmological abnormalities, such as conjunctivitis, chemosis, retinopathy or optic neuritis 11 , 12 , 13 , 14 , 15 . These findings are relatively rare among COVID-19-infected patients, ranging from 2 to 32% 14 , 15 , 16 , 17 , 18 . Only a few MRI studies reported orbital and/or visual pathways abnormalities in patients with severe COVID-19 19 , 20 , 21 , 22 , 23 , 24 .…”