Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis

Abstract

Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed randomeffects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71–17.72). In the studies that reported the details of observed ocular symptoms, the most common ocular manifestations were dry eye or foreign body sensation (n = 138, 16%), redness (n = 114, 13.3%), tearing (n = 111, 12.8%), itching (n = 109, 12.6%), eye pain (n = 83, 9.6%) and discharge (n = 76, 8.8%). Moreover, conjunctivitis had the highest rate among reported ocular diseases in COVID-19 patients (79 out of 89, 88.8%). The results suggest that approximately one out of ten COVID-19 patients show at least one ocular symptom. Attention to ocular manifestations, especially conjunctivitis, can increase the sensitivity of COVID-19 detection among patients.

Influence of Face Masks on the Use of Contact Lenses

“…On the other hand, we also have to consider that dry eye, together with the sensation of a foreign body, redness, tearing, itching, eye pain, and discharge were the most important ocular manifestations in patients with COVID-19. In the systemic review by Nasiri et al [ 55 ], it was concluded that the mechanism of dry eye or foreign body sensation is unclear in COVID-19 patients and may not be directly associated with SARS-CoV-2. The appearance of dry eye during the COVID-19 epidemic can be related to the use of face masks, mainly when the masks are loose against the face and nose, and the airflow is greater towards the eyes.…”

A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic

“…The literature includes a vast number of studies and articles indicating that DED is likely to have been worsened during the COVID-19 pandemic period [32][33][34][35][36]. In addition to the ocular signs and symptoms reported among people contracting the COVID-19 virus, the lifestyle changes associated with social distancing measures and the wearing of masks have implications for ocular health [32][33][34][35][36][37][38][39]. The term ''quarantine dry eye'' has been proposed by Napoli et al in their recent hypothesis paper discussing the aspects of lockdown lifestyle likely to affect ocular surface health, from environmental and behavioural factors through to diet, hydration, sleep deprivation and the psychological challenges associated with the pandemic restrictions [32].…”

Ocular findings among patients surviving COVID-19

“…Among the patients with COVID-19 in the acute phase of the disease, approximately 10% exhibited ocular symptoms, particularly related to ocular surface (conjunctivitis, red eye, foreign body sensation, dry eye, photophobia, blurry vision, itching, epiphora, ocular pain, and floaters) 3 – 6 . Concerning posterior segment commitment, flame-shaped or microhemorrhages and cotton wool spots in the papillomacular bundle were shown 7 – 9 .…”