Systematic Review of Ocular Involvement of SARS-CoV-2 in Coronavirus Disease 2019

Abstract

Purpose of Review Studies have reported ocular involvement in the coronavirus disease 2019 (COVID-19), with SARS-CoV-2 having been detected in ocular swab samples. This has implicated the eye as a portal of transmission. The aim of this systemic review is to summarise and discuss the current literature regarding ocular involvement of SARS-CoV-2 in COVID-19. Recent Findings In this systematic review, the prevalence of ocular symptoms and signs was low (from 0 to 31.58%) and conjunctivitis was a relatively rare occurrence. The rate of detection of SARS-CoV-2 in the ocular swab samples was low as well and this ranged from 0 to 11.11%. The development of ocular symptoms and signs was not always accompanied by the detection of SARS-CoV-2 in the ocular swab samples. The opposite was described as well. This may reflect issues related to the characteristics of SARS-CoV-2 and of the study design. Nonetheless, the nature of research in a pandemic is that conclusions can change as more information is obtained. Summary Whilst the eye is unlikely to be a main transmission route, we need to consider the possibilities of conjunctivitis as a presenting complaint and of the eye playing a role in the transmission of SARS-CoV-2. Furthermore, we need to take the appropriate precautions in our practice. Further studies are needed to evaluate the viral tropism of SARS-CoV-2 and its role in the eyes.

SARS‐CoV‐2 and COVID‐19 for the ophthalmologist

“…From there, SARS‐CoV‐2 may reach the nasal mucosa (through the nasolacrimal epithelium), the gastrointestinal tract, and/or the systemic circulation, at times leaving conjunctivitis as a local manifestation of viral infection, 89,97 similar to other respiratory viruses. Indeed, findings consistent with viral conjunctivitis have been reported in 0.3% to 30% of individuals with COVID‐19 91 . Interestingly, SARS‐CoV‐2 RNA may be found in tears and in conjunctival swabs, even in the absence of ocular symptoms 35,91,98 …”

“…Indeed, findings consistent with viral conjunctivitis have been reported in 0.3% to 30% of individuals with COVID‐19 91 . Interestingly, SARS‐CoV‐2 RNA may be found in tears and in conjunctival swabs, even in the absence of ocular symptoms 35,91,98 …”

“…Indeed, ophthalmologists are at particular occupational risk, as SARS‐CoV‐2 is a respiratory virus transmitted primarily through contaminated liquid droplets exhaled by infected individuals 86,87 . In addition, the novel coronavirus and/or its RNA have also been recovered from the ocular tissue and tears of infected individuals, with conjunctivitis and other possible ocular changes being increasingly characterized in association with COVID‐19 88‐91 …”

“…Viral conjunctivitis is indeed a possible, but likely uncommon manifestation of COVID‐19, with the concomitant detection of viral particles being achieved in some inflamed eyes 91 . On the other hand, despite anecdotal reports of the detection of SARS‐CoV‐2 in intraocular tissue, whether the virus can directly induce intraocular inflammation remains an important issue to be determined 107 .…”

Role of Eyes and Eyes Protection Amidst SARS-CoV-2 Infection

“…In a systematic review 4 , the prevalence of ocular signs and symptoms varies from 0 to 31.58% while the detection rate of SARS-CoV-2 in the ocular sample ranged from 0 to 11.1%. Conjunctivitis was a relatively rare occurrence.…”