Update on overview of ocular manifestations of COVID-19

Abstract

The coronavirus disease 2019 (COVID-19) has become the most critical health crisis at present, and research is continued about the exact pathophysiology, presentations, and complications of this pandemic. It influences several organs, and many studies have addressed the organs, the involvement of which during the COVID-19 results in patients' death. One of the important organs that can be involved during COVID-19, which is also a transmission route of the disease, is the eye. According to the evidence, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can have ocular manifestations and complications. According to the literature, conjunctivitis is the most common presentation, which can develop at any stage of COVID-19 (during and even after the disease), and the major pathophysiology of the eye involvement during the disease is attributed to the direct effect of the virus on the eyes, tissue damage caused by inflammation, underlying diseases, and the adverse effect of the medications prescribed. There are also reports of life-threatening complications, such as rhino-orbital cerebral mucormycosis, which require urgent treatment and are associated with a great mortality rate. Ocular manifestations may also be the presentation of a life-threatening event, such as stroke; therefore, it is necessary to pay great attention to the ocular manifestations during COVID-19. In this review, after about 2 years of the pandemic started, we present a narrative review on ocular manifestations during COVID-19, categorized into three main categories; ophthalmic, orbital, and neuro-ophthalmological manifestations with a detailed description of the presenting symptoms, risk factor, diagnostic, and therapeutic strategies suggested for each.

SARS-CoV-2 infects cells lining the blood-retinal barrier and induces a hyperinflammatory immune response in the retina via systemic exposure

“…The long-term effects of COVID-19 on visual function and ocular anatomy are not yet fully understood. Some clinical studies have shown that SARS-CoV-2 can cause retinal vascular occlusions, including central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), vitritis, and acute retinal necrosis (ARN) [ 46 ]. Because we observed the presence of S-antigen in various parts of the eye and SARS-CoV-2-induced cell death in cells lining the BRB, we aimed to evaluate the long-term consequences of S-antigen on overall retinal health.…”

Ocular Symptoms Associated with COVID-19 Are Correlated with the Expression Profile of Mouse SARS-CoV-2 Binding Sites

“…Viral transmission from eye tissue and its related secretions thus needs to be seriously considered, particularly regarding the direct proximity between persons or vector animals that could be encountered; this includes, for example, frontline workers, including medical personal or researchers, as well as vulnerable populations [ 82 , 83 ]. Mitigation approaches, in order to prevent direct ocular transmission could, therefore, include wearing eye shields or the application of a blocking agent, such as heparin-based formulations in the exposed face area [ 84 ]; these measures would be potent and personal protective approaches to limit the steady rise of viral transmission and ocular symptoms [ 85 ].…”

Retinal complications following COVID-19: Real-life insights and implications

“…According to preliminary clinical data, ophthalmologic COVID-19 cases can usually be characterised by an associated in ammatory state, vasculopathy, thrombotic microangiopathy, and intravascular coagulopathy [4].…”

“…However, following or during infection, patients also demonstrated changes to their posterior eye segments, which are the subjects of these case studies. Further information about the connections of connections to retinovascular illnesses is continually being reported [2][3][4]. With a rise in newer and potentially more threatening variants of the COVID-19 virus, being acquainted with the possible clinical manifestations would pave the way for an effective treatment plan and improve patient clinical outcomes and visual acuity.…”