Ocular Manifestations and Tear or Conjunctival Swab PCR Positivity For SARS-CoV-2 In Patients With COVID-19: A Systematic Review and Meta-Analysis

Abstract

Background: Respiratory viruses have a tendency for ocular-tropism and SARS-CoV-2 is one of them. In this context, we have undertaken this systematic literature-review and metaanalysis for systemic evaluation of ocular symptoms of COVID-19. Material and Method: We have screened 14 literature databases applying key-words “Ocular”, “Ophthalmic”, “Conjunctiva”, “Cornea”, “Retina”, “Sclera”, “Uvea”, “2019-nCov”, “2019 novel corona virus”, “COVID-19”, “corona virus disease-2019”. Studies published till 26th April 2020 were included. Studies conducted in COVID-19 population and reporting ocular ma infestations were included. Case reports, series, observational studies were included in the systematic review part, while only observational studies were included in the metaanalysis part. Pooled proportions were evaluated and reported along with 95% confidence interval. Heterogeneity was evaluated using I2 statistics and random or fixed-effect model was selected to evaluate the pooled proportions based upon presence of extent of heterogeneity. Result: A total of 14 studies (total 2259 patients) were included in our systematic-review and metaanalysis which reported occurrence of ocular symptoms in COVID-19. In our study, prevalence of conjunctivitis/red eye in COVID-19 was 2.8% (95% CI 1.3% to 4.2%, I2=72.41%). Conjunctivitis/red eye was the first symptom of COVID-19 in 1.08% of patients (95% CI 0.37% to 2.44%, I2=0%). Tear sample PCR positivity rate in COVID-19 was 2.6% (1.3% to 4.5%, I2=47%). However, among COVID-19 patients with conjunctivitis/red eye, the PCR positivity rate in tear sample was 20.6% (6/29 cases). Again, among patients who were positive for the virus in tear sample by PCR, the proportion of conjunctivitis/red eye was 33.3% (4/12 cases). We also evaluated the association between occurrence of ocular manifestations and disease severity (mild and moderate vs. severe and critical). The odds was 0.28 (95% CI 0.12-0.67, I2=0%). This highlights that the mild to moderate severity disease had significantly lower occurrence of the ocular symptoms compared to the severe and critical group. However, we couldn’t find any association between tear sample PCR positivity and disease severity [odds ratio 0.46 (95% CI 0.06-3.45, I2=0%)]. Conclusion: In patients with COVID-19, 2.8% of patients show ocular manifestation. However, among patients with ocular manifestation, only 20.6% cases showed tear/conjunctival swab RT-PCR positivity. So, ocular symptoms may warrant a COVID-19 screening test during thie epidemic of COVID-19.