Abstract
Apart from conjunctival involvement which is the most well-known ocular manifestation of coronavirus infectious disease 2019 (COVID-19), there are multiple reports of the involvement of other ocular structures by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We comprehensively reviewed PubMed, Scopus, Embase, and Google Scholar for available evidence regarding COVID-19 various ocular manifestations, with special focus on less known and unusual ocular findings. We then categorized the findings based on the parts of the eye which was involved. In anterior sections of the eye, the involvement of the eyelid (tarsadenitis), conjunctiva and cornea (follicular conjunctivitis, pseudomembranous conjunctivitis, and keratoconjunctivitis), episclera (nodular episcleritis), uvea (anterior uveitis) were reported. Also, third, fourth, and sixth nerve palsy, retinal vasculitis, retinal optical coherence tomography (OCT) changes (hyper-reflective lesions and increased retinal nerve fiber layer thickness [RNFLT]), optic neuritis, papillophlebitis, Miller Fisher syndrome, posterior reversible leukoencephalopathy (PRES), ophthalmic artery and central retinal artery occlusion, and polyneuritis cranialis were reported in different studies. Postmortem evaluation of COVID-19 patients detected no viral RNA in different anterior and posterior segments of the eyes. However, another study revealed a 21.4% positivity of the retinal biopsies of dead patients. The results of this study can help ophthalmologists to be vigilant when they see these findings in a suspected case of COVID-19. In addition, wearing face masks and protective goggles or eye shields are recommended, especially in high risk contacts.
Highlights
Since December 2019, coronavirus has caused more than 990,000 deaths and contamination of more than 32.7 million people globally till September 27, 2020.[1]. Coronavirus disease 2019 (COVID-19) can be transmitted directly through person to person contacts via droplets released during sneezing or coughing
Ophthalmologists are at high risk of contracting COVID-19 due to their close contact with the patients during routine ophthalmologic exams such as slit lamp examinations and direct ophthalmoscopy.[6]
Epiphora, increased secretion, chemosis, and follicular conjunctivitis are the main symptoms of conjunctival involvement with SARS-CoV-2.[25]. Based on the “Report of the WHO−China Joint Mission on Coronavirus Disease 2019 (COVID−19),” conjunctival congestion occurs in about 0.8% of COVID-19 patients.[26]
Summary
Since December 2019, coronavirus has caused more than 990,000 deaths and contamination of more than 32.7 million people globally till September 27, 2020.[1]. Ophthalmologists are at high risk of contracting COVID-19 due to their close contact with the patients during routine ophthalmologic exams such as slit lamp examinations and direct ophthalmoscopy.[6] the patients’ prolonged stay at ophthalmology clinics for multiple ophthalmology examinations imposes ophthalmologists and other patients at increased risk of COVID-19.[7] A recent study revealed a high probability of contamination of environmental surfaces of ophthalmology clinics.[8] Ocular presentations of COVID-19 usually occur about two weeks after the first symptoms It can be the presenting finding of newly diagnosed COVID-19 patients, especially when the virus enters from the eye mucosa.[9] knowing the latest presentations of COVID-19 is crucial for every ophthalmologist. We gathered available data about ocular manifestations of COVID-19, focusing on recently reported manifestations
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