ABSTRACT
Purpose : To systematically investigate ocular changes in autopsied eyes from fatal cases of Coronavirus disease 2019 (COVID-19) and to investigate the localization of severe acute respiratory syndrome coronavirus (SARS-CoV-2) within ocular structures. Methods : Macroscopic and microscopic histopathological evaluation was performed and the localization of SARS-CoV-2 RNA within ocular tissues investigated using an in situ hybridization (ISH) technique in 13 eyes. Contralateral eyes were freshly dissected, and droplet digital polymerase chain reaction (ddPCR) assay was performed on ocular fluids and tissues to quantify SARS-CoV-2 RNA. Results : A total of 21 fatal COVID-19 cases were included (mean age, 60.2 years [range, 27- 91 years];23.8% female). Histopathological abnormalities include vascular changes (61.9%), cytoid bodies (52.4%), and retinal edema (23.8%) with minimal inflammation (0.09%) were observed. Non-CMV viral inclusions were identified in one eye. No CMV positivity was detected. Of the 21 contralateral eyes tested by ddPCR, 14 tested positive for SARS-CoV-2. Using ddPCR and ISH, SARS-CoV-2 localization was observed in the following ocular tissues and fluid: cornea (27.3%), aqueous (26.3%), lens (54.5%), vitreous (15.0%), retina (22.2%), choroid/sclera (47.4%), and optic nerve (50.0%). The choroid/sclera, optic nerve and lens were the most frequent ocular structures found to be ddPCR positive. Evidence of replication was detected in four cases. Conclusions : Our results suggest that SARS-CoV-2 localizes to intraocular tissues. However, histological changes observed are likely a secondary hemodynamic change rather than primary effect of the virus.
ABSTRACT
Purpose : Ocular findings have been reported in association with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite these reports, less is known on the frequency, spectrum and duration of associated ocular symptoms and their onset in the disease course. The purpose of this study is to systematically characterize ocular symptoms in participants with COVID-19 infection. Methods : An online Research Electronic Data Capture (REDCap) survey designed to characterize ocular symptoms was developed and the study information distributed to NIH employees who had tested positive for SARS-CoV-19.The survey was also advertised to the public through social media and patient recruitment mailing lists. All responses were anonymous, and participants were asked to consent to completing the survey, confirm a positive SARS-CoV PCR test and that they were 18 years of age or older. This study was approved as exempt by the National Institutes of Health (NIH) Office of IRB Operations. Results : Following exclusion of ineligible participants and incomplete responses, 181 (20.4% male and 79.0% female) complete survey responses were included for analysis including from hospitalized (9.9%) and non-hospitalized (90.1%) respondents as well NIH employees (27.1%). Ocular symptoms were reported by 77.9% of participants (mean number of ocular symptoms per participant: 2.19+/- 2.36). The most commonly reported ocular symptoms were light sensitivity 28.1%, itchy eyes (26.0%), tearing (25.4%), eye redness (24.9%), mucous discharge (20.1%), foreign body sensation (17.1%), and new onset floaters (15.4%). With the exception of itchy eyes, no significant differences in eye symptoms were found between age groups. The onset of ocular symptoms occurred mostly frequently at the same time as systemic symptoms (53.8%) compared to before (18.9%) and after systemic symptoms (27.3%). Notably, 10.6% of respondents with ocular symptoms sought medical attention by an eye care professional and 21.2% reported eye symptoms lasting ≥14 days. Conclusions : Our results show that the majority of survey respondents experienced ocular symptoms though only a minority required ophthalmic examination and our study is likely biased towards respondents with eye symptoms. Consistent with other reports, ocular surface related symptoms were more common and vision affecting symptoms were rare. Further work is needed to identify the sequalae of ocular symptoms associated with SARS-COV-2.