Incidence and clinical characteristic of ocular surface manifestation: an evaluation of conjunctival swab results in Corona Virus 2019 (COVID-19) patients in Jakarta, Indonesia.

OBJECTIVES: This study aimed to investigate the spectrum of ocular characteristics and viral presence in the conjunctival swab of patients with COVID-19. METHODS: In this cross-sectional study, fifty-three patients were recruited from two COVID-19 referral hospitals in Jakarta (Cipto Mangunkusumo Hospital and Persahabatan Hospital) from July 2020 to March 2021. The inclusion criteria were patients who were suspected of or confirmed cases of COVID-19 with or without ocular symptoms. Demographic data, history of COVID-19 exposure, underlying medical condition, systemic symptoms, ocular symptoms, supporting laboratory results, reverse-transcriptase polymerase chain reaction (RT-PCR) of naso-oropharyngeal (NOP) swab and conjunctival swab were collected. RESULTS: Fifty-three patients who were suspected, probable or confirmed cases of Covid-19 were included. Forty-six out of 53 patients (86.79%) tested positive for either Covid-19 antibody rapid test or naso-oropharyngeal (NOP) swab. Forty-two patients tested positive for NOP swab. Fourteen out of 42 patients (33.33%) experienced symptoms of ocular infection including red eye, epiphora, itchy eyes, and eye discharge. None of these patients were tested positive for conjunctival swab. Two out of 42 patients (4.76%), who were tested positive for conjunctival swab, did not experience any ocular symptoms. CONCLUSIONS: Establishing the relationship between Covid-19 infection, ocular symptoms, and presence of SARS-CoV-2 virus on the ocular surface proves to be challenging. In Covid-19 patients, ocular symptoms did not warrant a positive conjunctival swab result. On the contrary, a patient without ocular symptoms can also have detectable presence of SARS-CoV-2 virus on the ocular surface.

Endogenous panophthalmitis in a patient with COVID-19 during hospitalization in an intensive care unit: A case report.

Purpose: To report a case of endogenous panophthalmitis in a patient with COVID-19 during treatment in an Intensive Care Unit. Observation: A 64-year-old woman with COVID-19 and Salmonella septicemia presented with decreased visual acuity, ocular pain, and proptosis in her right eye after treatment with favipiravir, intravenous dexamethasone, and ceftriaxone. An ocular examination of her right eye revealed periorbital tenderness, exophthalmos, and corneal haze. The ultrasonography showed a subretinal abscess. Her right eye lost light perception vision and underwent enucleation. Microbiologic evaluation of the enucleated right eye was negative for organisms. Conclusions and importance: Patents with COVID-19 may develop severe ocular involvement after COVID-19 due to a generalized reduction in immunity. Comorbidities and intensive care unit treatments can predispose COVID-19 patients to endogenous panophthalmitis.

Infectious rate of ocular discharges in patients with approved COVID-19 respiratory infection.

Background: Since the relation between ocular manifestation and coronavirus disease 2019 (COVID-19) has been not elucidated well, thus this study was performed to assess the transmission to patients and healthcare providers via ocular secretions, and to decide if there is a link between ocular symptoms and COVID-19. Methods: A total of 101 patients who have been diagnosed with COVID-19 based on the clinical symptoms, radiological studies and confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR), and hospitalized in Corona ward of Imam Khomeini Hospital in Ardabil from April 15, 2020 to September 15, 2020. Ocular examination was done and patients' demographical data and ocular symptoms were recorded. Also, ocular secretion specimens were obtained to evaluate the COVID-19 RT-PCR test to detect the virus in ocular secretion specimen. Results: In this study, we observed that 15.8% of patients had positive RT-PCR test for COVID-19 in their ocular secretion specimens. In addition, we showed that there is no difference between male and female as well as age in patients with positive RT-PCR and negative tests obtained from ocular secretion. In addition, we observed that 27 patients (26.7%) were symptomatic patients for ocular manifestations including conjunctivitis, epiphora, injection, discharge, etc., but only 2 patients (1.98%) had follicular conjunctivitis during examination. Besides, nonsymptomatic patients (for ocular manifestations) had significant lower rate of positive RT-PCR test from their ocular secretion. Conclusion: This study showed that ocular secretion might be a source of COVID-19 infection even in nonsymptomatic patients. Thus, self-protection from ocular secretion should be observed by ophthalmologists from all patients (even nonsymptomatic patients).

Ocular Complication of a Child with Confirmed 2019 Novel Coronavirus Disease: A Case Report

Introduction: The first cases of coronavirus disease 2019 (COVID-19) were identified in Wuhan, China, in December 2019, and then it immediately spread to other parts of the world. Conjunctivitis has been reported as one of the manifestations of the disease. In this study, we report a three-year-old child with a confirmed diagnosis of COVID-19 developing conjunctivitis in Iran. Case Presentation: The patient was a three-year-old male child who was referred to Namazee Hospital (Shiraz) due to fever, dry cough, tachypnea, and respiratory distress. He was admitted with the impression of a COVID-19 infection. On the sixth day of admission, the patient developed unilateral red-eye and foreign body sensation in the left eye. A conjunctival swab was done for collecting tears and conjunctival secretions from the lower eyelid fornix without topical anesthesia and was sent for assessing the presence of SARS-CoV-2 RNA, which was demonstrated to be positive after two days. Conclusions: Our findings suggest that the COVID-19 virus can be present in tears and conjunctiva. Additionally, it should be taken into account that ocular complications may not appear in the early stages of infection. © 2021, Author(s).

A Case of Recurrent Acute Anterior Uveitis After the Administration of COVID-19 Vaccine.

We present a case of a 37-year-old healthy man who developed acute anterior uveitis after receiving the first and second doses of the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. To the best of our knowledge, this is the first report of a recurring incidence of ocular side effects associated with COVID-19 immunization. Based on the timing of the start of symptoms with the first and second vaccinations, the absence of prior medical conditions, and unremarkable investigations, we believe that the patient's anterior uveitis may have been induced by the vaccine itself. This case suggests that vaccination could be a risk factor in uveitis development and recurrence following redosing. As a result, we recommend that ophthalmologists investigate the recent immunization status in each case of uveitis with a temporal association with COVID-19 vaccine administration and record these cases to improve the quality of data tracking of potential adverse responses to vaccines.

Detection of COVID-19 in tears of ICU-admitted patients with SARS-CoV-2 infection.

PURPOSE: Upon the outbreak of 2019, novel coronavirus (COVID-19) pandemic confirmed the cases surpassed 20 million. Despite a few reports identified the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with ocular manifestations, it may assess the ocular symptoms of patients with the COVID-19 by ophthalmologists facilitate the diagnosis and prevent transmission. METHODS: A total of 60 patients with the COVID-19 admitted to Baghiatallah hospital from March 2020 to May 2020 were retrospectively reviewed and analyzed for the ocular manifestations, blood tests, and reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 using nasopharyngeal and conjunctival swabs. RESULTS: Among 60 included patients with clinically confirmed COVID-19, the median age 58.36 years (IQR: 30-88 years), 27 (45%) were male. Furthermore, 29 (48%) and 5 (8%) patients yielded positive for SARS-CoV-2 on RT-PCR from nasopharyngeal swabs and conjunctival specimens, respectively. Among 60 patients, 10 (16%) and 3 (5%), respectively, had the ocular manifestations and positive results for SARS-CoV-2 on RT-PCR from conjunctival and nasopharyngeal swabs. CONCLUSION: Although the positive rate of tear RT-PCR rate is not noticeable as nasopharyngeal swabs yet, COVID-19 transmission through the eyes is biologically plausible.

Ocular manifestations in COVID-19 patients: A systematic review and meta-analysis.

INTRODUCTION: With the accumulating evidence of ocular manifestations of the 2019 novel coronavirus disease (COVID-19), the study aimed to systematically summarize the ocular manifestations in COVID-19 patients. METHODS: The PubMed, EMBASE, Web of Science databases were searched through June 2021. Studies that provided clinical characteristics and outcomes and reported on the ocular manifestations or conjunctival swab RT-PCR tests among COVID-19 patients were included. RESULTS: A total of 30 studies involving 5,717 patients were identified. Ocular manifestations including conjunctival hyperemia (7.6%, 95% confidence interval [CI] 1.8-8.9%), conjunctival discharge (4.8%, 95% CI 1.8-8.9%), epiphora (6.9%, 95% CI 2.8-12.8%), and foreign body sensation (6.9%, 95% CI 2.4-13.0%) were observed. The positive rate of conjunctival swab tests was 3.9% (95% CI 0.2-6.4%). Severe cases of COVID-19 were associated with an increased risk of developing ocular complications (odds ratio [OR] = 2.77, 95% CI 1.75-4.40). CONCLUSIONS: Despite their relatively low incidence rate in COVID-19 patients, ocular manifestations may be non-specific and present as the initial symptoms of infection. The presence of SARS-CoV-2 in the conjunctival swabs implicates the eye as a potential source of infection. Early diagnosis and proper eye protection would help prevent viral transmission.

The Eye of the Storm: COVID-19 Vaccination and the Eye.

The COVID-19 pandemic has galvanized the global response towards the development of new vaccines based on novel technologies at an unprecedented pace. Since the widespread implementation of vaccination campaigns, case reports on vaccines' systemic side effects, including ocular manifestations, have emerged. Since administered vaccines are generally not able to cause the disease in the recipient, or induce an immune response against the pathogen, we hypothesize that the development of ocular phenomena post-COVID-19 vaccination may occur via an immune response elicited by the vaccine. Of many, the most common ocular adverse events include facial nerve palsy, central venous sinus thrombosis and acute anterior uveitis. These COVID-19 vaccine-induced ocular (CVIO) adverse events could resemble the ocular findings in some of the COVID-19 patients. This review will provide a comprehensive overview of published ocular side effects potentially associated with COVID-19 vaccination and serve as a springboard for further research into CVIO adverse events.

Ocular transmission and manifestation for coronavirus disease: a systematic review.

BACKGROUND: There is currently a lack of information regarding ocular tropism and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Globally, the cumulative number of coronavirus disease 2019 (COVID-19) cases is increasing daily. Thus the potential for ocular transmission and manifestations of SARS-CoV-2 requires more investigation. METHODS: A systematic search of electronic databases for ocular transmission and manifestations of SARS-CoV-2 was performed. Pooled cross-sectional studies were used for conducting a meta-analysis to estimate the prevalence of ocular transmission of SARS-CoV-2 to the respiratory system and ocular manifestations (associated symptoms) of SARS-CoV-2. RESULTS: The highest prevalence of SARS-CoV-2-positive tears using reverse transcription polymerase chain reaction was found to be 7.5%. However, the highest prevalence of ocular conjunctivitis associated with SARS-CoV-2 was 32%. Thus, SARS-CoV-2 can evidently infect the eye, as revealed in the conjunctival secretions of COVID-19 patients. CONCLUSION: The available data reflect the influence of the ocular structure on SARS-CoV-2. The analysis showed that ocular manifestation is an indication for SARS-CoV-2, particularly conjunctivitis. Moreover, there is no evidence that the ocular structure can be an additional path of transmission for SARS-CoV-2, however, it warrants further investigation.

Outcomes of the Ophthalmic Examinations in Patients Infected by SARS-CoV-2.

Purpose: To evaluate ophthalmic examination results which were performed with slit-lamp biomicroscope, in patients with laboratory-confirmed SARS-CoV-2 infection.Methods: In the present study, 50 patients with laboratory-confirmed SARS-CoV-2 infection, were enrolled. Ophthalmic examination with slit-lamp biomicroscopy was performed and the results were evaluated.Results: The mean age of 50 patients (24 females, 26 males) included in this study, was 58,26 ± 18,91 years. In nine patients, bilateral acute follicular conjunctivitis was present. In two patients, acute anterior uveitis was seen. Optic disc and macula were normal in all patients. Preauricular lymphadenopathy (LAP) was found in 6 (12%) patients. Of these six patients, five had follicular conjunctivitis, and one had anterior uveitis.Conclusion: Acute follicular conjunctivitis with preauricular LAP and anterior uveitis were detected and no fundus pathologies were found in detailed ophthalmic examination in patients with laboratory-confirmed SARS-CoV-2 virus infection.

Update and Recommendations for Ocular Manifestations of COVID-19 in Adults and Children: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic has instigated severe global turmoil both medically and socioeconomically. Research continues to rapidly develop in order to fully comprehend the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study focuses on the rare ophthalmologic manifestations of the SARS-CoV-2 disease process in both adults and children. There is evidence to suggest that viral transmission can occur via tears and conjunctival secretions, although it is not a predominant finding. This review considers all the published studies describing ocular findings and SARS-CoV-2 viral transmission through the eye. The review addresses the ongoing debate over the importance of ocular manifestations during this pandemic. The most updated safety guidelines, protocols, timelines of ocular manifestations during the disease course, and treatment recommendations are discussed. The majority of patients with COVID-19 with eye symptoms presented with them initially. It is possible that the virus becomes inoculated at the site of the eye and spreads via the nasolacrimal duct to the respiratory system. There are also some reports which show that ocular findings present later in the disease course, suggestive of a correlation between ocular manifestation and increased disease severity as the infection becomes systemic. We highlight the importance of recognizing conjunctivitis as an early finding of COVID-19, and that testing or appropriate follow-up could be beneficial in both the pediatric and adult populations.

The implication of ocular manifestation of COVID-19 for medical staff and patients - systematic review.

INTRODUCTION: SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a coronavirus that causes COVID-19 (coronavirus disease 2019) with mild to severe respiratory illness. It is a highly contagious disease transmitted through direct or indirect contact with infected people or contaminated surfaces, mainly through respiratory droplets, but other routes are being investigated. OBJECTIVE: It is known that coronaviruses (CoVs) can cause a variety of ocular pathologies in animals, including conjunctivitis, anterior uveitis, retinitis, and optic neuritis, many of which are severe. However, there is no evidence of the SARS-CoV-2 presence in the eye tissue of asymptomatic patients, even if the symptomatic incidence is low. This systematic review presents updated literature on this issue. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: COVID-19 has now spread throughout the continents and poses a global threat to public health. The risk of rapidly overloading health care systems and causing substantial mortality worldwide is real. On 11 March 2020, the World Health Organization (WHO) announced coronavirus as a global pandemic. Several studies described a few cases with initial ocular symptoms followed by systemic symptoms of the disease. SUMMARY: Although the frequency of transmission of SARS-CoV-2 infection through the eye is low, ocular symptoms are not uncommon in COVID-19. In some cases, eye symptoms may be the first signs of illness. This implies the need for hygienic recommendations and use of personal protective equipment (PPE) for medical staff and other services to minimize COVID-19 infection of both health-care workers and patients. A triage for ophthalmic outpatient clinic is mandatory.