The Implications of SARS-CoV-2 Infection in a Series of Neuro-Ophthalmological Manifestations-Case Series and Literature Review.

The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism secondary to viral antigens. The manifestations are atypical, being present even in the absence of the systemic symptoms typical of a SARS-CoV-2 infection. In this article, we introduce a series of three clinical cases with neuro-ophthalmological manifestations associated with COVID infection that were shown in Ophthalmology Clinic of St. Spiridon Emergency Hospital. Case 1 is that of a 45-year-old male patient with no personal history of general pathology or ophthalmology, with binocular diplopia, painful red eyes, and lacrimal hypersecretion with a sudden onset of about 4 days. Based on the evaluations, a positive diagnosis of orbital cellulitis in both eyes is made. Case 2 is that of a 52-year-old female patient with general PPA (personal pathological antecedents) of SARS-CoV-2 infection 1 month prior to presentation with decreased visual acuity in the right eye and a positive central scotoma, preceded by photopsia and vertigo with balance disorders. The diagnosis is made at the right eye for retrobulbar optic neuritis and post-SARS-CoV-2 infection status. The last clinical case is that of a 55-year-old male patient known to have high blood pressure (HBP) with a sudden, painless decrease in VARE approximately 3 weeks post-SARS-CoV-2 immunization (Pfizer vaccine first dose). The diagnosis is made after consulting all the RE results for central retinal vein thrombosis. Conclusions: Although the cases were quickly and efficiently investigated and the treatment was administered adequately by a multidisciplinary team (cases 1 and 3), the evolution was not favorable in all three situations. Atypical neuro-ophthalmological manifestations can also be present in the absence of systemic symptoms typical of SARS-CoV-2 infection.

Ophthalmic Manifestations of Multisystem Inflammatory Syndrome in Children

Objective The aims of this study were to determine the prevalence and clinical features of ophthalmic involvement in multisystem inflammatory syndrome in children (MIS-C) and to evaluate its association with other organ system involvement and the severity of the disease.Methods The demographic data and information on the ophthalmologic and other systemic organ manifestations, laboratory findings, treatment modalities, and clinical outcomes of 97 patients with MIS-C were retrospectively obtained from their hospital records. Sixty-two patients with MIS-C who were examined by ophthalmologists were included in the study. Statistical analysis was performed using R version 3.6.0, and a p- value < 0.05 was accepted as statistically significant.Results The patients' median age was 82 months (range, 11-204 months). Of the patients, 62.9% were male. The most common systemic involvements were mucocutaneous (83.9%) and cardiovascular (82.3%). Kawasaki disease was clinically observed in 71% of the patients (incomplete form, 53.2%). Ophthalmic involvement was observed in 39 patients (62.9%). Thirty-two patients (51.6%) had conjunctival hyperemia;29 (48.4%) lid edema;7 follicular conjunctivitis;3 uveitis;2 subconjunctival hemorrhage;and 1 episcleritis. The patients with ophthalmic involvement were 6.4 times (95% confidence interval [CI], 1.49-27.48;p = 0.013) more likely to exhibit cardiac involvement and 3.53 times (95% CI, 1.35-9.63;p = 0.012) more likely to have severe disease.Conclusion Conjunctival hyperemia, lid edema, and follicular conjunctivitis were observed in at least half of the patients with MIS-C, and those with ophthalmic involvement had a higher risk of cardiac involvement or severe disease.

SARS-CoV-2 virus-induced bilateral acute iris transillumination syndrome: The first case series in literature.

Inflammatory events with highly variable clinical features have been reported with the coronavirus disease 2019 (COVID-19) pandemic, which has affected the whole world. Only one case of COVID-19-associated bilateral acute iris transillumination (BAIT) syndrome has been reported in the literature. We present a case series in which we hypothesize that the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have a mechanism similar to the common viruses that cause BAIT, the etiology of which is still unknown.

A clinicoepidemiological study of orbital mucormycosis in COVID-19 pandemic at a tertiary healthcare hospital, North-West Rajasthan, India

Background Mucormycosis is an opportunistic fungal infection with high morbidity and mortality. Purpose The aim of this study was to determine the risk factors, clinical presentation, management, and outcome of management of orbital mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic. Patients and methods This is a prospective hospital-based observational study that was conducted on cases of rhino-orbital cerebral mucormycosis (ROCM) presented to a tertiary health-care center in North-West Rajasthan, India, during the second wave of COVID-19 over a period of 1 month (May 26, 2021 to June 25, 2021). The patients were followed up for 3 months. A total of 40 cases fulfilling the clinical, radiological, and pathological or microbiological criteria for the diagnosis of ROCM were included in the study. Results Out of a total of 126 mucormycosis patients, 40 had ocular manifestations ranging from lid edema, chemosis, and ptosis to severe manifestations such s ophthalmoplegia, optic neuritis, and cavernous sinus thrombosis. Rare presentations of corneal eschar and corneal ulcer were also reported. Among the 40 patients of orbital mucormycosis, 57.5% were in the age group of 51-65 years, 65% were males, 62.5% were COVID positive, 37.5% had a history of oxygen therapy during the COVID-19 illness, and 85% were not vaccinated against COVID-19. All patients with orbital involvement had rhinitis at presentation. Intravenous Amphotericin B was given to all patients. Functional endoscopic sinus surgery was done in 92.5% of the cases and orbital exenteration was done in 35% of the patients to prevent the spread of mucor and to reduce mortality. In 32.5% of the patients, retrobulbar Amphotericin B was given. The mean length of hospital stay was 24.62±11.70 days and 70% of the patients were discharged from the hospital on oral antifungal therapy. A total of 30% of the patients with cerebral involvement passed away. During the follow-up of 3 months, three (7.5%) more patients who discontinued treatment progressed to advanced disease and died, while 62.5% (25 out of 40) patients were alive with stable/regressed disease. The survival rate with retrobulbar Amphotericin B was 92.30% and with exenteration was 92.85%, which was statistically significant compared with the 5% survival rate in the cases in whom no such intervention was done. Conclusion Early diagnosis and treatment of ROCM reduced morbidity and mortality in mucormycosis patients. © 2022 Delta Journal of Ophthalmology ;Published by Wolters Kluwer - Medknow.

Ocular manifestations of coronavirus disease 2019(COVID-19)

Coronavirus disease 2019 (COVID - 19) is caused by novel coronavirus (SARS - CoV - 2), which is widely prevalent around the world and caused global panic. Evidences show that eye transmission is possible, so the ophthalmic medical staff is more likely to be infected. Ocular manifestations of COVID - 19 involve conjunctiva, corneal, sclera, anterior chamber, pupils, retina, optic nerve and visual cortex, extraocular muscles and theirs cranial nerves innervation, orbit and lacrimal system. Viral conjunctivitis is the most common ocular manifestation of COVID-19. In order to protect ophthalmic medical staff from infection and to safely carry out clinical work during the epidemic period of COVID-19, this article summarizes the ocular manifestations of COVID - 19, including epidemiology, pathophysiology and clinical manifestation. Copyright © 2022 International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.

Ocular manifestations of COVID-19.

COVID-19 is a disease caused by a SARS-CoV-2 viral infection, a disease that was first detected in December 2019 in Wuhan, Hubei Province, China. COVID-19, formerly known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease, was officially named COVID-19 by the World Health Organization (WHO) in February 2020. By 25 May 2021, there were 33,579,116 confirmed cases with 599,109 COVID-19 deaths worldwide. The purpose of this review article is to provide an update on what is currently known about COVID-19 ocular symptoms in adults, the elderly, and children in the literature. Finally, this article will review the eye protection precautions that should be implemented in our clinics. To assess the current literature, PubMed was searched from December 2019 to 25 May 2021. Randomized trials, observational studies, case series or case reports, letters of research, and letters to editors were selected for confirmed cases of COVID-19. According to current scientific literature since the outbreak in December 2019, 205 articles have been published. Conjunctivitis, conjunctival hyperemia, and chemosis have been reported in adults with COVID-19. There have been few studies on children and elderly patients, and further research in these age groups is needed. Finally, wearing eye protection when seeing patients on a daily basis during the pandemic is essential.

Covid-19 and its relation to the human eye: transmission, infection, and ocular manifestations.

BACKGROUND: The world is suffering from a new strain of the coronavirus family-Covid-19. This virus strain affected different organs in the human body with a wide range of mild symptoms and moderate signs to severe and deadly ones. Multiple organs can be infected, and one of these organs is the eye. The eye is a vital organ that consists of vascular tissues and is connected to the respiratory tract through the tears and the nasolacrimal duct. METHODS: Recent papers and research from PubMed, Researchgate, and Google Scholar were cited and thoroughly discussed. These papers were chosen based on their relevancy, reliability, publication year, published journal, and ease of accessibility to the paper itself. RESULTS: The theory concluded that the ocular surface might consider a pathway for the virus attack and infection causation through the tears and the angiotensin-converting enzyme 2 located in the eye. This article thoroughly reviewed the history, the existing aspects of Covid-19, the ocular system features, and the claims about the possible involvement of the eye in the virus transmission along with the eye infection. There was no consensus on the eye's involvement theory. CONCLUSION: The authors highlighted the extra work and research needed to be conducted to prove or deny these claims to provide a better understanding of the immune response of the eye to Covid-19 infection.

The Ophthalmic Manifestation And Transference Of Covid 19: Recommendation For Inhibition

The aim of the research was to see if there were any ocular surface symptoms in individuals who had coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus (SARS-CoV-2). SARS-CoV2 is usually transmitted by way of intimate interaction through pulmonary secretions;therefore, ocular transmission be also a risk, relating to the conjunctiva functioning like both a means of expression and a source of infectivity. COVID-19 ocular manifestations very commonly described included eye discomfort, redness, discharge, and follicular conjunctivitis. The presence of the CD147 and ACE2 receptors in ocular cells membrane indicates which these cells may act as a gateway of entrance point for SARS Coronavirus 2. Considering the absence of virus infection in tears and conjunctival swabs, the RT-PCR findings that were negative do not, SARS CoV 2 is considered out as a risk being present into ocular fluids. Microorganisms may transfer to the nasal passages by continual tear flow through the lacrimal duct pathway, producing illness. Although the eyes are considered to be the primary mode of transmission, their significance in increase of SARS Covid2 cannot be neglected. Medical professionals must inquire about patients' eye symptoms that are compatible with SARS-CoV2, utilize protective eyewear In addition to masks, typical personal protective equipment for high-risk patients includes goggles or face shields worn by either the patients and health care providers, and detect tearing as the cause of the sickness. © The Electrochemical Society

Ocular Manifestations of Pediatric Inflammatory Multisystem Syndrome

This article aims to present up-to-date information on ocular symptoms of pediatric multi-system inflammatory syndrome. The reviewers obtained the results based on a search of an electronic database. The pediatric multi-system inflammatory syndrome appears a few weeks after COVID-19 in children. The exact etiology remains unclear. It is diagnosed based on clinical and laboratory criteria. The most prevalent manifestation of the syndrome is non-purulent conjunctivitis (observed in around 50% of cases). The other ocular findings in the pediatric multi-system inflammatory syndrome can be;eyelid swelling, bilateral uveitis or vitreous hyperreflective dots in the posterior vitreous. The treatment of the ophthalmic symptoms is systemic and topical, targeting the enhanced inflammatory response of the organism and the presence of the given ocular findings.

The Association of Clinical Symptoms and Coexistent Clinical Conditions with Ophthalmic Manifesting in COVID-19 Patients.

Background: The ocular symptoms are common manifestations in coronavirus infectious disease 2019 (COVID-19), which faces secondary complications and therapeutic challenges. Underlying diseases actuate the body to infectious diseases and their related manifestations through the aberration of metabolism and suppressing the immune system. This study aimed to investigate the correlation of underlying diseases and ocular manifestations in COVID-19 patients. Methods: This cross-sectional study was held on 108 hospitalized COVID-19 patients (confirmed by molecular detection) admitted to Rouhani hospital, Babol, Iran. Upon hospitalization, all clinical symptoms and underlying diseases were registered. Detailed clinical examinations regarding ophthalmological protocols were used to investigate the ocular symptoms. All analyses were performed by SPSS, version 25. Results: Our results showed that 26.67% of patients with at least one ocular symptom had hyperlipidemia, while 10.42% of patients without any ocular symptoms had hyperlipidemia (P=0.049). In this study, 97.81% of COVID-19 patients without epiphora had no thyroid disorders (hyper-/hypo-thyroidism), while 82.35% of COVID-19 patients with epiphora had not any thyroid disorders (P=0.012). Also, 75.00% of patients with blurred vision had diabetes mellitus, while 35.00% of patients without blurred vision suffered from diabetes mellitus. This difference was borderline significant (P=0.051). Other results showed that 13.04% of COVID-19 patients with eye redness suffer from myalgia, while 35.29% of patients without eye redness had myalgia (P=0.044). Also, 35.11% of COVID-19 patients without photophobia had myalgia, while none of the patients with photophobia had myalgia (P=0.005). Finally, 70.00% of patients with respiratory distress had at least one ocular symptom, while 43.10% of patients without respiratory distress had at least one ocular symptom (P=0.007). Conclusion: Some underlying diseases, e.g., hyperlipidemia, diabetes mellitus, and thyroid disorders, and some clinical symptoms in hospitalized patients, e.g., myalgia and respiratory distress, are correlated with ocular manifestations in COVID-19 patients.

[Ocular symptoms in SARS-CoV-2 infection]

The first cases of COVID-19 were reported in Wuhan city, Hubei province, China. Patients reported symptoms such as dry cough, dyspnea, fever. Bilateral infiltrates in the lung parenchyma could be seen in imaging studies. Two years after the diagnosis of the first case of COVID-19, we are confident that symptoms manifest in every organ, including the eyes. Ocular manifestations may result from the COVID- 19 infection itself as well as from associated treatment, including mechanical ventilation or drug therapy. Ocular manifestations may be the first signs of COVID-19, so this knowledge is essential for making a prompt and correct diagnosis. It is important to be aware of the risks associated with the possibility of infection during the ophthalmic examination of these patients. AIM: The aim of the analysis was to perform a literature review systematizing the knowledge on ocular manifestations in the course of the COVID-19 infection with particular emphasis on the relation between the occurrence of ocular symptoms and the age of patients as well as the severity of the COVID-19 course. The review also included studies that evaluated the detection of the SARS-CoV-2 virus in tears or conjunctival sac swabs of patients with COVID-19. MATERIALS AND METHODS: Articles for the literature review were collected from the PubMed database. The expression "COVID-19 ocular manifestations" was used as the selection criteria. Finally, fifteen papers published in 2020 and fifteen papers published in 2021 were included in the review. Nineteen of these were original papers, two were meta-analyses, and nine were classified as review papers. RESULTS: The most commonly reported ocular manifestations include dry eye or foreign body sensation, conjunctival hyperaemia, tearing, itching, and eye pain. Conjunctivitis was the most commonly diagnosed ophthalmic disease among COVID-19 patients. The SARS-CoV-2 infection is also associated with a risk of a significant decrease in visual acuity due to retinal vascular occlusion, ischemic optic neuropathy, inflammation of the choroid, retina and the optic nerve. The incidence of the most common ocular surface-related symptoms was higher in children than in adults. In several studies it has been shown that patients with more severe COVID-19 infection are more likely to have ocular symptoms. CONCLUSIONS: Physicians, especially ophthalmologists, should be aware of the link between SARS-CoV-2 infection and the possibility of ocular symptoms and should recommend testing for COVID-19 if SARS-CoV-2 infection is suspected to reduce the possibility of infection spread.

Ocular manifestations of COVID-19: facts and figures from a tertiary care center.

INTRODUCTION: COVID-19 patients presenting with ocular manifestations are from 0.8% to 32% of patients seen in the ED. The available literature is scarce regarding COVID-19 patients presenting with ocular manifestations from the Middle Eastern region. PURPOSE: This study aims to report the incidence of ocular signs and symptoms in COVID-19 patients and find any correlation between the occurrence of ocular manifestations and patients' comorbidities. METHODS: All patients having the primary diagnosis of COVID-19 infection and concurrent ocular manifestations on admission to our tertiary COVID-19 health care centre were included in the study. The patient's demographic data, comorbidities, and type of ocular manifestations were recorded from the patients' health records retrospectively. RESULTS: In our study, 39 (7.8%) patients presented with ocular manifestations. The majority of COVID-19 patients were male, and 200 (20%) patients had a history of other comorbidities. The majority of our patients had hyperaemia (13 [33.3%]), followed by eye pain (9 [23.1%]), epiphora (8 [20.5%]), burning sensation (4 [10.3%]), and photophobia (2 [5.1%]) patients. There was no statistically significant difference in the occurrence of ocular manifestations and patients' gender or comorbidities (p > .05). CONCLUSION: The occurrence of ocular manifestations was lower compared to the present literature. There was no significant association between the occurrence of ocular manifestations and the patient's gender or comorbidities.

COVID-19 and the Eye: Ocular Manifestations, Treatment and Protection Measures.

The novel pandemic coronavirus disease 2019 (COVID-19) leading to health and economic problems worldwide is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although COVID-19 mainly occurs as a lower respiratory tract infection, there is multiorgan involvement in infected patients. The disease is transmitted from person to person through air droplets or contact with contaminated surfaces. SARS-CoV-2 leads to this systemic involvement by attaching to angiotensin-converting enzyme 2 (ACE2) receptors located on several human cells. Since SARS-CoV-2 RNA has been found in tears of infected patients, ocular surface may allow the virus to transmit to nasopharynx via the nasolacrimal duct. This narrative review aims to sum up all segmental ocular complications, ocular adverse effects of COVID-19 treatment, and preventive measures suggested to minimize the SARS-CoV-2 transmission between patients and ophthalmologists by reviewing currently available literature.

Evaluation and comparison of conjunctival swab polymerase chain reaction results in SARS-CoV-2 patients with and without ocular manifestations.

PURPOSE: The aim of this study was to evaluate and compare the presence of SARS-CoV-2 in tears of patients with and without ocular symptoms in SARS-CoV-2 positive patients. METHODS: The prospective observational study conducted on 60 consecutive SARS-CoV-2 positive patients with ocular complaints was compared with 60 controls who had no ocular manifestations. The tear samples were taken within 48 h of admission from both the eyes of the enrolled patients for evaluating the presence SARS-CoV-2 by reverse transcription-polymerase chain reaction. RESULTS: Eleven cases (18.33%) tested positive for SARS-CoV-2 in tears on RT-PCR from cojunctival swab compared to 10 (16.66%) controls. The difference was not statistical significant. The difference between mean age of patients who tested positive or negative was also without statistical significance (P = 0.652), but the difference between patients who tested positive or negative by conjunctival swab for SARS-CoV-2 was statistically significant in terms of severity of COVID-19 disease (P = 0.0011), presence of comorbidity (P = 0.0015), mean TLC (P = 0.00498), and mean d dimer (P = 0.00465). CONCLUSION: Though the percentage of patients with positive RT PCR from conjunctival secretions is significantly less than nasopharyngeal swabs, potential risk of transmission of SARS-Co-2 through tears cannot be ruled out. Moreover, SARS-CoV-2 can be present in tears irrespective of ocular involvement.

COVID-19 Ocular Manifestations in the Early Phase of Disease.

Purpose: To evaluate and establishe the number of patients with ocular manifestations in the early phase of systemic COVID-19 infection.Methods: A cross-sectional study was performed in a COVID-19 referral center regarding ocular findings in patients with COVID-19 in the first few days of the disease. The patients were submitted to a clinical examination, an ophthalmic exam and a RT-PCR for SARS-COV-2.Results: Out of 1740 patients, we reported 108 patients with ocular manifestations. Forty-nine with markedly conjunctivitis had conjunctival swab positive for SARS-COV-2, four of them developed keratitis. There were mostly no evidence of retinopathy nor decrease in visual acuity. They had no marked clinical symptoms, which can contribute and demonstrate that the virus may cause ocular disease as an only finding or in the very early stage of the infection.Conclusion: Patients were in the first days of COVID-19 infection, presented ocular manifestations suggested to be related to the virus and need to be aware of the pathways of transmissions.

Retinal manifestations in patients following COVID-19 infection: A consecutive case series.

PURPOSE: To describe retinal manifestations seen in patients associated with COVID-19 infection at a multi-specialty tertiary care hospital in Southern India. METHODS: In this retrospective chart review, all consecutive cases presenting to the Retina-Uveitis service from May 2020 to January 2021 with retinal manifestations associated with COVID-19 infection or its sequelae or as a result of treatment given for COVID-19 were included. RESULTS: : Of the 7 patients, 3 were female, and 4 were male. Four patients had onset of symptoms during the active phase of COVID-19 infection. Four had bilateral and three had unilateral involvement. The manifestations ranged from mild to vision threatening. Vision threatening manifestations included infections: endogenous endophthalmitis, candida retinitis and tubercular choroidal abscess and bilateral pre-foveal hemorrhages. Milder manifestations included paracentral acute middle maculopathy, central serous chorio-retinopathy and voriconazole induced visual symptoms. Final visual acuity was 6/36 or better in the four severe cases and 6/9 or better in the mild cases. CONCLUSION: This study highlights the retinal manifestations associated with COVID-19 infection and its sequelae. As these patients presented with an association with COVID-19 (either during or after recovery), ophthalmologists should be vigilant and screen for such entities in case of complaints of visual symptoms or in the presence of systemic sepsis. The outcomes can be good with prompt and aggressive management.

Ocular Manifestations of Hospitalized COVID-19 Patients in a Tertiary Care Academic Medical Center in the United States: A Cross-Sectional Study.

PURPOSE: Studies have identified a wide range of ocular signs and symptoms in coronavirus disease 2019 (COVID-19) patients; however, these studies were often conducted outside of the United States. We aim to investigate the ocular manifestations of hospitalized COVID-19 patients at a tertiary care medical center in the United States. PATIENTS AND METHODS: A retrospective, cross-sectional study was conducted on individuals aged 18 and over who were hospitalized for COVID-19 between March 10, 2020 and April 13, 2020. The electronic health record was reviewed for all patients, and a follow-up phone survey was conducted on patients who were discharged home. Data on patient history, physical exam, laboratory results, and hospital disposition were collected and analyzed. RESULTS: A total of 400 patients were included. The mean patient age was 61.7 years (SD 15.5) and 233 (58.3%) were males. Ocular signs and symptoms were noted in 38 (9.5%) patients. The most common ocular abnormality was conjunctival injection, followed by vision changes and ocular irritation. Among the 38 patients, 30 (79.0%) developed ocular involvement prior to day 30 of onset of their COVID symptoms. Univariate analysis showed that age, gender, ocular history, fever, mechanical ventilation, and increasing inflammatory markers were not significantly associated with the presence or development of ocular symptoms. CONCLUSION: In this study, 9.5% of hospitalized COVID-19 patients exhibited ocular signs and symptoms. Factors associated with severe systemic COVID-19 disease were not associated with developing ocular abnormalities. The rate of ocular manifestations of COVID-19 should not be ignored, and thus physicians should routinely evaluate for ocular involvement in hospitalized COVID-19 patients.

COVID-19 in the light of current clinical eye research.

COVID-19 is a disease caused by a SARS-CoV-2 virus infection first reported in Wuhan city, Chinese province of Hubei, in December 2019. Previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease, COVID-19 was declared official name by the World Health Organization (WHO) as COVID-19 in February 2020. By July 2nd, 2020 10,818,005 confirmed cases with 519,467 COVID-19 deaths worldwide. The aim of this review article is to inform the audience of what is available in the current literature on how COVID-19 affects the eyes in adults, children, and elderly. PubMed search was used between December 2019 and July 2nd, 2020. Randomized trials, observational studies, case series or case reports, and letters of research, letters to editors were selected for confirmed cases of COVID-19. According to current scientific literature since the outbreak in December 2019 there have been 218 papers written. Conjunctivitis and keratoconjunctvitis have been reported in adults with COVID-19. Further studies are needed in children and geriatric patients.

COVID-19 and the eye: a review.

BACKGROUND: To provide a review for general practitioners and medical specialists about the most common eye complaints and ocular manifestations in a COVID-19 patient. METHODS: Reviewed 50 articles referenced in 4 databases from 20 December 2019 to 16 September 2020. RESULTS: Of the 50 articles reviewed, 26 met the criteria for analysis and were included in the study. Among them were 5 reviews, 6 case series, 7 case reports, 4 cross-sectional studies, 2 systematic reviews, 1 cohort study and 1 correspondence. We found that the prevalence of ocular manifestations in patients during the course of COVID-19 varied between 0.8% and 31.6%, depending on the study design. Symptoms of acute conjunctivitis were the most frequent clinical findings. Acute phase reactants were also correlated to ocular manifestations and the severity of the systemic disease in many reports. CONCLUSIONS: Ocular manifestations are not uncommon in COVID-19 patients and have been associated with higher levels of acute phase reactants as well as a higher degree of severity of the systemic disease. We recommend that all physicians consider COVID-19 as a differential diagnosis in the presence of acute conjunctivitis with or without systemic symptoms.

Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis.

Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed random-effects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71-17.72). In the studies that reported the details of observed ocular symptoms, the most common ocular manifestations were dry eye or foreign body sensation (n = 138, 16%), redness (n = 114, 13.3%), tearing (n = 111, 12.8%), itching (n = 109, 12.6%), eye pain (n = 83, 9.6%) and discharge (n = 76, 8.8%). Moreover, conjunctivitis had the highest rate among reported ocular diseases in COVID-19 patients (79 out of 89, 88.8%). The results suggest that approximately one out of ten COVID-19 patients show at least one ocular symptom. Attention to ocular manifestations, especially conjunctivitis, can increase the sensitivity of COVID-19 detection among patients.