Acute and sub-acute ocular manifestations in pediatric patients with COVID-19: A systematic review

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has been the most challenging health problem in the last 2 years. Post-COVID-19 multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-19 complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-19.
 Methods: We included all online primary studies, with no language restriction and published between January 1, 2019 and November 18, 2020, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-19. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: “eye,” “ophthalmologic,” “ocular,” “vision,” “conjunctivitis,” “severe acute respiratory syndrome coronavirus 2,” “SARS-CoV-2,” “corona,” “2019-nCoV,” “COVID19,” and “COVID.” The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review.
 Results: A total of 1,192 records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among 463 pediatric patients with COVID-19, 72 (15.5%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among 895 pediatric patients with post-COVID-19 MIS-C, 469 (52.4%) had ocular manifestations, which only included non-purulent conjunctivitis.
 Conclusions: Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-19. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-19 pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-19 inflammatory syndrome.

Isolated Depo-Medrol Administration under Tenon’s Capsule for Post-COVID-19 Uveitis in a Child: A Case Report and Literature Review

“…Ocular manifestations of COVID-19 infection in children are variable, and the prevalence ranges from 0.7% to 31.6% in children worldwide [ 11 , 12 , 13 , 14 ]. They may resolve spontaneously or be the first signs of a severe infection, especially in MIS-C, where accelerated treatment may improve the prognosis [ 15 ]. Ocular manifestations so far reported and documented in the course of COVID-19 in children include conjunctivitis, chorioretinitis and/or retinal vasculitis, epitheliitis, corneal epitheliopathy, orbital cellulitis, orbital inflammatory disease, lacrimal gland inflammation, retinal vascular obstruction, retinopathy, maculopathy, intraocular inflammation, cranial nerve palsy and optic neuritis [ 6 , 11 , 16 ].…”

Endogenous endophthalmitis in post-COVID-19 patients: a case report

“…Ocular involvement is not uncommon and various ophthalmic manifestations have been reported 1 , 2 . Anterior segment manifestations include conjunctival congestion, conjunctivitis, severe keratitis, and acute angle closure; uveal manifestations include anterior uveitis, panuveitis, reactivation of uveitis, retinal vasculitis, and chorioretinitis; retinal manifestations include microangiopathy, cotton wool spots, hemorrhages, central serous retinopathy, central retinal artery/vein occlusion, and Purtscher-like retinopathy; neuro-ophthalmic manifestations include optic neuritis, extraocular muscle palsies, and benign idiopathic intracranial hypertension with papilloedema; and orbital includes mucomycosis 1 – 6 . COVID-19 affects the retina possibly through viral invasion or immune-mediated inflammation, even after recovery 7 .…”

Post-COVID-19 Retinal Manifestations in Pediatric Patient with Retinoblastoma: A Case Report

“…While the impact of COVID-19 in pediatric cases primarily affects the respiratory system similar to those observed in adults, it has been associated with a range of systemic manifestations, including ocular involvement. Notably, conjunctivitis was the most frequent ocular manifestation in children with acute, sub-acute, or post-COVID-19 multisystem in ammatory syndrome [4]. Regarding posterior segment manifestations, several studies have reported pathological changes in the retina resulting from the in ammatory processes linked to previous or concomitant SARS-CoV-2 infection in the adult population [5][6][7][8].…”