Ocular Involvement in COVID-19: Conjunctivitis and More

Abstract

Since the beginning of 2020, SARS-CoV-2, the pathogen of COVID-19, has led to a global pandemic that also affects ophthalmology. Ophthalmologists can be confronted at any time with potentially COVID-19 associated ocular symptoms or manifestations in patients and also become infected through close patient contact. Even without systemic infection, the ocular surface can come into direct contact with aerosols or liquids containing SARS-CoV-2 particles. A smear infection through hand-to-eye contact is also possible. A purely isolated ocular infection has not yet been shown. Rather, it seems that ocular complications occur in the context of a systemic infection. However, ocular symptoms can also be the first symptom of COVID-19. The most common ocular complication of COVID-19 is mild follicular conjunctivitis. Haemorrhagic conjunctivitis, dry eye disease, episcleritis, or retinal involvement can also occur less frequently. There are currently no evidence-based therapy recommendations for COVID-19 associated diseases of the ocular surface. Artificial tears might be helpful for symptom relief. There is no evidence for antiviral, antibiotic, or anti-inflammatory therapies, but these medications might be used in individual cases. Potential intraocular complications include retinal artery occlusions and haemorrhages, as well as cotton wool spots caused by complement-mediated thrombotic angiopathy. Neuro-ophthalmological complications including Miller-Fisher syndrome or infarct-related central blindness can also occur in very rare cases. Knowledge of potential transmission routes and personal protective equipment is just as essential for each ophthalmologist as a basic knowledge of potential ocular symptoms and complications.

Ocular manifestations of COVID-19

“…Other ocular manifestations include dry eye syndrome and episcleritis. 41 Follicular conjunctivitis, 9 , 41 – 44 conjunctival hyperemia, 11 chemosis, epiphora, and increased secretions have been reported. 2 , 28 Increased conjunctival secretions, ocular pain, 9 ocular discharge and redness, 9 photophobia, dry eye, tearing, and conjunctival congestion, as well as xerophthalmia and keratitis, are chronic COVID-19 ocular manifestations.…”

“…Miller-Fisher syndrome or infarct-related central blindness are two neuro-ophthalmological consequences that might develop in extremely uncommon situations. 41 …”

Ocular Complications Following Vaccination for COVID-19: A One-Year Retrospective

“…Previous research has demonstrated a link between COVID-19 infection and ocular complications, direct or indirect [5][6][7][8][9][10][11][12][13]. It has been well-documented that conjunctivitis, scleritis, orbital inflammatory disease, phlyctenular keratoconjunctivitis and retinal involvement may take place in COVID-19 infection.…”

A Pediatric COVID-19 Study: Retinal Nerve Fiber Layer, Ganglion Cell Layer, and Alterations in Choroidal Thickness in Swept-Source OCT Measurements

“…The World Health Organization accepted the coronavirus disease 2019 (COVID- 19), raised from China in December 2019, as a global pandemic in March 2020 due to its quick spread and possible serious sequels and fatal results [1]. The pathogen is an enveloped RNA virus of the beta coronavirus family and is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [2,3].…”

“…Meanwhile, microhemorrhages, cotton wool spots, and hyperreflective lesions have been documented as retinal findings in adult COVID-19 patients [17]. The existence of viral RNA has also been demonstrated in the conjunctiva and tear secretions of pediatric patients [19]. It has been postulated that pediatric COVID-19 patients have a better prognosis, shorter disease duration, and lower disease prevalence than adult patients [20,21].…”