Ocular symptoms in COVID-19 infection: a survey study

Abstract

Background Coronavirus disease 2019 (COVID-19) systemic symptoms and sequelae have been studied extensively, but less is known about the characterization, duration, and long-term sequelae of ocular symptoms associated with COVID-19 infection. The purpose of this study was to analyze the frequency, spectrum, and duration of ocular symptoms in participants with COVID-19 infection treated in inpatient and outpatient settings. Methods A retrospective electronic survey was distributed to NIH employees and the public who reported testing positive for SARS-CoV-2. The anonymous survey collected information on demographics, past ocular history, systemic COVID-19 symptoms, and ocular symptoms. Results A total of 229 (21.9% male and 78.1% female, mean age 42.5 ± 13.9) survey responses were included. Ocular symptoms were reported by 165 participants with a mean of 2.31 ± 2.42 symptoms. The most commonly reported ocular symptoms were light sensitivity (31.0%), itchy eyes (24.9%), tearing (24.9%), eye redness (24.5%), and eye pain (24.5%). Participants with ocular symptoms had a higher number of systemic symptoms compared to participants without ocular symptoms (mean 9.17 ± 4.19 vs 6.22 ± 3.63; OR: 1.21; 95% CI: 1.11 – 1.32; p < 0.001). Ocular symptoms were more common in those who reported a past ocular history compared to those who did not (81.8% vs 67.1%; OR: 2.17; 95% CI: 1.08 – 4.37; p = 0.03). Additionally, the onset of ocular symptoms occurred most frequently at the same time as systemic symptoms (47.5%), and 21.8% reported symptoms lasting ≥ 14 days. Conclusions Ocular surface-related symptoms are the most frequent ocular manifestations, and systemic disease severity is associated with the presence of ocular symptoms. Additionally, our results show that ocular symptoms can persist post-COVID-19 infection. Further work is needed to better understand ocular symptoms in COVID-19 and long-term sequelae.

Does SARS-CoV-2 infection cause persistent ocular symptoms?: A cross-sectional study after the lifting of lockdown in Chongqing, China

“…Previous studies have suggested ocular pain is a common symptom after SARS-CoV-2 infection. [ 14 , 29 , 30 ] We found that the prevalence of ocular pain (9.8%) during SARS-CoV-2 infection was significantly higher than pre-infection (2.3%). Our study was in agreement with Pardhan et al [ 31 ] Ocular pain during the infection period was found to be related to conjunctival hyperemia.…”

“…The self-reported red eye symptom among SARS-CoV-2 infection was 6.4%, and conjunctival hyperemia diagnosed by split lamp examination was 9.1% when recovery In previous studies, the rate of conjunctival hyperemia related to SARS-CoV-2 infection was 0.8% to 31%. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, the diagnosis of conjunctival hyperemia in other studies was based on phone call interviews [8][9][10][11][12][13][14][15] or by examination with a flashlight or portable slit lamp. [16][17][18][19][20][21] In our study, the diagnosis of conjunctival hyperemia consisted of face-to-face interviewing and examination using a slit lamp.…”

“…Previous studies showed that COVID-19 caused conjunctival congestion lasting from 2 days to over a month. [ 8 , 14 , 21 ] Conjunctival congestion during infection may be related to a direct eye coronavirus infection. Current evidence suggests the potential for ocular transmission via 2 mechanisms: viruses disseminate through the tear film, [ 22 ] or viruses bind to the angiotensin-converting enzyme 2 (ACE2) receptor on the ocular surface.…”

Post COVID-19 Ocular Manifestations

“…We reported that main post COVID-19 infection patient's complaint was pain, red eye, diminution of vision and itching in percentage of (37.5%,28.6%,18.2% and 14.3%) respectively. While McHarg et al [13] reported that most common post COVID-19 patient's complaint were itching, red eye, pain and blurred vision in percentage of (24.9%, 24.5%,24.5% and 22.7%) respectively.…”

Macrophage Activation in Follicular Conjunctivitis during the COVID-19 Pandemic

“…The secretion is serous, often scarce, but never purulent unless bacterial co-infection occurs, with abundant colorable mononuclear cells in the smear. There, electron microscopy (EM) and immunoelectron microscopy (IEM) allow the identification and characterization of viral particles [ 17 ], while PCR is superior to ELISA for sensitivity and accuracy in detecting infections [ 18 ], where the conjunctiva and cornea seem to be the ophthalmic structures most affected by viral infections, as previously summarized by Frezzotti and Guerra [ 19 ], Sen et al [ 20 ], and McHang et al [ 21 ]. A new discovery showed for the first time that in the tears of vaccinated COVID-19 patients, ocular secretory IgA (sIgA) values are remarkably different vs. those of non-vaccinated patients [ 22 ], with significant differences in available vaccines.…”