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.

Key words

transmission - pandemic - conjunctivitis - SARS-CoV-2 - COVID-19

^‡ Shared senior authorship: LMH and CC contributed equally to this manuscript and should both be acknowledged as senior authors.

Publikationsverlauf

Eingereicht: 20. Dezember 2020

Angenommen: 16. März 2021

Artikel online veröffentlicht:
21. Mai 2021

• References/Literatur

• 1 Parrish 2nd RK, Stewart MW, Duncan Powers SL. Ophthalmologists Are More Than Eye Doctors – In Memoriam Li Wenliang. Am J Ophthalmol 2020; 213: A1-A2
• 2 Rokohl AC, Loreck N, Wawer Matos PA. et al. [The role of ophthalmology in the COVID-19 pandemic]. Ophthalmologe 2020; 117: 642-647
• 3 Ruiz-Lozano RE, Garza-Garza LA, Cardenas-de la Garza JA. et al. Slit-lamp evaluation during SARS-CoV-2 pandemic: safety first!. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2865-2866
• 4 Bostanci Ceran B, Karakoç A, Taciroğlu E. Airborne pathogen projection during ophthalmic examination. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2275-2282
• 5 Rokohl AC, Loreck N, Wawer Matos PA. et al. More than loss of taste and smell: burning watering eyes in coronavirus disease 2019. Clin Microbiol Infect 2020; 26: 1560.e5-1560.e8
• 6 Yang C. Does hand hygiene reduce SARS-CoV-2 transmission?. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1133-1134
• 7 Saban O, Levy J, Chowers I. Risk of SARS-CoV-2 transmission to medical staff and patients from an exposure to a COVID-19-positive ophthalmologist. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2271-2274
• 8 Lu R, Zhao X, Li J. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395: 565-574
• 9 Seah I, Agrawal R. Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals. Ocul Immunol Inflamm 2020;
• 10 Rothe C, Schunk M, Sothmann P. et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med 2020; 382: 970-971
• 11 Peng Y, Zhou YH. Is novel coronavirus disease (COVID-19) transmitted through conjunctiva?. J Med Virol 2020;
• 12 Liu X, Zhang S. COVID-19: Face Masks and Human-to-human Transmission. Influenza Other Respir Viruses 2020; 14: 472-473
• 13 van Doremalen N, Bushmaker T, Morris DH. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382: 1564-1567
• 14 Wiersinga WJ, Rhodes A, Cheng AC. et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020; 324: 782-793
• 15 Zhang X, Chen X, Chen L. et al. The evidence of SARS-CoV-2 infection on ocular surface. Ocul Surf 2020; 18: 360-362
• 16 Cheema M, Aghazadeh H, Nazarali S. et al. Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19). Can J Ophthalmol 2020; 55: e125-e129
• 17 Yu AY, Tu R, Shao X. et al. A comprehensive Chinese experience against SARS-CoV-2 in ophthalmology. Eye Vis (Lond) 2020; 7: 19
• 18 Wu P, Duan F, Luo C. et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol 2020; 138: 575-578
• 19 Xia J, Tong J, Liu M. et al. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020; 92: 589-594
• 20 Zeng W, Wang X, Li J. et al. Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection. JAMA Ophthalmol 2020; 138: 1196-1199
• 21 Barnett BP, Wahlin K, Krawczyk M. et al. Potential of Ocular Transmission of SARS-CoV-2: A Review. Vision (Basel) 2020; 4: 40
• 22 Sungnak W, Huang N, Becavin C. et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med 2020; 26: 681-687
• 23 Grajewski RS, Rokohl AC, Becker M. et al. Malignancy going viral: ACE2 and TMPRSS2 expression in conjunctival neoplastic diseases. Ann Anat 2021; 234: 151661
• 24 Grajewski RS, Rokohl AC, Becker M. et al. A missing link between SARS-CoV-2 and the eye?: ACE2 expression on the ocular surface. J Med Virol 2021; 93: 78-79
• 25 Rokohl AC, Grajewski RS, Wawer Matos PA. et al. No secret hiding place? Absence of SARS-CoV-2 on the ocular surface of 1145 hospitalized patients in a pandemic area. Graefes Arch Clin Exp Ophthalmol 2021;
• 26 Bayyoud T, Iftner T, Bartz-Schmidt KU. et al. [First results of investigations of SARS-CoV-2 RNA in human corneal tissue]. Ophthalmologe 2020; 117: 615-617
• 27 Thuret G, Courrier E, Poinard S. et al. One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe. Br J Ophthalmol 2020;
• 28 Strain WD, Chaturvedi N. The renin-angiotensin-aldosterone system and the eye in diabetes. J Renin Angiotensin Aldosterone Syst 2002; 3: 243-246
• 29 Zhang BN, Wang Q, Liu T. et al. [A special on epidemic prevention and control: analysis on expression of 2019-nCoV related ACE2 and TMPRSS2 in eye tissues]. Zhonghua Yan Ke Za Zhi 2020; 56: 438-446
• 30 Pirraglia MP, Ceccarelli G, Cerini A. et al. Retinal involvement and ocular findings in COVID-19 pneumonia patients. Sci Rep 2020; 10: 17419
• 31 Li JO, Lam DSC, Chen Y. et al. Novel Coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol 2020; 104: 297-298
• 32 Liang L, Wu P. There may be virus in conjunctival secretion of patients with COVID-19. Acta Ophthalmol 2020; 98: 223
• 33 Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet 2020; 395: e39
• 34 Seah IYJ, Anderson DE, Kang AEZ. et al. Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients. Ophthalmology 2020; 127: 977-979
• 35 Siedlecki J, Brantl V, Schworm B. et al. COVID-19: Ophthalmological Aspects of the SARS-CoV 2 Global Pandemic. Klin Monbl Augenheilkd 2020; 237: 675-680
• 36 Aggarwal K, Agarwal A, Jaiswal N. et al. Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One 2020; 15: e0241661
• 37 Guan WJ, Ni ZY, Hu Y. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382: 1708-1720
• 38 Dutescu RM, Banasik P, Schildgen O. et al. Detection of Coronavirus in Tear Samples of Hospitalized Patients With Confirmed SARS-CoV-2 From Oropharyngeal Swabs. Cornea 2021; 40: 348-350
• 39 Vereinigung Deutscher Contactlinsen-Spezialisten und Optometristen e. V.. Hygiene – Kontaktlinsentragen und COVID-19. Accessed December 2, 2020 at: https://www.vdco.de/hygiene-contactlinsen-tragen-covid19/
• 40 Navel V, Chiambaretta F, Dutheil F. Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. Am J Ophthalmol Case Rep 2020; 19: 100735
• 41 Bostanci Ceran B, Ozates S. Ocular manifestations of coronavirus disease 2019. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1959-1963
• 42 Otaif W, Al Somali AI, Al Habash A. Episcleritis as a possible presenting sign of the novel coronavirus disease: A case report. Am J Ophthalmol Case Rep 2020; 20: 100917
• 43 Gambini G, Savastano MC, Savastano A. et al. Ocular surface impairment after COVID-19: a cohort study. Cornea 2020;
• 44 Chadwick O, Lockington D. Addressing post-operative Mask-Associated Dry Eye (MADE). Eye (Lond) 2020;
• 45 Moshirfar M, West jr. WB, Marx DP. Face Mask-Associated Ocular Irritation and Dryness. Ophthalmol Ther 2020; 9: 397-400
• 46 Invernizzi A, Torre A, Parrulli S. et al. Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. EClinicalMedicine 2020; 27: 100550
• 47 Acharya S, Diamond M, Anwar S. et al. Unique case of central retinal artery occlusion secondary to COVID-19 disease. IDCases 2020; 21: e00867
• 48 Zhang Y, Xiao M, Zhang S. et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med 2020; 382: e38
• 49 Gavriilaki E, Brodsky RA. Severe COVID-19 infection and thrombotic microangiopathy: success does not come easily. Br J Haematol 2020; 189: e227-e230
• 50 Benito-Pascual B, Gegundez JA, Diaz-Valle D. et al. Panuveitis and Optic Neuritis as a Possible Initial Presentation of the Novel Coronavirus Disease 2019 (COVID-19). Ocul Immunol Inflamm 2020; 28: 922-925
• 51 Mazzotta C, Giancipoli E. Anterior Acute Uveitis Report in a SARS-CoV-2 Patient Managed with Adjunctive Topical Antiseptic Prophylaxis Preventing 2019-nCoV Spread Through the Ocular Surface Route. Int Med Case Rep J 2020; 13: 513-520
• 52 Luers JC, Rokohl AC, Loreck N. et al. Olfactory and Gustatory Dysfunction in Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2020; 71: 2262-2264
• 53 Luers JC, Rokohl AC, Loreck N. et al. Reply to Gourtsoyannis. Clin Infect Dis 2020; 71: 3018-3019
• 54 Abu-Rumeileh S, Abdelhak A, Foschi M. et al. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol 2020;
• 55 Gutiérrez-Ortiz C, Méndez-Guerrero A, Rodrigo-Rey S. et al. Miller Fisher syndrome and polyneuritis cranialis in COVID-19. Neurology 2020; 95: e601-e605