Advances in
eISSN: 2377-4290
Submit manuscript...
Mini Review Volume 10 Issue 3
Ocular manifestations of COVID-19 disease
Anna Major Bastian,1 
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Dawn S Russell Hermanns2
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
1Senior House Officer, Division of Ophthalmology, Princess Margaret Hospital, Canada
2Director, Division of Ophthalmology, Princess Margaret Hospital, Canada
Correspondence: Dawn S Russell-Hermanns, Director, Division of Ophthalmology, Princess Margaret Hospital Nassau, The Bahamas
Received: May 15, 2020 | Published: May 25, 2020
Citation: Bastian AM, Hermanns DSR. Ocular manifestations of COVID-19 disease. Adv Ophthalmol Vis Syst. 2020;10(3):51-52. DOI: 10.15406/aovs.2020.10.00383
Abstract
The highly contagious novel coronavirus 2019-nCoV is a new strain not previously identified in humans. Also known as coronavirus 2 (SARS-CoV-2), this virus causes a severe acute respiratory syndrome and has had widespread impact gaining pandemic status by the World Health Organization. There have been reports on the ocular manifestations of infection with this virus and this article provides a mini review of the published data.
Keywords: SARS-CoV-2, COVID-19, ocular manifestations, conjunctivitis, red eyes, tearing
Abbreviations
WHO, world health organization; SARS, severe acute respiratory syndrome; RNA, ribonucleic acid; AAO, american academy of ophthalmology
Introduction
COVID-19/Coronavirus Disease, a severe respiratory illness caused by the highly contagious novel coronavirus 2019-nCoV, is a new strain not previously identified in humans. The coronavirus 2 (SARS-CoV-2), a positive-sense single stranded RNA virus, causes a severe acute respiratory syndrome, which has affected more than 4 million people globally. On 11th March 2020, the World Health Organization declared COVID-19 a pandemic (WHO 2020). The most common symptoms of COVID-19 are fever, dry cough, shortness of breath, fatigue, loss of appetite, and body aches. However, albeit rare, SARS-CoV-2 has also been found to cause conjunctivitis. This article will highlight the ocular manifestations of SARS-COV-2.
Methods
A mini-review of the current published data.
Discussion
As the data continues to evolve, anecdotal reports have shown that conjunctivitis may indeed be a manifestation of SARS-CoV-2. According to the American Academy of Ophthalmology,1 1% - 3% of persons with confirmed SARS-CoV-2 will have conjunctivitis, either as the initial presenting illness or during the advanced phase of the COVID-19 illness.1,2 Some common reported ocular symptoms in patients with conjunctivitis and confirmed SARS-CoV-2 include: itching, redness, tearing, discharge, and foreign body sensation.3 Symptoms of the viral conjunctivitis caused by SARS-CoV-2 can closely resemble those seen in other types of conjunctivitis such as allergic conjunctivitis. It is therefore essential during this SARS-CoV-2 pandemic to be able to distinguish between the viral conjunctivitis caused by SARS-CoV-2 and other types like allergic conjunctivitis. Some notable differences are that allergic conjunctivitis is typically seasonal, occurring around the same time each year, whereas viral conjunctivitis is usually an isolated incident. Additionally, viral conjunctivitis caused by SARS-CoV-2 will usually be accompanied by the main symptoms of SARS-CoV-2 such as fever, cough, shortness of breath, fatigue, loss of appetite, and body aches.1
Studies of patients with confirmed SARSCoV-2 and conjunctivitis
One study by Wu et al.(2020) showed that of 38 confirmed COVID-19 hospitalized patients in China, 12 had conjunctivitis that manifested as conjunctival hyperaemia, chemosis, epiphora, or increased secretions. Xia et al.4 showed that one patient of 30 confirmed COVID-19 patients at the First Affiliated Hospital of Zhejiang University in China, had conjunctivitis. Sun et al.5 revealed that 2.78% of 72 patients with confirmed SARS-CoV-2 had conjunctivitis. Another study by Guan et al.2 conducted in thirty hospitals across China, showed that 0.8% of 1.099 hospitalized patients with confirmed COVID-19 had conjunctival congestion. Additionally, a case report by Chen et al.6 described a 30-year-old man with confirmed COVID-19, who developed bilateral acute conjunctivitis 13 days after illness onset. In yet another case report by Daruich, Martin, and Bremond-Gignac,7 a 27-year-old man who initially presented with symptoms of conjunctivitis such as foreign body sensation, redness, and eyelid swelling, subsequently tested positive for SARS-CoV-2.
Moreover, many studies have revealed that SARS-CoV-2 can be found in ocular secretions or tears.4‒6,8,9 The likelihood however, of SARS-CoV-2 being readily transmissible via ocular secretions is low.10 Nevertheless, contact with infectious aerosols or droplets from the ocular mucosa is a reported mode of transmission for SARS-CoV-2. Furthermore, the eye can also be the route or entry point of infection with SARS-CoV-2.11 This process was believed to be the route of transmission for Guangfa Wang, a Chinese Medical Expert, who upon visiting a Wuhan Fever Clinic wearing an N95 mask but no protective eyewear, was infected with SARS-CoV-2, that initially presented as conjunctivitis.12 Therefore it is highly recommended that protective eyewear, such as goggles or face shields, be worn in addition to an n95 mask when interacting with confirmed cases of SARS-CoV-2 Sun et al.5
Conclusion
This mini review of the current literature confirms conjunctivitis as the main ocular manifestation of SARS-CoV-2 disease. The symptoms can mimic those of other forms of conjunctivitis such as allergic conjunctivitis but the distinguishing features of SARS-CoV-2 conjuntivitis from other similar forms of conjunctivitis are the concurrent respiratory tract symptoms of SARS-CoV-2. Studies have also confirmed the presence of the virus in the tears of infected individuals hence, even though rare, the eyes can be considered a mode of transmission. The ocular surface can also be a potential route for acquiring infection with this disease and for that reason, strong emphasis is placed on the need for protective eye wear when seeing SARS-CoV-2 positive patients or suspected cases.13,14
Acknowledgments
None.
Funding
None.
Conflicts of interest
We declare no conflicts of interest.
References
- Kierstan Boyd. Is It COVID-19 or Allergies? AAO. 2020.
- Wei-jie Guan, Zheng-yi Ni, Yu Hu, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020;382(18):1708‒1720.
- Yunyun Zhou, Chaoye Duan, Yuyang Zeng, et al. Ocular findings and proportion with conjunctival SARS-COV-2 in COVID-19 patients. Ophthalmology. 2020;S0161‒S6420.
- Jianhua Xia, Jianping Tong, Mengyun Liu, et al. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS‐CoV‐2 infection. J Med Virol. 2020;92(6):589‒594.
- Xufang Sun, Xian Zhang, Xuhui Chen, et al. The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study. medRxiv. 2020.
- Lu Chen, Meizhou Liu, Zheng Zhang, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020;104(6):748‒751.
- Daruich Alejandra, Daniel Martin, Dominique Bremond-Gignac. Ocular manifestation as first sign of Coronavirus Disease 2019 (COVID-19): interest of telemedicine during the pandemic context. J Fr Ophtalmol. 2020;43(5):389‒391.
- Francesca Colavita, Daniele Lapa, Fabrizio Carletti, et al. SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection. Ann Intern Med. 2020;M20‒1176.
- Ping Wu, Fang Duan, Chunhua Luo, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA ophthalmology. 2020;138(5):575‒578.
- Ivan Yu Jun Seah, Danielle E Anderson, Adrian Eng Zheng Kang, et al. Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients. Ophthalmology. 2020;S0161‒S6420.
- DeBroff B. COVID-19: ocular manifestations, ocular secretions, and ocuar portal of entry. Advances in Ophthalmology and Visual System. 2020;10(2):48‒49.
- Lu Cheng-wei, Xiu-fen Liu, Zhi-fang Jia. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395(10224):e39.
- https://www.who.int/emergenciesx/diseases/novel-coronavirus-2019
- COVID-19 background primer for ophthalmologists.
©2020 Bastian, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.