Ocular Involvement in COVID-19: Conjunctivitis and More

AbstractSince 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.

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114. Chorioretinal Lesions in Persons Who Inject Drugs and Are Hospitalized with Bloodstream and Related Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.189 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S88-S89

Author(s):

Margaret A Greven ◽

Jessica Weinstein ◽

Kathy Tsamis ◽

Philippe F Ayres ◽

Erin W Barnes ◽

...

Keyword(s):

Systemic Infection ◽

Injection Drug ◽

Ocular Involvement ◽

Persons Who Inject Drugs ◽

Disseminated Infection ◽

Drug Of Choice ◽

Cotton Wool Spots ◽

Ocular Symptoms ◽

Retinal Examination ◽

The Many

Abstract Background Eye infection is one of the many potential sites of infection in persons who inject drugs (PWID). The purpose of this study was to determine the prevalence of chorioretinal (CR) lesions, identify causative organisms, and correlate symptoms with ophthalmic involvement in PWID hospitalized with bloodstream infection (BSI) and/or related metastatic foci of infection (MFI). Methods Actively using PWID 18 years or older admitted to Wake Forest Baptist Med Ctr with documented BSI or MFI related to injection drug use (IDU) were prospectively enrolled after providing informed consent. All patients, whether or not they had eye symptoms, received a dilated retinal examination as soon as feasible after admission. Ocular symptoms, visual acuity, and ocular examination findings were recorded and fundus photos were obtained as indicated. Patients could be re-enrolled if re-admitted with a different infection. Results Fifty-three PWID with 55 episodes of disseminated infection related to IDU underwent ophthalmic exams at a median of 7 days post-admission. Mean age was 33.4 years and 51% were female. Twenty (38%) patients had HCV viremia but none had active HIV infection. Heroin was the injection drug of choice in 55% of patients. Of the 55 episodes of systemic infection, 33 were classified as infective endocarditis (IE), 6 were BSI only, 10 were BSI with MFI, and 5 were MFI without active BSI. Nine (17%) patients had CR involvement on examination but only 33% (3/9) were symptomatic. Of those with ocular involvement, 1 had fungal endophthalmitis due to Candida albicans. Single or multifocal subretinal infiltrates were found in 5/9 patients (MSSA 2, MRSA 2, H. parainfluenzae 1), 2/9 had cotton wool spots (S. mitis 1, MRSA 1), and 7/9 had intraretinal or white-centered hemorrhages (MSSA 3, MRSA 2, S. mitis 1, H. parainfluenzae 1). Of the 9 patients with CR lesions, 7 had IE. Interestingly, 3.8% (3/53) had old multifocal CR scars, possibly related to prior disseminated infection. Conclusion PWID admitted with BSI or MFI may have ophthalmic involvement even in the absence of ocular symptoms, especially in the setting of IE. Further study is needed to characterize the epidemiology of these infections, to identify risk factors for ocular involvement, and to optimize diagnosis and management. Disclosures All authors: No reported disclosures.

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Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062916 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2916

Author(s):

Joanna Dolar-Szczasny ◽

Mario D. Toro ◽

Anna Dworzańska ◽

Tomasz Wójtowicz ◽

Izabela Korona-Glowniak ◽

...

Keyword(s):

Genetic Material ◽

Eye Disease ◽

Ocular Infection ◽

Ocular Involvement ◽

Consecutive Series ◽

Respiratory Involvement ◽

Ocular Symptoms ◽

Male Patients ◽

Tight Correlation ◽

Variable Efficiency

The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by COVID-19. A consecutive series of 74 COVID-19-positive patients (age 21–89) were enrolled at two Polish COVID-19 hospitals for 4 months and were characterized by PCR for the presence of the SARS-CoV-2 genetic material in nasopharyngeal (NP) and ocular swabs, while their respiratory and ocular symptoms were noted. Almost 50% of them presented with severe/critical respiratory involvement, and some degree of eye disease. No tight correlation was observed between the presence of ocular and respiratory symptoms. Three male patients presenting with severe/critical lung disease tested positive in ocular swab, however with mild/moderate ocular symptoms. In conclusion, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not such a frequent occurrence.

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Potential of Ocular Transmission of SARS-CoV-2: A Review

Vision ◽

10.3390/vision4030040 ◽

2020 ◽

Vol 4 (3) ◽

pp. 40 ◽

Cited By ~ 4

Author(s):

Brad P. Barnett ◽

Karl Wahlin ◽

Michal Krawczyk ◽

Doran Spencer ◽

Derek Welsbie ◽

...

Keyword(s):

Ocular Surface ◽

Molecular Mechanisms ◽

Expression Profiles ◽

Cathepsin L ◽

Gene Expression Profiles ◽

Systemic Infection ◽

Nasolacrimal Duct ◽

Ocular Infection ◽

Angiotensin Converting Enzyme 2 ◽

Transmembrane Serine Protease

Purpose of review: to provide a prospective on the current mechanisms by which SARS-CoV-2 enters cells and replicates, and its implications for ocular transmission. The literature was analyzed to understand ocular transmission as well as molecular mechanisms by which SARS-CoV-2 enters cells and replicates. Analysis of gene expression profiles from available datasets, published immunohistochemistry, as well as current literature was reviewed, to assess the likelihood that ocular inoculation of SARS-CoV-2 results in systemic infection. Recent findings: The ocular surface and retina have the necessary proteins, Transmembrane Serine Protease 2 (TMPRSS2), CD147, Angiotensin-Converting Enzyme 2 (ACE2) and Cathepsin L (CTSL) necessary to be infected with SARS-CoV-2. In addition to direct ocular infection, virus carried by tears through the nasolacrimal duct to nasal epithelium represent a means of ocular inoculation. Summary: There is evidence that SARS-CoV-2 may either directly infect cells on the ocular surface, or virus can be carried by tears through the nasolacrimal duct to infect the nasal or gastrointestinal epithelium.

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Ectoine in the Treatment of Irritations and Inflammations of the Eye Surface

BioMed Research International ◽

10.1155/2021/8885032 ◽

2021 ◽

Vol 2021 ◽

pp. 1-16

Author(s):

Andreas Bilstein ◽

Anja Heinrich ◽

Anna Rybachuk ◽

Ralph Mösges

Keyword(s):

Ocular Surface ◽

Uv Light ◽

Inflammatory Diseases ◽

Symptom Relief ◽

Stress Factors ◽

Eye Drops ◽

Ophthalmic Surgery ◽

Ocular Symptoms ◽

Preclinical And Clinical Studies ◽

Standard Treatment Regimen

The ocular surface is facing various unspecific stress factors resulting in irritation and inflammation of the epithelia, causing discomfort to the patients. Ectoine is a bacteria-derived extremolyte with the ability to protect proteins and biological membranes from damage caused by extreme environmental conditions like heat, UV-light, high osmolarity, or dryness. Evidence from preclinical and clinical studies attest its effectiveness in treating several epithelium-associated inflammatory diseases, including the eye surface. In this review, we analysed 16 recent clinical trials investigating ectoine eye drops in patients with allergic conjunctivitis or with other unspecific ocular inflammations caused by e.g. ophthalmic surgery. Findings from these studies were reviewed in context with other published work on ectoine. In summary, patients with irritations and unspecific inflammations of the ocular surface have been treated successfully with ectoine-containing eye drops. In these patients, significant improvement was observed in ocular symptoms of allergic rhinoconjunctivitis, postoperative secondary dry eye syndrome, or ocular reepithelisation after surgery. Using ectoine as an add-on therapy to antihistamines, in allergy patients accelerated symptom relief by days, and its use as an add-on to antibiotics resulted in faster wound closure. Ectoine is a natural substance with an excellent tolerability and safety profile thus representing a helpful alternative for patients with inflammatory irritation of the ocular surface, who wish to avoid local reactions and side effects associated with pharmacological therapies or wish to increase the efficacy of standard treatment regimen.

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Topical Ophthalmic Cyclosporine in the Treatment of Toxic Epidermal Necrolysis

Case Reports in Medicine ◽

10.1155/2011/416842 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

Zafer Onaran ◽

Gülşah Usta ◽

Mukadder Koçak ◽

Kemal Örnek ◽

Ünase Büyükkoçak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Toxic Epidermal Necrolysis ◽

Ocular Surface ◽

Acute Stage ◽

Ocular Involvement ◽

Pathologic Finding ◽

Ocular Complication ◽

Case Presentation ◽

Intravenous Corticosteroid

Aim. To describe a case of toxic epidermal necrolysis (TEN) with ocular involvement treated with topical ophthalmic cyclosporine.Case Presentation. A 20-year-old woman developed TEN following administration of carbamazepine that was prescribed for epilepsy. Ophthalmic examination revealed bilateral pseudomembranous conjunctivitis. She was hospitalized in the intensive care unit and treated with intravenous corticosteroid and immunoglobulin. Topical cyclosporine was used in combination with topical corticosteroids for ocular surface disease. Following two months of ocular treatment, she recovered without any severe ocular complication. Ocular examination at the four-month followup showed a 2 mm of symblepharon in the lower fornix as the sole pathologic finding.Conclusion. Topical ophthalmic cyclosporine may contribute to decrease the ophthalmic complications of TEN and should be considered in the acute stage of the disease.

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Lichen Planus as a Possible Rare Cause of an Ocular Disease

Czech and Slovak Ophthalmology ◽

10.31348/2019/4/6 ◽

2019 ◽

Vol 75 (4) ◽

pp. 219-223

Author(s):

Jana Nekolová ◽

Markéta Středová ◽

Miroslav Podhola ◽

Naďa Jirásková

Keyword(s):

Lichen Planus ◽

Inflammatory Disease ◽

Ocular Surface ◽

Negative Impact ◽

Rare Event ◽

Chronic Inflammatory Disease ◽

Mental Condition ◽

Unknown Etiology ◽

Ocular Involvement ◽

Irreversible Damage

Lichen planus is a relatively common mucocutaneous papulosquamous disorder of unknown etiology that is thought to be immunologically mediated. Ocular involvement of lichen planus (LP) is a rare event, which can lead to irreversible damage to the ocular surface and loss of vision from cicatrizing blepharoconjunctivitis and corneal scarring. Steroids are the first treatment choice. Treatment with topical ciclosporin A is also a possible treatment. We report a case of 79-year-old woman who was treated for long lasting severe inflammatory disease of a ocular surface. It led to blindness of one eye and low vision of the second eye. The diagnosis was made thanks to correlation of biopsy results from oral and ocular surface. The patient was also diagnosed with middle-stage dementia. Negative impact of steroid therapy on mental condition of this patient was considered. On the other hand, dementia could cause worse compliance with recommended treatment regime. Chronic inflammatory disease of ocular surface requires long lasting treatment very often and it is sometimes not as effective as expected. Discovering etiological causes of the disease is a priority for the right treatment. We emphasize also the key role of physical and mental condition in management of ocular surface disease.

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Human coronaviruses: ophthalmic manifestations

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000630 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000630

Author(s):

Mohd-Asyraaf Abdul-Kadir ◽

Lik Thai Lim

Keyword(s):

Viral Entry ◽

Ocular Surface ◽

Animal Studies ◽

Preliminary Finding ◽

Ocular Manifestations ◽

Ophthalmic Manifestations ◽

Global Pandemic ◽

Conflicting Evidence ◽

Human Coronaviruses ◽

Novel Coronavirus

The 2019 novel coronavirus which causes severe acute respiratory syndrome (SARS) known as SARS-CoV-2 still remains as a global pandemic since its discovery and continues to spread across the world, given how highly contagious the virus is. We reviewed various articles that explore eye involvement in COVID-19 and other human coronaviruses, its human manifestations in comparison to animal studies and potential mechanism of viral entry into the eye surface. Evidence of animal studies depicted various complications of coronaviruses infection into the eyes, in both anterior and posterior segments of the eye. Conjunctival inflammation remains uncommon in association with COVID-19, with other ophthalmic findings. The risk of transmission via the ocular surface remains likely low, though it is inarguably present based on preliminary finding of viral load in ocular samples and expression of ACE2 on the ocular surface. Testing the tears sample for diagnosing SARS-CoV-2 was unreliable due to limitations of the testing kits and conflicting evidence of the viral titre in the ocular samples. Further larger, more precise and specific studies are required to allow us to better understand the pattern of virulence underlying the associations of SARS-CoV-2 in the eye despite its rare occurrence. This review article aims to enhance better awareness among clinicians regarding ocular manifestations associated with COVID-19 and necessary precautions should be implemented to minimise the risk of person-to-person especially in the nosocomial setting.

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Metagenomics in ophthalmology: current findings and future prospectives

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2018-000248 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000248 ◽

Cited By ~ 7

Author(s):

Davide Borroni ◽

Vito Romano ◽

Stephen B Kaye ◽

Tobi Somerville ◽

Luca Napoli ◽

...

Keyword(s):

Dna Sequencing ◽

Microbial Communities ◽

High Throughput ◽

Ocular Surface ◽

Future Research ◽

Ocular Infection ◽

Ocular Diseases ◽

Ocular Surface Diseases ◽

High Throughput Dna Sequencing ◽

Functional Profiles

Less than 1% of all microorganisms of the available environmental microbiota can be cultured with the currently available techniques. Metagenomics is a new methodology of high-throughput DNA sequencing, able to provide taxonomic and functional profiles of microbial communities without the necessity to culture microbes in the laboratory. Metagenomics opens to a ‘hypothesis-free’ approach, giving important details for future research and treatment of ocular diseases in ophthalmology, such as ocular infection and ocular surface diseases.

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Effect of a Topical Combination of Latanoprost and Pranoprofen on Intraocular Pressure and the Ocular Surface in Open-Angle Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2018/7474086 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Simin Zhu ◽

Dabo Wang ◽

Jing Han

Keyword(s):

Intraocular Pressure ◽

Ocular Surface ◽

Open Angle Glaucoma ◽

Study Groups ◽

Control Group ◽

Open Angle ◽

Conjunctival Hyperemia ◽

Ocular Symptoms ◽

Nsaid Group ◽

Symptom Scores

Objective. A prospective study was performed to observe the effects of nonsteroidal anti-inflammatory drug (NSAID) eyedrops on intraocular pressure (IOP) and the ocular surface in primary open-angle glaucoma (POAG) patients treated with 0.005% latanoprost eyedrops. Methods. Forty-eight subjects were randomized into two study groups (NSAID and control). Latanoprost was continued for 10 weeks in all subjects. At the end of week 4, pranoprofen was added in the NSAID group, and treatment lasted for 4 weeks, whereas patients in the control group were treated with latanoprost alone. IOP was measured in both groups every 2 weeks, and the changes in the ocular surface in the NSAID group were evaluated once a month. Results. Pranoprofen addition resulted in a decrease in IOP in the NSAID group compared to the control group (p<0.01). After pranoprofen was discontinued, IOP significantly increased in the NSAID group (p<0.01), remaining approximately at the same IOP as when they were being treated with latanoprost alone. During the same examination, no significant variations in IOP were found in the control group. Patients who were treated with latanoprost alone showed gradual improvements in ocular surface symptom scores and conjunctival hyperemia scores during the first four weeks of treatment (p<0.01). When pranoprofen eyedrops were added, ocular surface symptom scores decreased (p<0.01), but conjunctival hyperemia scores did not change significantly. Conclusions. For POAG patients treated with latanoprost, the combination of pranoprofen can not only significantly enhance the latanoprost-induced IOP-lowering effect but also relieve the uncomfortable ocular symptoms caused by latanoprost.

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Xeroderma Pigmentosum: Ocular Findings in an Isolated Brazilian Group with an Identified Genetic Cluster

Journal of Ophthalmology ◽

10.1155/2019/4818162 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Maria Claudia Schelini ◽

Luis Fernando O. B. Chaves ◽

Marcia C. Toledo ◽

Francisco W. Rodrigues ◽

Tauan de Oliveira ◽

...

Keyword(s):

Ocular Surface ◽

Xeroderma Pigmentosum ◽

Genetic Disorder ◽

Skin Pigmentation ◽

Previous History ◽

Case Series ◽

Corneal Neovascularization ◽

University Hospital ◽

Ocular Symptoms ◽

History Of

Purpose. Xeroderma pigmentosum (XP) is a rare autosomal recessive genetic disorder characterized by increased susceptibility to UV radiation- (UVR-) induced skin pigmentation, skin cancers, ocular surface disease, and, in some patients, sunburn and neurological degeneration. Eight different genes are affected, and the prevalence of the disease differs across the world. The present study describes the main ophthalmologic features and symptoms in patients with XP in this case series. Methods. Patients were examined consecutively at the University Hospital of the Federal University of Goias between January 2016 and June 2018. All patients underwent ophthalmologic examination and were asked about their ophthalmological history and the presence of ocular symptoms. Results. Twenty-one patients with genetic confirmation were evaluated. The genetic variants XPV and XPC were detected in the patients. The most prevalent findings include eyelid changes, observed in 80.9% of the patients, and ocular surface changes as punctate keratopathy, occurring in 16 patients (76.2%), corneal neovascularization, and corneal opacities. Six patients (28.5%) presented corneoconjunctival tumor. More than half of patients had previous history of treatment of ocular neoplasia. Ocular burning was the most reported symptom. Conclusions. The ocular characteristics identified in this study corroborate the existing literature, mainly related to the surface. Concerning the XP variant and the gravity of ocular signs, XPC has earlier and more severe symptoms than XPV. Due to their relative rarity, publications of XP cases are important to understand the possible damages caused by the disease in the eyes and surrounding area.

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