Manifestations and Virus Detection in the Ocular Surface of Adult COVID-19 Patients: A Meta-Analysis

Purpose. This study aims to examine the prevalence rate of ocular manifestations and the positive rate for the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival/tear swabs among adult patients with coronavirus disease 2019 (COVID-19). Methods. PubMed and EMBASE were reviewed between December 1, 2019, and January 31, 2021, and only peer-reviewed clinical studies in our pooled analyses were included. Details regarding the patient numbers, demographics, ocular manifestations, positivity of ocular surface RT-PCR, and severity of pneumonia were recorded from each study. Primary outcomes were the occurrence of ocular manifestations and virus detection on the ocular surface. Meanwhile, secondary outcomes included frequencies of various ocular symptoms/signs (s/s), the proportion of patients with ocular manifestation as the initial symptom, and the relationship between the severity of pneumonia and the presentation of ocular manifestations. Results. In total, 35 studies with 4,432 adult COVID-19 patients were included in this analysis. The overall prevalence rate of ocular manifestations was found to be 11.3%, and the positive rate of SARS-CoV-2 in the ocular surface was 7.4%. The four most common ocular s/s were follicular conjunctivitis, redness, watering, and discharge. A proportion of 3.3% presented with ocular s/s preceding other findings. Besides, patients with higher severity of pneumonia were more likely to have ocular manifestations (odds ratio = 2.25; 95% confidence interval (CI): 1.45–3.50). Conclusion. As per our findings, it was determined that ocular transmission of SARS-CoV-2 might be possible, highlighting the importance of eye protective equipment among healthcare personnel.

Download Full-text

Current Evidence of 2019 Novel Coronavirus Disease (COVID-19) Ocular Transmission: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/7605453 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Kai Cao ◽

Brad Kline ◽

Ying Han ◽

Gui-shuang Ying ◽

Ning Li Wang

Keyword(s):

Systematic Review ◽

Prevalence Rate ◽

Meta Analysis ◽

Current Evidence ◽

Prevalence Rates ◽

Ocular Symptoms ◽

Pooled Prevalence ◽

Conjunctival Swab ◽

Positive Rate ◽

Novel Coronavirus

Objective. To estimate the prevalence rate of ocular symptoms and the positive rate of conjunctival swab samples of patients diagnosed with 2019 Novel Coronavirus Disease (COVID-19). Methods. We performed a systematic review and meta-analysis. A comprehensive literature search was done based on PubMed, Embase, MedRxiv, and the Cochrane Library. The primary outcomes are the prevalence rate of conjunctivitis/conjunctival congestion and the positive rate of conjunctival swab samples. Rates were expressed as proportions with 95% confidence intervals (CIs). Results. A total of 12 studies with 1930 participants were included for meta-analysis. The pooled prevalence rate of conjunctivitis/conjunctival congestion was 8% (95% CI: 5%-12%). 1% (95% CI: 1%-4%) of COVID-19 patients were diagnosed with conjunctivitis/conjunctival congestion as the initial symptom. The pooled positive rate of conjunctival swab samples was 3% (95% CI: 2%-5%). We also assessed other ocular symptoms reported in the 12 studies, including foreign body sensation, increased secretion, and eye itching. The pooled prevalence rates were 6% (95% CI: 3%-10%), 10% (95% CI: 8%-12%), and 9% (95% CI: 7%-10%), respectively. Conclusions. The evidence on the positive rate of conjunctival swab samples and the prevalence rates of ocular symptoms indicated that COVID-19 ocular transmission was possible but less likely.

Download Full-text

Identification of SARS-CoV-2 on the ocular surface in a cohort of COVID-19 patients from Brazil

Experimental Biology and Medicine ◽

10.1177/15353702211024651 ◽

2021 ◽

pp. 153537022110246

Author(s):

Matheus S Gasparini ◽

Leandro M dos Santos ◽

Ahmad MA Hamade ◽

Luísa G Gross ◽

Arthur P Favarato ◽

...

Keyword(s):

Ocular Surface ◽

Cross Sectional Study ◽

Hospital Environment ◽

Pcr Analysis ◽

Rt Pcr ◽

Cross Sectional ◽

Ocular Manifestations ◽

Eyelid Edema ◽

Ocular Symptoms ◽

Surface Samples

In this cross-sectional study, we investigate the presence of Severe Acute Respiratory Syndrome Coronavirus 2 Ribonucleic Acid (SARS-CoV-2 RNA) in the tears of hospitalized COVID-19 patients. After laboratory confirmation of SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR) analysis, tear samples from both eyes of each patient were collected using conjunctival swab for RT-PCR. Detailed demographic profile, systemic and ocular symptoms, comorbidities, clinical, ancillary, and ocular manifestations were evaluated. Of the 83 patients enrolled in the study, 7 (8.43%) had SARS-CoV-2 RNA detected in the tear samples. Neutrophils’ count, C-reactive protein, and D-dimer were higher in patients with SARS-CoV-2 detected in tears than in patients without virus in ocular surface samples. One patient with SARS-CoV-2 in tears showed mild ocular eyelid edema, hyperemia, and chemosis. No relevant ocular manifestations were detected in the other patients. Although the levels of viral RNA on ocular surface samples were low for most patients (5/7), with positivity only for gene N and CT higher than 30, two patients were positive for all viral targets tested ( N, E, and RpRd), with viral load near 1 × 105 ePFU/mL, indicating that the ocular transmission of SARS-CoV-2 is a possibility that needs to be considered, especially in the hospital environment. Further studies need to be conducted to demonstrate whether infective viral particles could be isolated from tears.

Download Full-text

OCULAR MANIFESTATIONS IN LABORATORY CONFIRMED COVID-19

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2068 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Shakti Krishan Rajguru ◽

Udesh Rajpurohit

Keyword(s):

Polymerase Chain Reaction ◽

Rt Pcr ◽

Ocular Pain ◽

Chain Reaction ◽

Hospital Unit ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Eyelid Swelling ◽

Polymerase Chain ◽

Isolation Facility

Background: Scarce literature has been published thus far regarding ocular findings in the COVID-19. Methods: All patients were confirmed by SARS-CoV-2 real-time reverse transcriptase– polymerase chain reaction (RT-PCR) of nasopharynx or oropharynx swab specimens collected at an isolation facility, fever clinic, or hospital unit designated for suspected cases pending confirmation. Results: Overall, 25 patients (25.00%) had various ocular symptoms during COVID-19 infection. Among those with ocular symptoms, 19 patients (76.00%) presented with increased conjunctival discharge, including white mucoid (6 [24.00%]), thin watery (3 [12.00%]) and yellow-green purulent (11 [44.00%]) discharge, and with conjunctival congestion (2 [8.00%]). Other ocular manifestations contained ocular pain (3 [12.00%]), tearing (1 [4.00%]), and eyelid swelling (1 [4.00%]). Conclusion: We concluded that common ocular manifestations were conjunctival discharge, eye rubbing, and conjunctival congestion. Keywords: COVID-19, Ocular, Eye.

Download Full-text

The Prevalence of ocular manifestations and ocular samples polymerase chain reaction positivity in patients with COVID 19 - a systematic review and meta-analysis

10.1101/2020.06.29.20142414 ◽

2020 ◽

Author(s):

Soumen Sadhu ◽

Sushmitha Arcot Dandapani ◽

Deepmala Mazumdar ◽

Sangeetha Srinivasan ◽

Jyotirmay Biswas

Keyword(s):

Systematic Review ◽

Polymerase Chain Reaction ◽

Case Reports ◽

Meta Analysis ◽

Initial Symptom ◽

Chain Reaction ◽

Ocular Manifestations ◽

Polymerase Chain Reaction Positivity ◽

Pooled Prevalence ◽

Polymerase Chain

AbstractObjectiveTo estimate the prevalence of ocular manifestations and ocular samples polymerase chain reaction (PCR) positivity among COVID-19 patients.MethodsA systematic literature review was performed using search engines (PubMed, Google Scholar, Medrixv and BioRixv) with keywords “SARS-CoV-2”, “novel coronavirus”, “COVID-19”, “ocular manifestations”, “conjunctival congestion”, “Ocular detection”, “Polymerase chain reaction”, and “conjunctivitis”. The measure of heterogeneity was evaluated with the I2 statistic. The pooled proportion of patients presenting with symptoms and ocular samples PCR positivity was estimated.ResultsA total of 20 studies (14 studies and 6 case-reports) were included in the systematic review and 14 studies were included in the meta-analysis. The pooled prevalence of conjunctivitis was 5.17% (95% CI: 2.90-8.04). Conjunctivitis was reported as an initial symptom of the disease in 0.858 % (95% CI: 0.31-1.67). Common associated features include itching, chemosis, epiphora. Seven patients (29 %) with conjunctivitis showed positive results in ocular samples, whereas 13 patients (54%) showed positive only in their nasopharyngeal samples (NPs) or sputum samples and 4 patients (16 %) were negative for both NPs and Sputum as well as ocular samples. The pooled prevalence of ocular PCR positivity was 2.90 % (95% CI: 1.77 – 4.46) vs. NPs 89.8% (95% CI: 78.80-79.0).ConclusionThe prevalence of conjunctivitis and ocular samples PCR positivity among COVID-19 patients was low indicating that the eye is a less affected organ. However, conjunctivitis may present as the first symptom of the disease making the patient seek medical care at the earliest.SynopsisViral conjunctivitis was the only symptom reported. The prevalence of conjunctivitis and ocular samples polymerase chain reaction positivity among COVID-19 patients was low indicating the eye is a less effected organ.

Download Full-text

Association of Ocular Surface Diseases With SARS-CoV-2 Infection in Six Districts of China: An Observational Cohort Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.695428 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shengjie Li ◽

Yichao Qiu ◽

Li Tang ◽

Zhujian Wang ◽

Wenjun Cao ◽

...

Keyword(s):

Logistic Regression ◽

Ocular Surface ◽

Ocular Diseases ◽

Rt Pcr ◽

Serum Samples ◽

Ocular Manifestations ◽

Increased Risk ◽

Ocular Surface Diseases ◽

Observational Cohort ◽

Respiratory Droplets

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses is mainly transmitted through respiratory droplets. Notably, some coronavirus disease 2019 (COVID-19) patients have ocular manifestations, including conjunctival hyperaemia, chemosis, epiphora, and increased secretions. However, the association between SARS-CoV-2 and ocular surface diseases is poorly described. Between May 2020 and March 2021, a total of 2, 0157 participants from six districts of China were enrolled. Serum samples were tested for immunoglobulin G and M (IgG and IgM) antibodies against the SARS-CoV-2 spike protein and nucleoprotein using magnetic chemiluminescence enzyme immunoassays. Throat swabs were tested for SARS-CoV-2 RNA using RT-PCR assays in a designated virology laboratory. Fisher exact, χ2 test, and logistic regression analysis were performed. Of 2, 0157 serum samples tested, 1, 755 (8.71%) were from ocular surface diseases, 1, 2550 (62.26%) from no-ocular surface diseases (ocular diseases except ocular surface diseases), 5, 852 (29.03%) from no-ocular diseases. SARS-CoV-2 prevalence for the combined measure was 0.90% (182/2, 0157). Seroprevalence of SARS-CoV-2 was significantly (p<0.05) higher in the population with ocular surface diseases (2.28%, 40/1755) compared with no-ocular surface diseases (0.70%, 88/1, 2550), and no-ocular diseases (0.92%, 54/5, 852). Similar results were also observed with respect to sex, age, time, and districts. Logistic regression analyses revealed that ocular surface diseases [ocular surface diseases vs. no-ocular diseases (p=0.001, OR =1.467, 95% CI=1.174-1.834); ocular surface diseases vs. no-ocular surface diseases (p<0.001, OR =2.170, 95% CI=1.434-3.284)] were associated with increased risk of susceptible to SARS-CoV-2 infection. In a word, there was a significant association between ocular surface disease and SARS-CoV-2 infection. Therefore, increasing awareness of eye protection during the pandemic is necessary, especially for individuals with ocular surface diseases.

Download Full-text

Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i1.8256 ◽

2021 ◽

Author(s):

Naser Nasiri ◽

Hamid Sharifi ◽

Azam Bazrafshan ◽

Atefeh Noori ◽

Mohammad Karamouzian ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cross Sectional ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Body Sensation ◽

Pooled Prevalence ◽

Using Data ◽

Meta Analyses

Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed randomeffects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71–17.72). In the studies that reported the details of observed ocular symptoms, the most common ocular manifestations were dry eye or foreign body sensation (n = 138, 16%), redness (n = 114, 13.3%), tearing (n = 111, 12.8%), itching (n = 109, 12.6%), eye pain (n = 83, 9.6%) and discharge (n = 76, 8.8%). Moreover, conjunctivitis had the highest rate among reported ocular diseases in COVID-19 patients (79 out of 89, 88.8%). The results suggest that approximately one out of ten COVID-19 patients show at least one ocular symptom. Attention to ocular manifestations, especially conjunctivitis, can increase the sensitivity of COVID-19 detection among patients.

Download Full-text

SARS-CoV-2 in Conjunctiva and Tears and Ocular Symptoms of Patients with COVID-19

Vision ◽

10.3390/vision5040051 ◽

2021 ◽

Vol 5 (4) ◽

pp. 51

Author(s):

Teresa Rodríguez-Ares ◽

David Lamas-Francis ◽

Mercedes Treviño ◽

Daniel Navarro ◽

María Cea ◽

...

Keyword(s):

Ocular Surface ◽

Preventive Measures ◽

Threshold Values ◽

Rt Pcr ◽

Chain Reaction ◽

Ocular Surface Disease Index ◽

Cross Sectional ◽

Ocular Symptoms ◽

The Mean ◽

Polymerase Chain

This study investigates the presence of SARS-CoV-2 in conjunctival secretions and tears and evaluates ocular symptoms in a group of patients with COVID-19. We included 56 hospitalized patients with COVID-19 in this cross-sectional cohort study. Conjunctival secretions and tears were collected using flocked swabs and Schirmer strips for SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR). Assessment of ocular surface manifestations included an OSDI (Ocular Surface Disease Index) questionnaire. Patients had been admitted to hospital for an average of 2.4 days (range 0–7) and had shown general symptoms for an average of 7.1 days (range 1–20) prior to ocular testing. Four (7.1%) of 56 conjunctival swabs and four (4%) of 112 Schirmer strips were positive for SARS-CoV-2. The mean E-gene cycle threshold values (Ct values) were 31.2 (SD 5.0) in conjunctival swabs and 32.9 (SD 2.7) in left eye Schirmer strips. Overall, 17 (30%) patients presented ocular symptoms. No association was found between positive ocular samples and ocular symptoms. This study shows that SARS-CoV-2 can be detected on the conjunctiva and tears of patients with COVID-19. Contact with the ocular surface may transmit the virus and preventive measures should be taken in this direction.

Download Full-text

SARS-COV-2 in Ophthalmology: Current Evidence and Standards for Clinical Practice

Acta Médica Portuguesa ◽

10.20344/amp.14118 ◽

2020 ◽

Vol 33 (13) ◽

Cited By ~ 1

Author(s):

Sónia Torres-Costa ◽

Mário Lima-Fontes ◽

Fernando Falcão-Reis ◽

Manuel Falcão

Keyword(s):

Nasolacrimal Duct ◽

Current Evidence ◽

Upper Respiratory Tract ◽

Rt Pcr ◽

Ocular Manifestations ◽

Protection Strategies ◽

Positive Rate ◽

Eye Involvement ◽

Upper Respiratory ◽

The Relationship

Introduction: COVID-19 is caused by the coronavirus SARS-CoV-2. Ocular manifestations have been reported including conjunctivitis and retinal changes. Therefore, it is of the utmost importance to clarify eye involvement in COVID-19 in order to help with its diagnosis and to further prevent its transmission. The purpose of this review is to describe the structure and transmission of SARS-CoV-2, reported ocular findings and protection strategies for ophthalmologists.Material and Methods: Literature search on PubMed for relevant articles using the keywords ‘COVID-19’, ‘coronavirus’, and ‘SARS-CoV-2’ in conjunction with ‘ophthalmology’ and ‘eye’. Moreover, official recommendations of ophthalmological societies were reviewed.Results: Although the conjunctiva is directly exposed to extraocular pathogens, and the mucosa of the ocular surface and upper respiratory tract are connected by the nasolacrimal duct, the eye is rarely involved in human SARS-CoV-2 infection and the SARS-CoV-2 RNA positive rate by RT-PCR test in tears and conjunctival secretions from patients with COVID-19 is also extremely low.Discussion: The eye can be affected by SARS-CoV-2, which is supported by some reports of conjunctivitis and retinal changes, but its role in the spread of the disease is still unknown.Conclusion: Given the current scarce evidence, more research is needed to clarify the relationship between SARS-CoV-2 and the eye.

Download Full-text

Ocular Manifestations and Viral Prevalence in Conjunctival Secretions of Patients with COVID 19 – A Meta–Analysis

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i4.1126 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Ayisha Shakeel ◽

Sharjeel Sultan ◽

Syed Imtiaz Ali

Keyword(s):

Key Words ◽

Meta Analysis ◽

The Body ◽

Low Risk ◽

Protective Equipment ◽

Risk Of Infection ◽

Rt Pcr ◽

Ocular Manifestations ◽

Pcr Test

PubMed was searched using key words “COVID-19”, “coronavirus”, and “SARS CoV‑2” in conjunction with “ophthalmology” and “eye” on 17th May 2020. Total 483 articles were identified. After screening eleven articles were included in the analysis. The frequencies of ocular manifestations and the presence of virus in conjunctiva were analyzed and final results were compiled.Ten out of eleven articleswere analyzed for ocular manifestations. In our analysis a total of 2115 cases had Covid 19, out of which 77 patients developed ocular manifestations (3.64%, 95% CI 2.88 – 4.53). The most common being conjunctival congestion. Twelve patients had SARS – CoV-2 in their ocular secretions confirmed by RT PCR test (2.61%, 95% CI 1.36 – 4.52). This meta-analysis concludes that conjunctiva is neither a preferred site of infection nor a preferred gateway for entry of SARS CoV-2 in the body. As a low risk of infection does exist, eye protective equipment should be used when treating COVID – 19 patients. Key Words: SARS CoV 2, COVID 19, Conjunctiva, Ophthalmology.

Download Full-text

Ocular manifestations and SARS-CoV-2 detection in tears and conjunctival scrape from non-severe COVID-19 patients

International Journal of Ophthalmology ◽

10.18240/ijo.2021.08.01 ◽

2021 ◽

Vol 14 (8) ◽

pp. 1133-1137

Author(s):

Bing Jiang ◽

◽

Wen-Long Wang ◽

Min Hu ◽

Sui He ◽

...

Keyword(s):

Virus Disease ◽

Virus Detection ◽

Rt Pcr ◽

Chain Reaction ◽

Pharyngeal Swab ◽

Nucleoprotein Gene ◽

Ocular Manifestations ◽

Normal Chest ◽

Polymerase Chain ◽

Positive Results

AIM: To explore the ocular features of corona virus disease (COVID)-19 and severe acute respiratory syndrome coronavirus (SARS-CoV)-2 detection in tears and conjunctival scrapes in non-severe COVID-19 patients. METHODS: This is a multicenter observational clinical study with no intervention conducted from Jan 25th to March 1st, 2020. Clinical data and samples of tears and conjunctival scraping were collected in consecutive laboratory-confirmed, non-severe COVID-19 patients from three hospitals. COVID-19 virus was analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) kits. RESULTS: Totally 255 laboratory-confirmed, non-severe COVID-19 patients were recruited for ocular manifestation investigation. Of them, 54.9% were females, with a mean age of 49.4y. None of the patients has evidence of uveitis; 11 patients (4.3%) complained of mild asthenopia; 2 (0.8%) had mild conjunctival congestion and serous secretion. Twenty-five of them had performed tears and conjunctival scrape for COVID-19 virus detection, with 4 yield possible positive results in the nucleoprotein gene. One of them were asymptomatic with normal chest CT and positive pharyngeal swab result. CONCLUSION: Ocular manifestations are neither common nor specific in non-severe COVID-19 patients. Meanwhile, COVID-19 virus nucleotides can be detected in the tears and conjunctival scrape samples, warranting further research on the transmissibility by the ocular route.

Download Full-text