Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Purpose This study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods A systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible. Results A total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens in 3.5% patients. Conclusion The most common reported ocular presentations of COVID-19 included ocular pain, redness, discharge, and follicular conjunctivitis. A small proportion of patients had viral RNA in their conjunctival/tear samples. The available studies show significant publication bias and heterogeneity. Prospective studies with methodical collection and data reporting are needed for evaluation of ocular involvement in COVID-19.

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Ophthalmology-focused publications and findings on COVID-19: A systematic review

European Journal of Ophthalmology ◽

10.1177/1120672121992949 ◽

2021 ◽

pp. 112067212199294

Author(s):

Ya-Ping Jin ◽

Graham E Trope ◽

Sherif El-Defrawy ◽

Elin Y Liu ◽

Yvonne M Buys

Keyword(s):

United States Of America ◽

Case Reports ◽

Meta Analysis ◽

Ocular Involvement ◽

Middle Phase ◽

Cross Sectional ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Pooled Prevalence

Purpose: To summarize COVID-19 research endeavors by ophthalmologists/researchers in terms of publication numbers, journals and author countries, and to detail key findings. Methods: The LitCovid database was systematically reviewed for ophthalmology-focused COVID-19 articles. The quality of the evidence was assessed for articles investigating conjunctivitis in COVID-19 patients. Results: There were 21,364 articles in LitCovid on June 12, 2020, of which 215 (1%) were ophthalmology-focused. Of articles on COVID-19 transmission, 3.3% were ophthalmology-focused. Ophthalmology-focused articles were published in 68 journals and originated from 25 countries. The top five countries publishing ophthalmology-focused articles (China, India, United States of America, Italy, and United Kingdom) produced 145/215 (67%) articles. A total of 16 case reports/series from eight countries reported that conjunctivitis can be the initial or the only symptom of COVID-19 infection. Conjunctivitis may occur in the middle phase of COVID-19 illness. A total of 10 hospital-based cross-sectional studies reported that between 0% and 31.6% of COVID-19 patients have conjunctivitis or other ocular conditions, with a pooled prevalence of 5.5% reported in a meta-analysis. Viral RNA was detected in conjunctival swabs of patients with and without ocular manifestations, after resolution of conjunctivitis, after nasopharyngeal swabs turned negative and in retina of deceased COVID-19 patients. Conclusion: Within 3 months of declaring the COVID-19 pandemic, 215 ophthalmology-focused articles were published in PubMed, concentrating on disease manifestations and transmission. The reported presence of conjunctivitis or other ocular conditions in COVID-19 patients is varied. Clinicians should be alert for ocular involvement in COVID-19 infections and possible ocular transmission even in patients without ocular symptoms.

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Ocular manifestations in Herpes Zoster Ophthalmicus

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v3i2.5271 ◽

1970 ◽

Vol 3 (2) ◽

pp. 165-171 ◽

Cited By ~ 16

Author(s):

LR Puri ◽

GB Shrestha ◽

DN Shah ◽

M Chaudhary ◽

A Thakar

Keyword(s):

Herpes Zoster ◽

Young Patients ◽

Ocular Involvement ◽

Post Herpetic Neuralgia ◽

Visual Disability ◽

Herpes Zoster Ophthalmicus ◽

Cross Sectional ◽

Ocular Manifestations ◽

Visual Status ◽

The Mean

Background: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. Aim: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. Materials and methods: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. Results: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. Conclusion: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination. Key words: herpes virus, herpes zoster, conjunctivitis, keratitis DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5271 Nepal J Ophthalmol 2011; 3(2): 165-171

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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.

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Association of multiple sclerosis with vitiligo: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-74298-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Meng-Han Shen ◽

Chau Yee Ng ◽

Kuo-Hsuan Chang ◽

Ching-Chi Chi

Keyword(s):

Multiple Sclerosis ◽

Cohort Studies ◽

Genetic Factors ◽

Meta Analysis ◽

Case Control ◽

Systemic Review ◽

Case Control Studies ◽

Cross Sectional ◽

Pooled Data ◽

Newcastle Ottawa Scale

Abstract Polyautoimmunity implicates that some autoimmune diseases share common etiopathogenesis. Some studies have reported an association between multiple sclerosis (MS) and vitiligo; meanwhile, other studies have failed to confirm this association. We performed a systemic review and meta-analysis to examine the association of MS with vitiligo. We searched the MEDLINE and Embase databases on March 8, 2020 for relevant case–control, cross-sectional, and cohort studies. The Newcastle–Ottawa Scale was used to evaluate the risk of bias of the included studies. Where applicable, we performed a meta-analysis to calculate the pooled odds ratio (OR) for case–control/cross-sectional studies and risk ratio for cohort studies with 95% confidence interval (CI). Our search identified 285 citations after removing duplicates. Six case–control studies with 12,930 study subjects met our inclusion criteria. Our meta-analysis found no significant association of MS with prevalent vitiligo (pooled OR 1.33; 95% CI 0.80‒2.22). Analysis of the pooled data failed to display any increase of prevalent vitiligo in MS patients compared with controls. Ethnic and genetic factors may play an important role for sporadically observed associations between MS and vitiligo. Future studies of this association should therefore consider stratification by ethnic or genetic factors.

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Is Depression Related to Low Folate Levels in People with Epilepsy? An Observational Study and Meta-analysis

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_468_16 ◽

2017 ◽

Vol 08 (03) ◽

pp. 381-388 ◽

Cited By ~ 1

Author(s):

Bhargavi Ramanujam ◽

Bhupender Kumar Bajaj ◽

Kirandeep Kaur ◽

Kuljeet Singh Anand ◽

Gurdeep Buxi

Keyword(s):

Depressive Symptomatology ◽

Meta Analysis ◽

Serum Levels ◽

Significant Negative Correlation ◽

Cross Sectional Study ◽

Serum Folate ◽

Folate Supplementation ◽

Cross Sectional ◽

Pooled Data ◽

Low Serum

ABSTRACT Background: Both depression and low serum levels of folate are common in people with epilepsy (PWE), the latter especially in patients on hepatic enzyme-inducing antiepileptic drugs (AEDs). We did a cross-sectional study and a meta-analysis to assess if lower folate levels have any relation with depression in PWE. Materials and Methods: Two hundred and one PWE were recruited and assessed for depression using the Inventory of Depressive Symptomatology-Self-Rated (IDS-SR) and Inventory of Depressive Symptomatology-Clinician Rated; serum folate levels were measured in them at the same time. Literature search was carried out and studies with data on depression as well as folate levels in PWE were included. Statistical analysis to determine frequency of depression, low folate levels, and relation between them among our cases and the pooled data from the included studies was done. Results: Depression was observed in 65.68% and low serum folate (<4 ng/ml) in 48.75% of PWE (over 80% on older AEDs); there was no statistically significant correlation between them. However, on analyzing the pooled data of six studies including the present, the Fisher’s z-transformed correlation coefficient was −0.1690 (95% confidence interval [−0.3175, −0.0124], P = 0.0464). Conclusions: Depression and low folate levels are common in PWE. Low folate levels have a mild but significant negative correlation with depression in this population, and folate supplementation would be advisable for those on the older AEDs.

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COVID-19: Effects on Eye in Bangladesh

Bangladesh Medical Journal ◽

10.3329/bmj.v49i2.55814 ◽

2020 ◽

Vol 49 (2) ◽

pp. 14-18

Author(s):

Md Sharfuddin Ahmed ◽

Md Showkat Kabir ◽

Mazharul Hoque Bhuiyan

Keyword(s):

Signs And Symptoms ◽

Cross Sectional Study ◽

Ocular Infection ◽

Ocular Involvement ◽

College Hospital ◽

Cross Sectional ◽

Medical College ◽

Ocular Manifestations ◽

Medical University ◽

Ocular Signs

COVID-19 is a contagious disease which can spread person to person mainly by respiratory droplet from infected person and contact by contaminated objects or body limbs through the routes nose, mouth, and eyes. To find out the ocular manifestations that are found in Bangladesh during COVID-19 pandemic this descriptive type of cross-sectional study was conducted to detect the ocular infection and its manifestation among patients admitted at different COVID-19 dedicated hospitals. Total 26 doctor’s (Eye Specialists, ICU Consultants, ICU Residents/ Medical Officers, Consultants of other Specialities, Medical Officers/ Residents) observational and examination findings were recorded in this study who have already completed one or more roster [07 days] duties in Corona Dedicated hospitals to treat the COVID-19 affected patients directly. Total 3,678 patients information from different hospitals were collected and interviews were taken directly or over telephone from the participants. Data collected from the participants based on the observations of physicians during COVID roster duties in different corona dedicated hospitals. Age sex and ocular signs and symptoms found in patients during hospitalization were recorded. Total 08 (eight) Corona dedicated hospitals; one Medical University, five tertiary level Govt. hospitals, one private Medical College hospital and one largest Isolation center of South-Asia were included as study place. Among the cases 66.2% were male and 33.8% female. Maximum patients were in age group 40-60 years [40%] and minimum of them were above 70 years [10%]. Ocular manifestations found in 48 cases and.30 in suspected, total 78 cases found with ocular manifestations. Total 2.121% patients hade ocular manifestations in confirmed and suspected cases. In COVID confirmed cases 1.316% patients hade ocular manifestations. In conclusion, we found several ocular manifestations in patients who are hospitalized as COVID-19 patients. Moreover, the ocular involvement could be the presenting finding of disease. Further studies are required in Bangladesh and this information may be valuable for future studies. Bangladesh Med J. 2020 May; 49(2) : 14-18

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Ocular manifestations of atopic dermatitis

Journal of Dermatology & Cosmetology ◽

10.15406/jdc.2019.03.00112 ◽

2019 ◽

Vol 3 (2) ◽

pp. 36-40

Author(s):

Omeed Memar

Keyword(s):

Atopic Dermatitis ◽

Ocular Surface ◽

Google Scholar ◽

Ocular Involvement ◽

Ocular Manifestations ◽

Inflammatory Dermatosis ◽

Immunological Profile ◽

Literature Searches ◽

Common Manifestation

Purpose: A review of the published literature on the history, pathogenesis, and treatment of atopic dermatitis (AD) and its ocular involvement. Methods: Literature searches were conducted in MEDLINE (Ovid) and Google scholar for AD and ocular AD. Results: AD is an inflammatory dermatosis that has classic presentations on the skin at different age points. The primary immunological profile is a Th2 profile, releasing an abundance of IL4 and IL10 both systemically and locally. AD can involve the eye and have devastating consequences. Here we review the latest understanding of AD pathogenesis and treatments vis-à-vis the ocular surface. Conclusion: Ocular AD is a common manifestation of AD. The newest drugs for systemic AD might be deleterious for ocular AD.

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Ocular Affection as an Extraintestinal Manifestation in Cases of Inflammatory Bowel Disease at the Kafrelsheikh Governorate

Journal of Coloproctology ◽

10.1055/s-0041-1724056 ◽

2021 ◽

Vol 41 (01) ◽

pp. 008-013

Author(s):

Mohammed Hussien Ahmed ◽

Mohammed Elashery ◽

Hebatallah Abdel Maksoud ◽

Aya Mohammed Mahros

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

University Hospital ◽

Ocular Involvement ◽

Extraintestinal Manifestations ◽

Extraintestinal Manifestation ◽

Cross Sectional ◽

Ocular Manifestations ◽

Significant Difference ◽

Inflammatory Bowel

Abstract Introduction The manifestations of inflammatory bowel disease (IBD) are not restricted to the gastrointestinal tract. Musculoskeletal conditions are considered the most common extraintestinal manifestations, followed by mucocutaneous and ocular diseases. Many general practitioners are unaware of the variety and severity of the ocular affection in IBD patients. Objective To assess the prevalence of extraintestinal manifestations in IBD patients at Kafrelsheikh governorate, and to evaluate the different ocular manifestations and their relationship to the severity of the disease. Methods A cross-sectional study evaluating 120 patients treated at the Kafrelsheikh University Hospital. The diagnosis of IBD was made between December 2018 and December 2019 through clinical, endoscopic and histopathological examinations. All patients were assessed for any extraintestinal manifestation or evidence of ocular affection through slit-lamp examinations, tonometry, visual acuity, and indirect ophthalmoscopy. Results The mean age of the sample was 35.5 ± 13.3 years. In total, 52 (43.3%) patients were male and 68 (56.7%) were female. Ocular manifestations represent ∼ 22.5% of extraintestinal manifestations. The most common ocular findings were conjunctivitis (25.8%) and anterior uveitis (10.8%), followed by scleritis (9.2%) and cataract (8.3%). Other extraintestinal manifestations were observed in 41 (34.1%) 29 (29.9%) of ulcerative colitis cases, and 12 (52%) of Crohn disease cases. There was no statistically significant difference in the presence of ocular involvement in relation to the two types of IBD included in the Montreal classification. Conclusion Ocular manifestations in cases of IBD are common and usually nonspecific in presentation. The severity of the IBD does not reflect the severity of the ocular affection.

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Ophthalmic Manifestations of HIV Patients in a Rural Area of Western Maharashtra, India

International Scholarly Research Notices ◽

10.1155/2014/347638 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Pratik Y. Gogri ◽

Somen L. Misra ◽

Raghunandan N. Kothari ◽

Akshay J. Bhandari ◽

Hitesh V. Gidwani

Keyword(s):

Rural Area ◽

Anterior Uveitis ◽

Anterior Segment ◽

Cd4 Count ◽

Ocular Involvement ◽

Herpes Zoster Ophthalmicus ◽

Cross Sectional ◽

Cmv Retinitis ◽

Ocular Manifestations ◽

Hiv Aids

Introduction. HIV/AIDS is one of twenty first century’s biggest global challenges to mankind with protean manifestations affecting all organs of our body, not even sparing the eyes. The purpose of this study was to determine the pattern of ocular manifestations of HIV/AIDS and their correlation with CD4-count in a rural area of India. Methods. A hospital based observational cross-sectional study was done on 40 HIV-positive patients presenting to ART center with ocular complaints. Data were collected using face-to-face interview, clinical examination, slit lamp examination, fundus examination, and laboratory investigations. Results. Out of 40 patients, 21 were males and 19 were females with mean age of 38.75 ± 13.9 years. HIV retinopathy was the most common HIV-associated ophthalmic lesion while anterior uveitis was the most common anterior segment finding. Posterior segment lesions showed significant association (P<0.05) with low CD4-count of the patient. CMV retinitis, retinal detachment, tubercular chorioretinitis, and acute retinal necrosis were all seen in patients with CD4-count less than 100 cells/mm3. Conclusions. HIV retinopathy, CMV retinitis, herpes zoster ophthalmicus, and anterior uveitis are common ocular manifestations associated with HIV infection. Low CD4-count is a risk as well as predictor for ocular manifestations. There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination.

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

Journal of Ophthalmology ◽

10.1155/2021/9997631 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Yu-Yen Chen ◽

Yung-Feng Yen ◽

Li-Ying Huang ◽

Pesus Chou

Keyword(s):

Ocular Surface ◽

Prevalence Rate ◽

Meta Analysis ◽

Virus Detection ◽

Healthcare Personnel ◽

Initial Symptom ◽

Rt Pcr ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Positive Rate

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.

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