Eye manifestations of COVID-19. Step one
Keywords:COVID-19, conjunctivitis, ophthalmoscopy, cotton wool spots, hemorrhages, optical coherence tomography, diplopia, ophthalmoparesis, ocular complications in patients of the intensive care unit, glaucoma; eye surface; perfusion pressure, Thealoz® Duo
In the past few months, medical practice has changed faster than in the past few decades. This was due to the coronavirus disease (COVID-19) pandemic. Ophthalmic problems are most significant in patients with severe pneumonia. The exact incidence of conjunctivitis in COVID-19 patients ranges from 0.8 to 31.6 %. Optical coherence tomography demonstrated hyperreflective lesions at the level of ganglion cells and inner plexiform layers, more pronounced in the papillomacular bundle of both eyes. Retinal hemorrhages were found in at least one eye in five patients (9.25 %), cotton wool spots were detected in four people (7.4 %), and drusen was observed in six patients (11.1 %). On examination of the fundus, dilated veins were revealed in 15 patients (27.7 %), tortuous vessels — in 7 individuals (12.9 %). The literature reports describe patients who were diagnosed with COVID-19 after the detection of diplopia and ophthalmoparesis. The incidence of ocular complications in patients of the intensive care units in different studies ranges from 3 to 60 %. The most common manifestations are ocular surface diseases, increased intraocular pressure, and disorders of the anterior and posterior segments.
Andersen K.G., Rambaut A., Lipkin W.I. The proximal origin of SARS-CoV-2. Nat Med. 2020. 26(4). 450-452. [PMC free article] [PubMed] [Google Scholar].
Atwater B.I., Wahrenbrock E., Benumof J.L., Mazzei W.J. Pressure on the face while in the prone position: proneview versus prone positioned. Journal of Clinical Anesthesia. 2004. Vol. 16. № 2. Р. 111-116. Publisher Site | Google scholar.
Belser J.A., Rota P.A., Tumpey T.M. Ocular tropism of respiratory viruses. Microbiol. Mol. Biol. Rev. 2013. 77(1). 144-156. [PMC free article] [PubMed] [Google Scholar].
Casagrande M., Fitzek A., Püschel K. et al. Detection of SARS-CoV-2 in human retinal biopsies of deceased COVID-19 patients. Ocul. Immunol. Inflamm. 20. 28(5).
Chen Y., Liu Q., Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. J. Med. Virol. 2020. 92(4). 418-423. [PMC free article] [PubMed] [Google Scholar].
Cheng M.A., Todorov A., Tempelhoff R., McHugh T., Crowder C.M., Lauryssen C. The effect of prone positioning on intraocular pressure in anesthetized patients. Anesthesiology. 2001. Vol. 95. № 6. Р. 1351-1355. Publisher Site | Google scholar.
Danesh-Meyer H.V., McGhee C.N.J. Implications of Coronavirus Disease 2019 for Ophthalmologists. Am. J. Ophthalmol. 2021 Mar. 223. 108-118. Published online 2020 Sep 22. doi: 10.1016/j.ajo.2020.09.027.
Dinkin M., Gao V., Kahan J. et al. COVID-19 presenting with ophthalmoparesis from cranial nerve palsy. Neurology. 2020. Vol. 95. № 5. Р. 221-223. Publisher Site | Google Scholar.
Wu Р., Duan F., Luo C. et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmology. 2020. Vol. 138. № 5. Р. 575-578. Publisher Site | Google Scholar.
Duane T.D. Valsalva hemorrhagic retinopathy. Transactions of the American Ophthalmological Society. 1972. Vol. 70. Р. 298-313. [Google Scholar].
Gelichkhani P., Esmaily M. Addiction to COVID-19 Patient Management; Commentary. Archives of Academic Emergency Medicine. 2020. Vol. 8. Р. e48. [Google Scholar].
Greenwood G. Case report of atypical hemolytic uremic syndrome with retinal arterial and venous occlusion treated with eculizumab. International Medical Case Reports Journal. 2015. Vol. 8. Р. 235-239. Publisher Site | Google Scholar.
Guerin K., Reigner J., Richard J.-C. et al. Stomach Positioning for Severe Acute Respiratory Distress Syndrome. New England Journal of Medicine. 2013. Vol. 368. № 23. P. 2159-2168. Publisher’s site | Google scholar.
Herbert L. Ophthalmology in Anesthesia and Intensive Care. Anesthesia and Intensive Care Medicine. 2004. Vol. 5. № 9. S. 304-307. Publisher’s site | Google scholar.
Hernandez E.V., Mannis M.J. Superficial Keratopathy in Intensive Care Unit Patients. American Journal of Ophthalmology. 1997. Vol. 124. № 2. P. 212-216. Publisher’s site | Google scholar.
Holappa M., Vapaatalo H., Vaajanen A. Many faces of renin-angiotensin system — focus on eye. Open Ophthalmol. J. 2017. 11. 122-142. [PMC free article] [PubMed] [Google Scholar].
Hönemann C., Brandt L. Valsalva retinopathy. A & A Case Reports. 2015. Vol. 5. № 12. Р. 231-233. Publisher Site | Google scholar.
Huang K., Wang Yu, Li X. et al. Clinical Features of 2019 Novel Coronavirus Patients in Wuhan, China. The Lancet. 2020. Vol. 395. № 10223. Р. 497-506. Publisher’s site | Google scholar.
Invernizzia A., Torred A., Parrullia S. et al. Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. EClinicalMedicine. 2020. 27. 100550.
Li W., Sui J., Huang I.-C. The S proteins of human coronavirus NL63 and severe acute respiratory syndrome coronavirus bind overlapping regions of ACE2. Virology. 2007. 367(2). 367-374. [PMC free article] [PubMed] [Google Scholar].
Marinho P.M., Marcos A.A.A., Romano A.C. et al. Retinal findings in patients with COVID-19. Lancet. 2020. 395. 1610.
Mela E.K., Drimtzia E.G., Christofidou M.K., Filos K.S., Anastassiou E.D., Gartaganis S.P. Bacterial colonization of the ocular surface in sedated ICU patients. Anesthesia and intensive. 2010. 38(1). 190-3.
Mercieca F., Suresh P., Morton A., Tullo A. Ocular Surface Disorders in Intensive Care Unit Patients. Eye. 1999. Vol. 13. № 2. P. 231-236. Publisher’s site | Google scholar.
Panchabhai T., Bandyopadhyay D., Kapooret A. еt al. Acute ischemic optic neuropathy with extended ventilation in the supine position in a lung transplant recipient. International Journal of Critical Illness and Trauma. 2016. Vol. 6. № 1. S. 45-47. Publisher’s site | Google Scholar.
Pereira L.A. et al. Retinal findings in hospitalised patients with severe COVID-19. Br. J. Ophthalmol. 2020. 0. 1-4. doi:10.1136/bjophthalmol-2020-31757.
Petsas A., Chapman G., Stewart R. Acute angle closure glaucoma — a potential blind spot in critical care. Journal of the Intensive Care Society. 2017. Vol. 18. № 3. Р. 244-246. Publisher Site | Google scholar.
Rasmussen K.L., Nordestgaard B.G., Nielsen S.F. Complement C3 and risk of diabetic microvascular disease: a cohort study of 95202 individuals from the general population. Clinical Chemistry. 2018. Vol. 64. № 7. Р. 1113-1124. Publisher Site | Google Scholar.
Saritas T.B., Bozkurt B., Simsek B. et al. Ocular Surface Disorders in Intensive Care Patients. Scientific World Journal. 2013. Vol. 2013. Article ID 182038. Publisher’s site | Google scholar.
Sea I., Agrawal R. Can Coronavirus Disease 2019 (COVID-19) Affect Eyes? An overview of coronaviruses and eye effects in humans and animals. Ocular Immunol. Inflammation. 2020. 28(3). 391-395.
Seah I.Y.J., Anderson D.E., Kang A.E.Z. et al. Assessment of viral shedding and infectivity of tears in patients with coronavirus disease 2019 (COVID-19). Ophthalmology. 2020. Vol. 127. № 7. P. 977-979. Publisher’s site | Google scholar.
Singer M.S., Salim S. Bilateral acute angle-closure glaucoma as a complication of facedown spine surgery. The Spine Journal. 2010. Vol. 10. № 9. Р. e7-e9. Publisher Site | Google scholar.
Strain W.D., Chaturvedi N. Review: the renin-angiotensin-aldosterone system and the eye in diabetes. Journal of the Renin-Angiotensin-Aldosterone System. 2002. Vol. 3. № 4. Р. 243-246. Publisher Site | Google Scholar.
Sun Y., Liu L., Pan X. Binding action between SARS-CoV S666 protein and ACE2 receptor in eyes. Rec. Adv. Ophthalmol. 2007. 27(4). 250-253. [Google Scholar].
Guan W.-J., Ni Z.-Y., Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020. Vol. 382. № 18. Р. 1708-1720. Publisher Site | Google Scholar.
Wan Y., Shang J., Graham R. Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS. J. Virol. 2020. 94(7). e00127-e001220. [PMC free article] [PubMed] [Google Scholar].
Wu P., Duan F., Luo C. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020. 138(5). 575-578. [PMC free article] [PubMed] [Google Scholar].
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. 589-94.
Zhang Y., Xia M., Zhang S. et al. Coagulopathy and antiphospholipid antibodies in patients with COVID-19. New England Journal of Medicine. 2020. Vol. 382. № 17. Р. e3-8. Publisher Site | Google Scholar.
Zhou Y., Zeng Y., Tong Y., Chen C. Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva. medRxiv. 2020. doi: 10.1101/2020.02.11.20021956. [CrossRef] [Google Scholar].
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.