Skip to main content
Top
Published in: Journal of Ophthalmic Inflammation and Infection 1/2020

Open Access 01-12-2020 | Conjunctivitis | Review

COVID-19 and ocular implications: an update

Authors: Raffaele Nuzzi, Luigi Ludovico Carucci, Flavia Tripoli

Published in: Journal of Ophthalmic Inflammation and Infection | Issue 1/2020

Login to get access

Abstract

Background

COronaVIrus Disease 19 (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. The purpose of this review is to highlight the possible ocular presentation of COVID-19 infection and the consequence of the pandemic in the daily ophthalmology routine. A total of 9 articles was included by searching PubMed database for articles published between December 2019 and April 2020.

Main body

Conjunctivitis (and keratoconjunctivitis) can be the first symptom in infected patients. The virus can be present in tear and conjunctival secretions, requiring maximum attention. It’s important to understand if COVID-19 could spread through the ocular route or present as the primary infected site.
Ocular implications should also be considered for therapy. In fact, one potential treatment is chloroquine and its derivatives, including hydroxychloroquine. Hydroxychloroquine, in fact, can induced retinal toxicity.
The exponential increase in lthe number of Covid-19 cases was like a tsunami for health care companies, which were not ready to face this emergency. Ophthalmology departments were also affected by the reorganization of healthcare services.

Conclusion

The studies analaysed have some limitations. First, the sample size and the covered population consisted mainly of patients with mild disease. Moreover, the studies are often descriptive study, without a correlation analysis.
Finally, no normal population was observed in the studies, so a normal control group should be included for comparison in future studies.
With the evolving COVID-19 pandemic and with its high infectivity, it is necessary to rearrange ophthalmologist routine clinical practice in order to control viral spread and try to maximize patient and health-care provider’s safety.
Literature
1.
go back to reference Lu H, Stratton C, Tang Y (2020) Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol 92:401–402CrossRef Lu H, Stratton C, Tang Y (2020) Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol 92:401–402CrossRef
2.
go back to reference Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506CrossRef Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506CrossRef
3.
go back to reference Xu X, Chen P, Wang J et al (2020) Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 63(3):457–460CrossRef Xu X, Chen P, Wang J et al (2020) Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 63(3):457–460CrossRef
4.
go back to reference Zhou P, Yang X-L, Wang X-G et al (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579:270–273CrossRef Zhou P, Yang X-L, Wang X-G et al (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579:270–273CrossRef
5.
go back to reference Senanayake PS, Drazba J, Shadrach K et al (2007) Angiotensin II and its receptor subtypes in the human retina. Invest Ophthalmol Vis Sci 48:3301–3311CrossRef Senanayake PS, Drazba J, Shadrach K et al (2007) Angiotensin II and its receptor subtypes in the human retina. Invest Ophthalmol Vis Sci 48:3301–3311CrossRef
6.
go back to reference Wagner J, Jan Danser AH, Derkx FH et al (1996) Demonstration of renin mRNA, angiotensinogen mRNA, and angiotensin converting enzyme mRNA expression in the human eye: evidence for an intraocular renin-angiotensin system. Br J Ophthalmol 80:159–163CrossRef Wagner J, Jan Danser AH, Derkx FH et al (1996) Demonstration of renin mRNA, angiotensinogen mRNA, and angiotensin converting enzyme mRNA expression in the human eye: evidence for an intraocular renin-angiotensin system. Br J Ophthalmol 80:159–163CrossRef
7.
go back to reference Yan Sun LL, Pan X, Jing M (2006) Mechanism of the action between the SARS-CoV S240 protein and the ACE2 receptor in eyes. J Virol 6:783–786 Yan Sun LL, Pan X, Jing M (2006) Mechanism of the action between the SARS-CoV S240 protein and the ACE2 receptor in eyes. J Virol 6:783–786
11.
go back to reference Cheema M, Aghazadeh H, Nazarali S, Ting A, Hodges J, McFarlane A, Kanji JN, Zelyas N, Damji KF, Solarte C (2020) Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19). Can J Ophthalmol 55:e125–e129CrossRef Cheema M, Aghazadeh H, Nazarali S, Ting A, Hodges J, McFarlane A, Kanji JN, Zelyas N, Damji KF, Solarte C (2020) Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19). Can J Ophthalmol 55:e125–e129CrossRef
12.
go back to reference Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, Xin N, Huang Z, Liu L, Zhang G, Wang J (2020) Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 104:748–751CrossRef Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, Xin N, Huang Z, Liu L, Zhang G, Wang J (2020) Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 104:748–751CrossRef
13.
go back to reference Sun X, Zhang X, Chen X, Chen L, Deng C, Zou X, et al (2020) The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study. MedRxIV. Sun X, Zhang X, Chen X, Chen L, Deng C, Zou X, et al (2020) The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study. MedRxIV.
14.
go back to reference Memish ZA, Al-Tawfiq JA, Makhdoom HQ et al (2014) Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome. J Infect Dis 210(10):1590–1594CrossRef Memish ZA, Al-Tawfiq JA, Makhdoom HQ et al (2014) Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome. J Infect Dis 210(10):1590–1594CrossRef
15.
go back to reference de Wit E, Rasmussen AL, Falzarano D et al (2013) Middle East respiratory syndrome coronavirus (MERS-CoV) causes transient lower respiratory tract infection in rhesus macaques. Proc Natl Acad Sci U S A 110(41):16598–16603CrossRef de Wit E, Rasmussen AL, Falzarano D et al (2013) Middle East respiratory syndrome coronavirus (MERS-CoV) causes transient lower respiratory tract infection in rhesus macaques. Proc Natl Acad Sci U S A 110(41):16598–16603CrossRef
16.
go back to reference Xia J, Tong J, Liu M, Shen Y, Guo D (2020) Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 92:589–597CrossRef Xia J, Tong J, Liu M, Shen Y, Guo D (2020) Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 92:589–597CrossRef
17.
go back to reference Wu D, Wu T, Liu Q, Yang Z (2020) The SARS-CoV-2 outbreak: what we know. Int J Infect Dis 94:44–48CrossRef Wu D, Wu T, Liu Q, Yang Z (2020) The SARS-CoV-2 outbreak: what we know. Int J Infect Dis 94:44–48CrossRef
19.
go back to reference Fonn D, Jones L (2019) Hand hygiene is linked to microbial keratitis and corneal in- flammatory events. Cont Lens Anterior Eye 42(2):132–135CrossRef Fonn D, Jones L (2019) Hand hygiene is linked to microbial keratitis and corneal in- flammatory events. Cont Lens Anterior Eye 42(2):132–135CrossRef
21.
go back to reference Jun I, Anderson DE, Kang AE, Wang L-F, Rao P, Young BE, Lye DC, Agrawal R (2020) Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients. Ophthalmology 127:977–979CrossRef Jun I, Anderson DE, Kang AE, Wang L-F, Rao P, Young BE, Lye DC, Agrawal R (2020) Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients. Ophthalmology 127:977–979CrossRef
22.
go back to reference Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS, C (2020) China Medical Treatment Expert Group for, Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 382(18):1708–1720CrossRef Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS, C (2020) China Medical Treatment Expert Group for, Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 382(18):1708–1720CrossRef
23.
go back to reference Kampf G, Todt D, Pfaender S, Steinmann E (2020) Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 104(3):246–251CrossRef Kampf G, Todt D, Pfaender S, Steinmann E (2020) Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 104(3):246–251CrossRef
24.
go back to reference Sarma P et al (2020) Virological and clinical cure in Covid-19 patients treated with Hydroxychloroquine: a systematic review and meta-analysis. J Med Virol 92:776–785CrossRef Sarma P et al (2020) Virological and clinical cure in Covid-19 patients treated with Hydroxychloroquine: a systematic review and meta-analysis. J Med Virol 92:776–785CrossRef
25.
go back to reference Sturrock BR, Chevassut TJ (2020) Chloroquine and COVID-19 - a potential game changer? Clin Med (Lond) 20(3):278–281CrossRef Sturrock BR, Chevassut TJ (2020) Chloroquine and COVID-19 - a potential game changer? Clin Med (Lond) 20(3):278–281CrossRef
26.
go back to reference Carter KL, Do DV (2020) Hydroxychloroquine-induced retinal toxicity. J Rheumatol 47(4):632CrossRef Carter KL, Do DV (2020) Hydroxychloroquine-induced retinal toxicity. J Rheumatol 47(4):632CrossRef
27.
go back to reference Marmor M, Kellner U, Lai TY, Melles RB, Mieler WF (2016) Recommendations on screening for chloroquine and hydroxy-chloroquine retinopathy (2016 revision). Ophthalmology 123(6):1386–1394CrossRef Marmor M, Kellner U, Lai TY, Melles RB, Mieler WF (2016) Recommendations on screening for chloroquine and hydroxy-chloroquine retinopathy (2016 revision). Ophthalmology 123(6):1386–1394CrossRef
28.
go back to reference Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L et al (2020) Hydroxychloroquine and azithromycin as a treatment ofCOVID-19: results of anopen-label non-randomized clinicaltrial. Int J Antimicrob Agents 20:105949CrossRef Gautret P, Lagier J-C, Parola P, Hoang VT, Meddeb L et al (2020) Hydroxychloroquine and azithromycin as a treatment ofCOVID-19: results of anopen-label non-randomized clinicaltrial. Int J Antimicrob Agents 20:105949CrossRef
29.
30.
go back to reference Field MJ (1997) Telecommunications in health care, vol 1, p 1997 Field MJ (1997) Telecommunications in health care, vol 1, p 1997
32.
go back to reference CDC. COVID-19: resources for households, 2020 CDC. COVID-19: resources for households, 2020
33.
go back to reference Jeffrey M, Liebmann MD (2020) Ophthalmology and Glaucoma practice in the COVID-19 era. J Glaucoma 29:407–408CrossRef Jeffrey M, Liebmann MD (2020) Ophthalmology and Glaucoma practice in the COVID-19 era. J Glaucoma 29:407–408CrossRef
Metadata
Title
COVID-19 and ocular implications: an update
Authors
Raffaele Nuzzi
Luigi Ludovico Carucci
Flavia Tripoli
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Journal of Ophthalmic Inflammation and Infection / Issue 1/2020
Electronic ISSN: 1869-5760
DOI
https://doi.org/10.1186/s12348-020-00212-4

Other articles of this Issue 1/2020

Journal of Ophthalmic Inflammation and Infection 1/2020 Go to the issue