Ocular Manifestations in Symptomatic Covid-19 Patients
DOI:
https://doi.org/10.15218/zjms.2025.002Keywords:
COVID-19, Posterior subcapsular cataract, Follicular conjunctivitis, Central serous chorioretinopathyAbstract
Background and objective: As we are in the era of COVID-19 as which is new disease for our communities and we are responsible for what’s new in our ophthalmology world, we want to report the new ocular finding in patients that got the infection and how this affected their vision.
Methods: The study was a hospital based prospective cross-sectional study which included patients with recent COVID-19 infection. The study was conducted in ophthalmology department of Erbil Teaching Hospital in Erbil city from June 2021 till April 2022. The participants were recruited from the outpatient clinic in a non-probability convenience sampling way.
Results: The most common ocular disease encountered in COVID-19 patients was posterior subcapsular cataract. Their ages were between 26->56. The cataract developed in twelve patients and it was bilateral in nine cases (18 eyes) with a varying degree of density. The next most common manifestation was multiple punctate epitheliopathy found in nine patients which was bilateral in all of them. Follicular conjunctivitis was encountered in eight patients; it resolved in a period of 5 to 8 days after the prescription of topical ant-inflammatory medications. Regarding the retina, eight patients had central retinal vein occlusion while branch retinal vein occlusion developed in two patients. Central serous chorioretinopathy developed in three patients and it was unilateral (3 eyes).
Conclusion: COVID-19 infection is a multi-systemic disease can cause a variety of ocular clinical symptoms and complications. Blurred vision and conjunctivitis like features are the most common ocular presentation of the infection.
Metrics
References
COVID-19 background primer for ophthalmologists [Internet]. American Academy of Ophthalmology 2021 [cited 2021]. Available from: https://www.aao.org/headline/covid-19-background-primer-ophthalmologists.
Coronavirus disease (COVID-19) – World Health Organization [Internet]. Who.int 2021 [cited 2021]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention 2021 [cited 2021]. Available from: https://www.cdc.gov/coronavirus/2019-nCoV/index.html.
Bertoli F, Veritti D, Danese C, Samassa F, Sarao V, Rassu Net al. Ocular Findings in COVID-19 Patients: A Review of Direct Manifestations and Indirect Effects on the Eye. J Ophthalmol 2020:4827304. doi: 10.1155/2020/4827304. PMID: 32963819; PMCID: PMC7491448.
Coronavirus (COVID-19). EyeWiki. San Francisco: Grant A. Justin; 2020.
Nalla AK, Casto AM, Huang MW, Perchetti GA, Sampoleo R, Shrestha L, et al. Comparative Performance of SARS-CoV-2 Detection Assays Using Seven Different Primer-Probe Sets and One Assay Kit. J Clin Microbiol. 2020; 58(6):e00557-20. doi: 10.1128/JCM.00557-20. PMID: 32269100; PMCID: PMC7269385
Khanna RC. Coronavirus and ophthalmology: What do we know and way forward. Indian J Ophthalmol. 2020; 68(5):942-4. doi: 10.4103/ijo.IJO_834_20. PMID: 32317500; PMCID: PMC7350497.
Perlman A, VodonosZilberg A, Bak P, Dreyfuss M, Leventer-Roberts M, Vurembrand Y, et al. Characteristics and Symptoms of App Users Seeking COVID-19-Related Digital Health Information and Remote Services: Retrospective Cohort Study. J Med Internet Res. 2020:e23197. doi: 10.2196/23197. PMID: 32961527; PMCID: PMC7609191.
Güemes-Villahoz N, Burgos-Blasco B, García-Feijoó J, Sáenz-Francés F, Arriola-Villalobos P, Martinez-de-la-Casa JM, et al. Conjunctivitis in COVID-19 patients: frequency and clinical presentation. Graefes Arch Clin Exp Ophthalmol. 2020; 258(11):2501-7. doi: 10.1007/s00417-020-04916-0. Epub 2020. PMID: 32860573; PMCID: PMC7455778.
Rokohl AC, Loreck N, Wawer Matos PA, Zwingelberg S, Augustin M, Dewald F.More than loss of taste and smell: burning watering eyes in coronavirus disease 2019. Clin Microbiol Infect 2020:1560.e5-8. doi: 10.1016/j.cmi.2020.08.018. PMID: 32835793; PMCID: PMC7442009.
Abrishami M, Tohidinezhad F, Daneshvar R, Omidtabrizi A, Amini M, Sedaghat A, et al. Ocular Manifestations of Hospitalized Patients with COVID-19 in Northeast of Iran. Ocul Immunol Inflamm. 2020; 28(5):739-44. doi: 10.1080/09273948.2020.1773868. Epub 2020. PMID: 32569494.
Kaur J, Kukreja S, Kaur A, Malhotra N, Kaur R. The oxidative stress in cataract patients. J Clin Diagn Res. 2012; 6(10):1629-32. doi: 10.7860/JCDR/2012/4856.2626. Epub 2012. PMID: 23373015; PMCID: PMC3552191.
D’Amico Ricci G, Del Turco C, Belcastro E. Covid-19 and acute conjunctivitis: Controversial data from a tertiary refferral Italian center. Eur J Ophthalmol. 2021; 31(6):2910-13. doi:10.1177/1120672121991049
Navel V, Chiambaretta F, Dutheil F. Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. Am J Ophthalmol Case Rep. 2020; 19:100735. doi: 10.1016/j.ajoc.2020.100735. PMID: 32377594; PMCID: PMC7201238.
Bostanci Ceran B, Ozates S. Ocular manifestations of coronavirus disease 2019. Graefes Arch Clin Exp Ophthalmol. 2020; 258(9):1959-63. doi: 10.1007/s00417-020-04777-7. Epub 2020. PMID: 32504100; PMCID: PMC7274940.
Öncül H, Öncül FY, Alakus MF, Çağlayan M, Dag U. Ocular findings in patients with coronavirus disease 2019 (COVID-19) in an outbreak hospital. J Med Virol. 2021; 93(2):1126-32. doi: 10.1002/jmv.26412. Epub 2020. PMID: 32776614; PMCID: PMC7436579.
Walinjkar JA, Makhija SC, Sharma HR, Morekar SR, Natarajan S. Central retinal vein occlusion with COVID-19 infection as the presumptive etiology. Indian J Ophthalmol. 2020; 68(11):2572-74. doi: 10.4103/ijo.IJO_2575_20. PMID: 33120696; PMCID: PMC7774137.
Sheth JU, Narayanan R, Goyal J, Goyal V. Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol. 2020; 68(10):2291-93. doi: 10.4103/ijo.IJO_2380_20. PMID: 32971697; PMCID: PMC7727974.
Invernizzi A, Pellegrini M, Messenio D, Cereda M, Olivieri P, Brambilla AM, et al. Impending Central Retinal Vein Occlusion in a Patient with Coronavirus Disease 2019 (COVID-19). Ocul Immunol Inflamm. 2020; 28(8):1290-92. doi: 10.1080/09273948.2020.1807023. Epub 2020. PMID: 32976055.
Gaba WH, Ahmed D, Al Nuaimi RK, Dhanhani AA, Eatamadi H. Bilateral Central Retinal Vein Occlusion in a 40-Year-Old Man with Severe Coronavirus Disease 2019 (COVID-19) Pneumonia. Am J Case Rep. 2020; 21:e927691. doi: 10.12659/AJCR.927691. PMID: 33116072; PMCID: PMC7603800.
Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19. Indian J Ophthalmol. 2021; 69(3):488-509. doi: 10.4103/ijo.IJO_297_21. PMID: 33595463; PMCID: PMC7942063.
Collange O, Tacquard C, Delabranche X, Leonard-Lorant I, Ohana M, Onea M, et al. Coronavirus Disease 2019: Associated Multiple Organ Damage. Open Forum Infect Dis. 2020; 7(7):ofaa249. doi: 10.1093/ofid/ofaa249. PMID: 32661498; PMCID: PMC7336548.
Mazzotta C, Giancipoli E. Anterior Acute Uveitis Report in a SARS-CoV-2 Patient Managed with Adjunctive Topical Antiseptic Prophylaxis Preventing 2019-nCoV Spread Through the Ocular Surface Route. Int Med Case Rep. J 2020; 13:513-20. doi: 10.2147/IMCRJ.S260252. PMID: 33116943; PMCID: PMC7568617.
Providência J, Fonseca C, Henriques F, Proença R. Serpiginous choroiditis presenting after SARS-CoV-2 infection: A new immunological trigger? Eur J Ophthalmol. 2022; 32(1):NP97-NP101. doi: 10.1177/1120672120977817. Epub2020. PMID: 33267645.
Dinkin M, Gao V, Kahan J, Bobker S, Simonetto M, Wechsler P, et al. COVID-19 presenting with ophthalmoparesis from cranial nerve palsy. Neurology. 2020; 95(5):221-23. doi: 10.1212/WNL.0000000000009700. Epub2020 . PMID: 32358218.
Falcone MM, Rong AJ, Salazar H, Redick DW, Falcone S, Cavuoto KM. Acute abducens nerve palsy in a patient with the novel coronavirus disease (COVID-19). J AAPOS. 2020; 24(4):216-17. doi: 10.1016/j.jaapos.2020.06.001. Epub2020 . PMID: 32592761; PMCID: PMC7311910.
Pascual-Goñi E, Fortea J, Martínez-Domeño A, Rabella N, Tecame M, Gómez-Oliva C, et al. COVID-19-associated ophthalmoparesis and hypothalamic involvement. Neurol Neuroimmunol Neuroinflamm. 2020; 7(5):e823. doi: 10.1212/NXI.0000000000000823. PMID: 32587102; PMCID: PMC7357415.
Belghmaidi S, Nassih H, Boutgayout S, El Fakiri K, El Qadiry R, Hajji I, et al. Third Cranial Nerve Palsy Presenting with Unilateral Diplopia and Strabismus in a 24-Year-Old Woman with COVID-19. Am J Case Rep. 2020;21:e925897. doi: 10.12659/AJCR.925897. PMID: 33056942; PMCID: PMC7571280.
Zhou S, Jones-Lopez EC, Soneji DJ, Azevedo CJ, Patel VR. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis and Myelitis in COVID-19. J Neuroophthalmol. 2020; 40(3):398-402. doi: 10.1097/WNO.0000000000001049. PMID: 32604245; PMCID: PMC7382408.
Szczęśniak M, Brydak-Godowska J. SARS-CoV-2 and the Eyes: A Review of the Literature on Transmission, Detection, and Ocular Manifestations. Med Sci Monit. 2021; 27:e931863. doi: 10.12659/MSM.931863.
Turbin RE, Wawrzusin PJ, Sakla NM, Traba CM, Wong KG, Mirani N, et al. Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19. Orbit. 2020; 39(4):305-10. doi: 10.1080/01676830.2020.1768560. Epub 2020. PMID: 32419568.
Shires CB, Klug T, Dryden S, Ford J. Unusual cause of acute sinusitis and orbital abscess in COVID-19 positive patient: Case report. Int J Surg Case Rep. 2021; 79:164-68. doi: 10.1016/j.ijscr.2021.01.043. Epub 2021. PMID: 33477076; PMCID: PMC7815979.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Hussein Ali Ramadhan, Ahmed Kareem Joma, Ahmed Abdulgani, Eman Hussein Alwan (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).
