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Salvetat, M.L.; Musa, M.; Pellegrini, F.; Salati, C.; Spadea, L.; Zeppieri, M. Ocular Manifestations of COVID-19. Encyclopedia. Available online: https://encyclopedia.pub/entry/48729 (accessed on 11 July 2025).
Salvetat ML, Musa M, Pellegrini F, Salati C, Spadea L, Zeppieri M. Ocular Manifestations of COVID-19. Encyclopedia. Available at: https://encyclopedia.pub/entry/48729. Accessed July 11, 2025.
Salvetat, Maria Letizia, Mutali Musa, Francesco Pellegrini, Carlo Salati, Leopoldo Spadea, Marco Zeppieri. "Ocular Manifestations of COVID-19" Encyclopedia, https://encyclopedia.pub/entry/48729 (accessed July 11, 2025).
Salvetat, M.L., Musa, M., Pellegrini, F., Salati, C., Spadea, L., & Zeppieri, M. (2023, September 01). Ocular Manifestations of COVID-19. In Encyclopedia. https://encyclopedia.pub/entry/48729
Salvetat, Maria Letizia, et al. "Ocular Manifestations of COVID-19." Encyclopedia. Web. 01 September, 2023.
Ocular Manifestations of COVID-19
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This entry is adapted from the peer-reviewed paper 10.3390/microorganisms11092220

Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. 

pandemic COVID-19 SARS-CoV-2 lockdown ophthalmology

1. Introduction

The SARS-CoV-2 is a new type of Coronavirus, first detected at the end of 2019 in China, which was responsible for the COVID-19 pandemic. The COVID-19 pandemic caused by the SARS-CoV-2 virus has had a profound impact on all aspects of healthcare, including ophthalmology. As a highly infectious disease, COVID-19 has led to significant changes in the way ophthalmic care is provided, with an increased focus on infection control measures and minimizing patient contact. In addition, COVID-19 has also been found to have ophthalmic manifestations [1]. These include conjunctivitis, uveitis, retinal abnormalities, and other ocular manifestations [2][3]. Understanding the impact of COVID-19 on ophthalmology is crucial in providing safe and effective care to patients during this challenging time.

Coronaviruses are a large family of viruses that can cause illness in animals and humans [4]. They are named for their crown-like spikes on their surface. Coronaviruses can cause a range of illnesses, from the common cold to more severe diseases such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 [5][6]. Coronaviruses are spread mainly through respiratory droplets when an infected person coughs, sneezes, talks, or breathes [7]. They can also be spread by touching a surface contaminated with the virus and then touching your mouth, nose, or eyes [8].

2. Ocular manifestations of COVID-19

There have been a limited number of reports on the ocular manifestations of COVID-19, and more research is needed to fully understand the relationship between the virus and the eyes. However, some examples of the reported ocular manifestations include the following:

Conjunctivitis and other inflammations of eyes’ outer layers: Considering all cases of COVID-19 disease, conjunctivitis was reported in 5-9% of cases, episcleritis in 2.2% of cases, keratitis in 0.5% of cases, and blepharitis or lid margin hyperemia in 5% of cases. Concerning the physiological mechanisms that occur during infection, these COVID-19-related ocular manifestations have been suggested to result from a direct impact of the virus on ocular tissues [9][10]. One study found that conjunctivitis was present in 1.1% of hospitalized COVID-19 patients [11][40]. Another study found that conjunctivitis was present in 3.6% of COVID-19 patients in China [12].

Epiphora (excessive tearing): A case report described a patient with COVID-19 who experienced epiphora in one eye, which resolved after treatment with antiviral medication. Another study by Scalinci and Trovato described epiphora as a manifestation of conjunctivitis in COVID-19 patients [13].

Dry Eye: Dry eye disease was reported in high rates among subjects affected by COVID-19 disease. School-based research revealed a preponderance of dry eye as measured with a validated paper-based instrument [14]. Female gender and being of an older age were indicated as exacerbating risk factors [15]. A theoretical explanation was proffered to be the increased screen time during the pandemic period. Diskmetas et al. also showed a correlation between mask use and reduced tear break-up time during the heat of the pandemic [16]. Researchers suggested that dry eye in itself was an epidemic during the COVID-19 pandemic [17].

Eye pain: COVID-19 sufferers may experience eye discomfort as a dull aching, soreness, or a sense of pressure. It is thought to be caused by viral infection-induced inflammation of the conjunctiva (conjunctivitis) or other ocular tissues. Several research and case reports have established the existence of ocular discomfort in COVID-19 instances. For example, Wu et al. discovered that roughly 12% of COVID-19 patients exhibited ocular symptoms such as eye discomfort [11]. Also, a case report described a patient with COVID-19 who experienced eye pain, which was relieved with topical steroids [18]. These findings imply that eye discomfort may be an additional manifestation of COVID-19, emphasizing the necessity of evaluating ocular symptoms in the disease’s diagnosis and therapy. More study is needed to thoroughly understand the underlying causes and incidence of ocular discomfort in COVID-19 individuals.

Photophobia: A few case reports have described COVID-19 patients who experienced photophobia [11][13].

Retinal changes: Retinal ganglion cells and plexiform layers were shown to have characteristic lesions when analyzed by ocular coherence tomography in a Brazilian study of 11 COVID-19 patients [19]. These findings mirrored animal model studies that reported similar changes [20].

It is worth noting that these ocular manifestations are relatively rare, and COVID-19 primarily affects the respiratory system. In most cases, the ocular symptoms linked to COVID-19 in children tend to have a mild course, and complete visual recovery is typical [21]. However, healthcare professionals should be aware of the potential ocular manifestations of the virus, particularly in patients who present with eye symptoms and have a history of exposure to COVID-19.

3. Confirmed ocular diseases in COVID-19

Dry eye diseases are the most common reported ocular complications of COVID-19 [22]. Krolo et al. reported that face mask use was related to higher ocular surface disease index (OSDI) scores [15]. Other possible reasons may include increased screen time occasioned by working from home and inability to obtained needed dry eye medications due to the lockdown [23].

Children with COVID-19 have been reported to present with a largely self-limiting vasculopathy akin to the Kawasaki disease [24]. The pathological and clinical manifestations of this disease include conjunctivitis, keratitis, intermediate uveitis, and inflammation of the optic nerve head.

Reyes-Bueno et al. detailed the post-COVID-19 Miller Fisher syndrome (MFS) reported in some patients which included complaints of blurred vision and extra-ocular muscle palsy [25]. Neophytou et al. published a systematic review of this syndrome in COVID-19 patients with a conclusion that the condition occurred more frequently after infection as compared to after vaccination [26]. The prognosis of MFS is spontaneous and very good even without administering intravenous immunoglobulin [26].

Generally, viral diseases are directly linked to reduction in CD4+ and CD8+ counts. This in turn has been implicated in the incidence and reoccurrence of diseases such as her-pes-zoster ophthalmicus, infection induced uveitis and infective cellulitis [27].

References

  1. Sen, M.; Honavar, S. G.; Sharma, N.; Sachdev, M. S., COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19. Indian J Ophthalmol 2021, 69 (3), 488-509.
  2. Gregorczyk, M.; Roskal-Walek, J., [Ocular symptoms in SARS-CoV-2 infection]. Pol Merkur Lekarski 2022, 50 (296), 86-93.
  3. Kumar, K. K.; Sampritha, U. C.; Prakash, A. A.; Adappa, K.; Chandraprabha, S.; Neeraja, T. G.; Guru Prasad, N. S.; Basumatary, J.; Gangasagara, S. B.; Sujatha Rathod, B. L.; Jayanthi, C. R., Ophthalmic manifestations in the COVID-19 clinical spectrum. Indian J Ophthalmol 2021, 69 (3), 691-694.
  4. Cascella, M.; Rajnik, M.; Aleem, A.; Dulebohn, S. C.; Di Napoli, R., Features, Evaluation, and Treatment of Coronavirus (COVID-19). In StatPearls, Treasure Island (FL). 2023.
  5. Coerdt, K. M.; Khachemoune, A., Corona viruses: reaching far beyond the common cold. Afr Health Sci 2021, 21 (1), 207-213.
  6. Chathappady House, N. N.; Palissery, S.; Sebastian, H., Corona Viruses: A Review on SARS, MERS and COVID-19. Microbiol Insights 2021, 14, 11786361211002481.
  7. Lotfi, M.; Hamblin, M. R.; Rezaei, N., COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta 2020, 508, 254-266.
  8. Dawood, A. A., Transmission of SARS CoV-2 virus through the ocular mucosa worth taking precautions. Vacunas 2021, 22 (1), 56-57.
  9. Baj, J.; Forma, A.; Teresinska, B.; Tyczynska, M.; Zembala, J.; Januszewski, J.; Flieger, J.; Buszewicz, G.; Teresinski, G., How Does SARS-CoV-2 Affect Our Eyes-What Have We Learnt So Far about the Ophthalmic Manifestations of COVID-19? J Clin Med 2022, 11 (12).
  10. Sen, M.; Honavar, S. G., After the Storm: Ophthalmic Manifestations of COVID-19 Vaccines. Indian J Ophthalmol 2021, 69 (12), 3398-3420.
  11. Wu, P.; Duan, F.; Luo, C.; Liu, Q.; Qu, X.; Liang, L.; Wu, K., Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol 2020, 138 (5), 575-578.
  12. Xia, J.; Tong, J.; Liu, M.; Shen, Y.; Guo, D., Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 2020, 92 (6), 589-594.
  13. Scalinci, S. Z.; Trovato Battagliola, E., Conjunctivitis can be the only presenting sign and symptom of COVID-19. IDCases 2020, 20, e00774.
  14. Tonkerdmongkol, D.; Poyomtip, T.; Poolsanam, C.; Watcharapalakorn, A.; Tawonkasiwattanakun, P., Prevalence and associated factors for self-reported symptoms of dry eye among Thai school children during the COVID-19 outbreak. PLoS One 2023, 18 (4), e0284928.
  15. Krolo, I.; Blazeka, M.; Merdzo, I.; Vrtar, I.; Sabol, I.; Petric-Vickovic, I., Mask-Associated Dry Eye During COVID-19 Pandemic-How Face Masks Contribute to Dry Eye Disease Symptoms. Med Arch 2021, 75 (2), 144-148.
  16. Dikmetas, O.; Tellioglu, H. T.; Ozturan, I.; Kocabeyoglu, S.; Cankaya, A. B.; Irkec, M., The Effect of Mask Use on the Ocular Surface During the COVID-19 Pandemic. Turk J Ophthalmol 2023, 53 (2), 74-78.
  17. Pandey, S. K.; Sharma, V., Mask-associated dry eye disease and dry eye due to prolonged screen time: Are we heading towards a new dry eye epidemic during the COVID-19 era? Indian J Ophthalmol 2021, 69 (2), 448-449.
  18. Cheema, M.; Aghazadeh, H.; Nazarali, S.; Ting, A.; Hodges, J.; McFarlane, A.; Kanji, J. N.; Zelyas, N.; Damji, K. F.; Solarte, C., Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19). Can J Ophthalmol 2020, 55 (4), e125-e129.
  19. Marinho, P. M.; Marcos, A. A. A.; Romano, A. C.; Nascimento, H.; Belfort, R., Jr., Retinal findings in patients with COVID-19. Lancet 2020, 395 (10237), 1610.
  20. Wang, Y.; Detrick, B.; Yu, Z. X.; Zhang, J.; Chesky, L.; Hooks, J. J., The role of apoptosis within the retina of coronavirus-infected mice. Invest Ophthalmol Vis Sci 2000, 41 (10), 3011-8.
  21. Alnahdi, M. A.; Alkharashi, M., Ocular manifestations of COVID-19 in the pediatric age group. Eur J Ophthalmol 2023, 33 (1), 21-28.
  22. Tatti, F.; Mangoni, L.; Pirodda, S.; Demarinis, G.; Iovino, C.; Siotto Pintor, E.; Orru, G.; Lecca, L. I.; Campagna, M.; Denotti, G.; Peiretti, E., Ocular Surface Changes Associated with Face Masks in Healthcare Personnel during COVID-19 Pandemic. Life (Basel) 2022, 12 (10).
  23. Subathra, G. N.; Rajendrababu, S. R.; Senthilkumar, V. A.; Mani, I.; Udayakumar, B., Impact of COVID-19 on follow-up and medication adherence in patients with glaucoma in a tertiary eye care centre in south India. Indian J Ophthalmol 2021, 69 (5), 1264-1270.
  24. Ramakers, J.; Verd, S.; Diez, R., COVID-19-associated risk in children who were never breastfed. Acta Paediatr 2023, 112 (9), 2013-2014.Przekwas, A.; Chen, Z., Washing hands and the face may reduce COVID-19 infection. Med Hypotheses 2020, 144, 110261.
  25. Reyes-Bueno, J. A.; Garcia-Trujillo, L.; Urbaneja, P.; Ciano-Petersen, N. L.; Postigo-Pozo, M. J.; Martinez-Tomas, C.; Serrano-Castro, P. J., Miller-Fisher syndrome after SARS-CoV-2 infection. Eur J Neurol 2020, 27 (9), 1759-1761.
  26. Neophytou, P.; Artemiadis, A.; Hadjigeorgiou, G. M.; Zis, P., Miller Fischer syndrome after COVID-19 infection and vaccine: a systematic review. Acta Neurol Belg 2023.
  27. Eleiwa, T.; Abdelrahman, S. N.; ElSheikh, R. H.; Elhusseiny, A. M., Orbital inflammatory disease associated with COVID-19 infection. J AAPOS 2021, 25 (4), 232-234.
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Subjects: Ophthalmology
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Maria Letizia Salvetat
,
Mutali Musa
,
Francesco Pellegrini
,
Carlo Salati
,
Leopoldo Spadea
,
Marco Zeppieri
View Times: 470
Revisions: 2 times (View History)
Update Date: 01 Sep 2023
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