Ophthalmic Complications of COVID-19

Introduction:

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early reports of COVID-19 patients experiencing eye redness and irritation suggested conjunctivitis as an ocular sign of SARS-CoV-2 infection. Individuals react differently to COVID-19 infections. Some individuals have minor to severe respiratory issues, while others show no apparent signs. Pink eye is the most common COVID indicator in both children and adults. Doctors are still studying the effects of COVID-19 on the eyes. However, some of the COVID-19 carriers have extensive body inflammation. Blood clots may occur as a result of this inflammation. These clots may pass through the eye's veins, arteries, and blood vessels.

How Does It Spread?

There is not much evidence of ocular transmission. The respiratory tract and other bodily cavities and organs are lined with mucous membranes, making them particularly vulnerable to viruses, including the new coronavirus. Infection occurs through the contaminated droplets that come into contact with the eye. According to reports, conjunctival aerosol contact may be a potential means of transmission for SARS-CoV-2. Respiratory droplets are the main mode of COVID-19 transmission, spreading from person to person. Although the risk of infection is typically low, touching the mouth, nose, or eyes after contact with an infected surface can still spread the virus for up to several days.

What Are the Ophthalmic Complications of COVID-19?

Some common ophthalmic complications of COVID-19 are:

• Conjunctivitis: Patients with SARS-CoV-2 infection may exhibit signs of acute conjunctivitis, such as edema, congestion, chemosis, tears, foreign body sensation, ocular irritation, and redness of the eyes and lids. These symptoms have been more common in people with severe COVID-19 systemic symptoms. People affected by mild follicular conjunctivitis exhibit symptoms such as mild eyelid edema, watery discharge, follicular reaction of the palpebral conjunctiva, and unilateral or bilateral bulbar conjunctival injection.

• Optic Neuritis: Some infected individuals have acquired optic neuritis and presented with anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies along with neuromyelitis optica spectrum illness. Patients showed signs of subacute vision loss, optic disc edema, a relative afferent pupillary deficit, pain with eye movements, and acute optic neuritis on radiographs after contracting COVID-19. Also, cases of acute optic neuritis after the COVID-19 vaccination have been reported.

• Newborns: The most prevalent ocular symptom seen in infants was periorbital edema (100 percent), which was followed by ciliary injection (53 percent), hemorrhagic conjunctivitis (73 percent), and chemosis. Also, infants are affected by posterior segment symptoms (20 percent), including retinopathy of prematurity, corneal edema (40 percent), rubeosis, and posterior synechiae.

• Covid’s Effects on the Retina: According to the latest research, most COVID-19 carriers do not appear to have visual impairments. However, the severity of those issues can vary, posing a hazard to vision. The retina is a layer of cells at the back of the eye essential for vision. These are the most prevalent ocular conditions that arise during COVID-19 infection.

• Cotton Wool Spots: Blood clots block the nutrients to the retina and cause the retinal tissue to swell and die. This area appears white and fluffy, similar to cotton wool, in examination with optical coherence tomography. These patches do not impair a person's vision.

• Retinal Artery Blockage, or Eye Stroke: Retinal artery blood clots can obstruct oxygen delivery, leading to the death of retinal cell tissue. This is referred to as an eye stroke or retinal artery occlusion. Sudden and painless loss of vision is the most prevalent sign of an eye stroke.

• Retinal Vein Occlusion: The blocked retinal vein leads to the accumulation of blood. Increased intraocular pressure from blood accumulation can result in hemorrhaging, edema, and fluid leaks. People suffering from this condition may experience blurred vision or permanent blindness.

• Retinal Hemorrhage: This happens when the retinal blood vessels begin to hemorrhage. It can be a result of a retinal vein blockage. Bleeding may result in blind spots and sudden or progressive vision loss.

What Is the Diagnosis for Ophthalmic Complications of COVID-19?

A detailed history is required to determine the symptoms' onset, duration, and features. A bedside or slit light examination of the anterior segment can verify conjunctivitis or episcleritis findings. A dilated fundus examination, intraocular pressure, and visual acuity measurement are necessary to rule out more serious eye conditions. The physician should assess patients for signs of optic neuropathy by carefully examining their pupils and doing a color test. An examination of extraocular motility could indicate cerebral neuropathies or nystagmus. Visual field testing is useful in identifying stroke-related impairments.

RT-PCR could identify SARS-CoV-2. It involves sweeping the lower eyelid fornicities with a viral sample swab to collect conjunctival secretions and tears. Neuroimaging can be useful for individuals with visual field impairments, optic neuritis, cranial neuropathies, or other neurologic complaints. It is important to ask all patients about their fever, travel history, exposure history, and respiratory symptoms to determine the need for additional COVID-19 testing.

What Is the Treatment for Ophthalmic Complications of COVID-19?

Eye care professionals should know the need to lower the potential viral load and spread. Ribavirin eye drops can be administered for COVID-19 conjunctivitis symptoms. Many patients can use cold compresses, lubricating ophthalmic ointment, and preservative-free artificial tears as a remote management strategy. A brief course of topical antibiotics can be used to treat bacterial superinfection.

What Are the Prevention Strategies?

The use of prevention techniques is essential to preventing the spread of illness. Apart from maintaining physical distance and cleaning their hands properly, patients should modify their behavior to minimize touching their eyes and face directly.

• Avoiding the use of contact lenses throughout the epidemic.

• Avoiding the application of cosmetics.

• Wearing sunglasses and eyeglasses.

• Replacing towels, pillows, and sheets regularly.

Conclusion:

The best methods to reduce transmissions are masking physical distancing, and hand hygiene practices. Consult a healthcare physician in case of experiencing COVID-19 symptoms. Please see an eye care professional in case of experience pain or irritation in the eyes or have trouble vision.