Unfolding COVID-19: Lessons-in-Learning in Ophthalmology

Area of Science:

• Ophthalmology
• Infectious Diseases
• Virology

Background:

• Ocular manifestations may be an initial presenting feature of COVID-19.
• The potential for SARS-CoV-2 transmission through ocular secretions requires further investigation.
• Understanding the pathogenesis of COVID-19-associated conjunctivitis is crucial.

Purpose of the Study:

• To conduct a scoping review of literature on ocular manifestations of SARS-CoV-2 infection.
• To identify gaps in current knowledge regarding COVID-19 and eye involvement.
• To propose a hypothesis on the etiopathogenesis of ocular involvement based on ACE2 receptor expression.

Main Methods:

• Scoping review of English language articles (December 2019 - April 2020).
• Inclusion of published and unpublished SARS-CoV-2 related research.
• Summarization of findings using text, tables, diagrams, and flowcharts.

Main Results:

• Follicular conjunctivitis is the most common ocular manifestation of SARS-CoV-2.
• SARS-CoV-2 can infect ocular secretions, with positive RT-PCR results in some cases.
• The ocular surface may act as an entry point for the virus, facilitating respiratory system infection via the lacrimal pathway.
• ACE2 receptor expression on the ocular surface is linked to conjunctivitis pathogenesis.

Conclusions:

• Conjunctivitis, though often mild and potentially unnoticed, can be a presenting symptom of COVID-19.
• The ocular surface may serve as a viral entry gateway, and ocular secretions can contribute to virus shedding.
• Eye care professionals and the public should exercise increased vigilance and implement protective eye measures against SARS-CoV-2.