COVID-19: Ophthalmological Aspects of the SARS-CoV 2 Global Pandemic

Abstract

Purpose: To perform a systematic analysis of articles on the ophthalmological implications of the global COVID-19 pandemic.

Methods: PubMed.gov was searched for relevant articles using the keywords "COVID-19", "coronavirus", and "SARS-CoV-2" in conjunction with "ophthalmology" and "eye". Moreover, official recommendations of ophthalmological societies were systematically reviewed, with a focus on the American Academy of Ophthalmology (AAO) and the Royal College of Ophthalmologists (RCOphth).

Results: As of April 16, 2020, in total, 21 peer-reviewed articles on the ophthalmological aspects of COVID-19 were identified. Of these, 12 (57.1%) were from Asia, 6 (28.6%) from the United States of America, and 3 (14.3%) from Europe. There were 5 (23.8%) original studies, 10 (47.6%) letters, 3 (14.2%) case reports, and 3 (14.2%) reviews. These articles could be classified into the topics "Modes and prevention of (ocular) transmission", "Ophthalmological manifestations of COVID-19", "Clinical guidance concerning ophthalmological practice during the COVID-19 pandemic", and "Practical recommendations for clinical infrastructure". Practical recommendations could be extracted from official statements of the AAO and the RCOphth.

Conclusion: Within a short period, a growing body of articles has started to elucidate the ophthalmological implications of COVID-19. As the eye can represent a route of infection (actively via tears and passively via the nasoacrimal duct), ophthalmological care has to undergo substantial modifications during this pandemic. In the eye, COVID-19 can manifest as keratoconjunctivitis.

Fig. 1

Implementation of triage during the COVID-19 pandemic in the University Eye Clinic Munich, Ludwig Maximilians University, Germany. a  Triage at the main entrance of the clinic is essential to directly isolate patients showing symptoms of COVID-19, and to evaluate the urgency of the requested ophthalmological consultation, especially in patients presenting without a prior appointment. All patients are provided with surgical masks. b  Non-contact thermometers can be implemented to screen for (largely) asymptomatic patients who, however, present with fever. c  Custom cabins limiting direct health care worker/patient interaction can be constructed to reduce contagion. Since implementing these measures in the beginning of March, no case of patient-personnel-related COVID-19 transmission was documented as of April 16, 2020.

Abb. 1

Triageeinsatz an der Augenklinik der LMU, Universitätsklinikum München, während der COVID-19-Pandemie. a  Die Durchführung einer Triage am Haupteingang der Klinik ist essenziell, um Patienten mit COVID-19-Symptomen sofort zu isolieren sowie die Dringlichkeit der gewünschten augenheilkundlichen Konsultation zu beurteilen, besonders bei Patienten, die ohne vorherigen Termin vorstellig werden. Alle Patienten erhalten eine OP-Maske. b  Ein berührungsloses Temperaturmessgerät wird eingesetzt, um diejenigen Patienten aufzuspüren, die zwar (weitgehend) asymptomatisch sind, aber dennoch Fieber haben. c  Es wurden passgenaue Kabinen aufgestellt, um den direkten Kontakt zwischen Pflegepersonal und Patienten zu minimieren und die Ansteckungsgefahr zu reduzieren. Nachdem diese Maßnahmen Anfang März umgesetzt wurden, gab es bis zum 16. April 2020 keinen Fall von COVID-19-Übertragung zwischen Patienten und medizinischem Fachpersonal.