Ocular Symptoms of SARS-CoV-2: Indication of Possible Ocular Transmission or Viral Shedding

Abstract

The recently identified novel coronavirus (CoV), the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes the coronavirus disease 2019 (COVID-19). While published data about other highly infectious human COVs [that is, the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV)] provide helpful information about the infectivity of SARS-CoV-2, there is limited understanding surrounding knowledge of ocular manifestation of the virus. This paper reviews published data which reveal the presence of SARS-CoV-2 RNA in tears and conjunctival scrappings of some COVID-19 patients by real-time-polymerase chain reaction assay, although the detection rate is low compared to samples from respiratory sites. Nevertheless, the ocular complications from SARS-CoV-2 infection are uncommon. The evidence partly supports the eye as a portal of entry for SARS-CoV-2 to infect respiratory cells or viral shedding from respiratory cells via the nasolacrimal duct unto the ocular surface. The possibility of ocular secretions as source for SARS-CoV-2 to spread externally has substantial public health implications.

Keywords: COVID-19; Coronavirus; infection; ocular surface; shedding; transmission.