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Meta-Analysis
. 2020 Nov 5;15(11):e0241661.
doi: 10.1371/journal.pone.0241661. eCollection 2020.

Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Kanika Aggarwal  1 , Aniruddha Agarwal  1 , Nishant Jaiswal  2 , Neha Dahiya  3 , Alka Ahuja  1 , Sarakshi Mahajan  3 , Louis Tong  4   5   6   7 , Mona Duggal  1 , Meenu Singh  2 , Rupesh Agrawal  4   5   8   9 , Vishali Gupta  1
Affiliations
Meta-Analysis

Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Kanika Aggarwal et al. PLoS One. .

Abstract

Purpose: This study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: A systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible.

Results: A total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens in 3.5% patients.

Conclusion: The most common reported ocular presentations of COVID-19 included ocular pain, redness, discharge, and follicular conjunctivitis. A small proportion of patients had viral RNA in their conjunctival/tear samples. The available studies show significant publication bias and heterogeneity. Prospective studies with methodical collection and data reporting are needed for evaluation of ocular involvement in COVID-19.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The PRISMA flow chart is represented in Fig 1.
Fig 2
Fig 2. Forest plot showing the proportion of ocular symptoms reported from cross-sectional studies on COVID-19 patients.
Fig 3
Fig 3. Forest plot showing subgroup analysis for various ocular symptoms amongst patients of COVID-19 who had ocular manifestations.
Fig 4
Fig 4. Forest plot showing the proportion of patients who had ocular manifestations as the first symptom of COVID-19.
Fig 5
Fig 5. Forest plot showing the proportion of COVID-19 patients with ocular manifestations who had severe or mild to moderate pneumonia.
Fig 6
Fig 6. Forest plot showing the proportion of COVID-19 patients who had positive reverse transcriptase polymerase chain reaction (RT-PCR) from conjunctival/tear samples.
Fig 7
Fig 7. Inverse funnel plot showing the publication bias of the cross-sectional studies included in the meta-analysis.
Fig 8
Fig 8. Egger’s linear regression showed a significant publication bias in the meta-analysis.
Fig 9
Fig 9. Galbraith plot showing heterogeneity of the cross-sectional studies included in the meta-analysis.
See this image and copyright information in PMC

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