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. 2022 Jan;42(1):323-336.
doi: 10.1007/s10792-021-01996-7. Epub 2021 Aug 11.

Retinal manifestations in patients with SARS-CoV-2 infection and pathogenetic implications: a systematic review

Sagnik Sen  1 , Naresh Babu Kannan  2 , Jayant Kumar  2 , Renu P Rajan  2 , Karthik Kumar  2 , Girish Baliga  2 , Harshavardhan Reddy  2 , Anubhav Upadhyay  2 , Kim Ramasamy  2
Affiliations

Retinal manifestations in patients with SARS-CoV-2 infection and pathogenetic implications: a systematic review

Sagnik Sen et al. Int Ophthalmol. 2022 Jan.

Abstract

Introduction: The pandemic of COVID-19 has been caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Apart from respiratory malfunction, COVID-19 causes a system-wide thromboembolic state, leading to serious cardiovascular, cerebrovascular and peripheral vascular manifestations. However, our knowledge regarding retinal manifestations due to systemic COVID-19 is minimal. This systematic review has comprehensively summarized all retinal manifestations secondary to COVID-19 disease recorded till date since the beginning of the pandemic.

Methods: All studies published till November 27, 2020, which have reported retinal manifestations in COVID-19 patients were systematically reviewed using the PRISMA statement.

Results: We included 15 articles: 11 case reports and four cross-sectional case series. The most commonly reported manifestations which did not affect visual acuity were retinal hemorrhages and cotton wool spots. The most common vision threatening manifestation was retinal vein occlusion with associated macular edema. Rarely, patients may also present with retinal arterial occlusions and ocular inflammation. These manifestations may occur from as soon as within a week after the onset of COVID-19 symptoms to more than 6 weeks after.

Conclusion: Mostly causing milder disease, COVID-19 may however lead to severe life-threatening thromboembolic complications, and systemic antithrombotic therapy has been suggested as a prophylactic and therapeutic management strategy for patients affected with serious systemic disease. However, both sick and apparently healthy patients may suffer from various retinal complications which may lead to loss of vision as well. No consensus regarding management of retinal complications with anticoagulants or anti-inflammatory medications have been proposed; however, they may be tackled on individual basis.

Keywords: Artery occlusion; COVID-19; Ophthalmology; Retina; Vasculitis; Vein occlusion.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing the flow of information in this systematic review
See this image and copyright information in PMC

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