Ocular Lesions Related to COVID-19 and Its Vaccines

Abstract

Objective: To review COVID-19 infection and COVID-19 vaccine-related ocular lesions.

Methods: We carried out a systematic search in PubMed, Web of Science, Embase, and the Cochrane Library on COVID-19 and ophthalmology and reviewed the incidence, specific manifestations, and risk factors for COVID-19-related eye diseases and the relationship between the detection of COVID-19 in the conjunctiva and tears and eye involvement.

Results: Conjunctivitis was the most common ocular lesion caused by 2019-nCoV infection, followed by uveitis and retinopathy. Conjunctivitis can be the first manifestation of COVID-19 infection and may be clinically related to the severity of pneumonia caused by COVID-19. In particular, conjunctivitis that occurs after pneumonia suggests that the patient has severe systemic disease. COVID-19 infection can cause uveitis, but the infection rate of COVID-19 in patients with uveitis is similar to that of the general population. Patients with uveitis need to reduce the dosage of systemic hormones and discontinue biological agents after being infected with COVID-19. Retinopathy caused by COVID-19 infection is mainly manifested as retinal microvascular disease, and the prognosis is good. SARS-CoV-2 detection in the conjunctiva and tears has high sensitivity and is of great value for disease diagnosis. Eye lesions caused by the COVID-19 vaccine, similar to other vaccines, have a low incidence and a good prognosis.

Conclusion: COVID-19-related ocular lesions are mainly manifested as conjunctivitis, uveitis, and retinal microvascular changes. These diseases are somewhat self-limiting and have a good prognosis.

Keywords: COVID-19; conjunctivitis; eye; retinopathy; uveitis.

Figure 1

Flowchart of the included studies.

Figure 2

Optical coherence tomography of a patient with white cotton wool patches after COVID‐19 infection. A 43‐year‐old male patient had declined vision after a 3‐day infection with COVID‐19. His vision was 0.04 and 0.02 in the right and left eyes, respectively. Fundus pictures showed white cotton wool patches scattered (black arrow) along the vascular arch of both eyes. Optical coherence tomography showed macular edema (yellow arrow), swelling of the outer retina (green arrow), and discontinuity of the ellipsoidal band (red arrow) (OD: right eye, OS: left eye).

Figure 3

Fundus image of patient with retinal vein occlusion after COVID‐19 infection. A 51‐year‐old male patient whose vision in the left eye dropped to 0.1 a week after infection with COVID‐19. Obstruction of the superior temporal branch vein, hemorrhage in the drainage area (red arrow), retinal edema, and cotton wool spots (black arrow) were observed.

Figure 4

Magnetic resonance imaging and optical coherence tomography of patients with optic neuritis after COVID‐19 infection. A 23‐year‐old female patient complained of right eye pain and decreased vision after infection with COVID‐19. Her vision was 0.08 and 0.5 in the right and left eyes, respectively. Magnetic resonance imaging in T1‐weighted imaging fat‐sat + C sag showed that the optic nerve margins were significantly strengthened (red arrow). OCT showed swollen optic discs in both eyes with blurred borders (yellow arrow). (OD: right eye, OS: left eye).