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As of February 2021, coronavirus disease 2019 (COVID-19) has been proven to affect the world of ophthalmology in multiple dimensions such as examination, surgery, and treatment processes [1, 2]. Relatively within a short period, many articles provided information regarding preventive measures during examination and ophthalmological implications of COVID-19 [1]. Hyperemia, epiphora, photophobia, and foreign body sensations were the first reported ocular symptoms and findings associated with COVID-19 [3, 4]. Following reports showed the presence of novel severe acute respiratory syndrome coronavirus (SARS Cov-2) in the ocular surface and revealed the direct link of COVID-19 [5]. Conflicting results have been reported regarding association of ocular symptom severity and clinical approach of COVID-19.
First, ophthalmologic reports were limited to the ocular surface; however, uveitis, chorioretinitis, retinal vascular occlusion, retinal microangiopathy, optic neuritis, diplopia, and cranial nerve palsies were reported as the pandemic continued [6, 7]. While academic research has shown much evidence about COVID-19’s ocular involvement, some critical questions still remain unanswered. Even in cases where COVID-19 appears to be the only possible etiological factor in patients, the available literature has not been able to describe these findings are directly related to COVID-19 or developed due to systemic complications of COVID-19. Promising results have been reported regarding the existence of SARS Cov-2 nucleic acid in the retina, vitreous, and aqueous humor in postmortem investigations; however, existence of complete SARS Cov-2 body and its infectivity in the ocular structures are still unknown [8, 9].
In the light of the current literature, assuming COVID-19 as an etiologic factor for ocular disorders without significant proof may cause misdiagnosis and inappropriate treatment. In this case, it would be wise to consider COVID-19 as the underlying factor after ruling out all other possible etiological factors characterized by a similar clinical presentation.
Recently, new mutations of SARS Cov-2 have been announced, and new SARS CoV-2 variants are hypothesized to increase transmissibility [10]. Current literature does not provide information whether new mutations can chance the affinity of SARS Cov-2 to bind to the ocular structures, course of the ocular involvement, or the prevalence of ocular symptoms.
On the other hand, the effectiveness and protection of a global vaccination is still a controversial issue. The impact of vaccination on ocular symptoms and signs will be an attractive topic for future clinical studies. A large proportion of the population should be vaccinated to reliably assess the effect of vaccination on ocular symptoms.
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References
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Hattenbach LO, Heinz P, Feltgen N et al (2020) Impacts of the SARS-CoV-2 pandemic on ophthalmic care in Germany. Ophthalmologe. 117(9):892–904. https://doi.org/10.1007/s00347-020-01220-4
Aggarwal K, Agarwal A, Jaiswal N et al (2020) Ocular surface manifestations of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. PloS one. 15(11):e0241661
Nasiri N, Sharifi H, Bazrafshan A et al (2021) Ocular manifestations of COVID-19: a systematic review and meta-analysis. J Ophthalmic Vis Res 16(1):103–112. https://doi.org/10.18502/jovr.v16i1.8256
Barnett BP, Wahlin K, Krawczyk M et al (2020) Potential of ocular transmission of SARS-CoV-2: a review. Vision (Basel). 4(3). https://doi.org/10.3390/vision4030040
Bertoli F, Veritti D, Danese C et al (2020) Ocular findings in COVID-19 patients: a review of direct manifestations and indirect effects on the eye. J Ophthalmol. 2020:4827304
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Casagrande M, Fitzek A, Püschel K et al (2020) Detection of SARS-CoV-2 in human retinal biopsies of deceased COVID-19 patients. Ocul Immunol Inflamm. 28(5):721–725
Casagrande M, Fitzek A, Spitzer MS et al (2021) Presence of SARS-CoV-2 RNA in the cornea of viremic patients with COVID-19. JAMA ophthalmology. https://doi.org/10.1001/jamaophthalmol.2020.6339
Leung K, Shum MH, Leung GM et al (2021) Early transmissibility assessment of the N501Y mutant strains of SARS-CoV-2 in the United Kingdom, October to November 2020. Euro Surveill 26(1). https://doi.org/10.2807/1560-7917.Es.2020.26.1.2002106
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The first draft of the letter was written by Serdar Ozates, and Basak Bostanci Ceran commented and revised the letter. All authors read and approved the final manuscript.
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Ozates, S., Bostanci Ceran, B. Keeping an eye on the many symptoms of COVID-19. Graefes Arch Clin Exp Ophthalmol 259, 2865–2866 (2021). https://doi.org/10.1007/s00417-021-05125-z
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DOI: https://doi.org/10.1007/s00417-021-05125-z