Table 2.
Description of the findings reported in eligible studies.
| Author (year) | Country | Population |
Comorbidity (%) |
Ocular Manifestations (%) | Time of onset | Treatment of ocular Manifestations | Outcome | Other results |
|---|---|---|---|---|---|---|---|---|
| Giampietro et al. (2023) | Brazil | 150 patients | Hypertension (Samaranayake et al., 2020) HIV (Domínguez-Varela et al., 2021) Obesity (Khan et al., 2021) Diabetes mellitus (Ranzenigo et al., 2021) |
Candle flame hemorrhage and cotton wool exudates (Qu et al., 2021) |
N/A | N/A | N/A | N/A |
| Firat and Kobat (2021) | Turkey | 32 patients 32 healthy |
N/A | No significant differences in terms of central choroidal thickness, central foveal thickness, nasal 500, nasal 1500, temporal 500, or temporal 500 µm distances were found between the groups. | N/A | N/A | N/A | Choroidal and retinal thicknesses were not affected in patients with recent mild COVID 19 without comorbidities. |
| Ganesh and Mohanan-Earatt (2022) | India | 13 patients | N/A | Anterior uveitis (Han et al., 2020) intermediate uveitis (Bedford et al., 2020) posterior uveitis (Nora et al., 2020) panuveitis (Khalili et al., 2020) |
Within the 6 weeks after COVID-19 diagnosis | Topical Steroids (anterior uveitis) Topical, Oral, and IV Steroids, Mycophenolate mofetil, and MTX (intermediate, posterior, and panuveitis) |
All patients responded well to treatment. Two patients had surgical treatment |
Bilateral eye involvement (Renu et al., 2020) unilateral eye involvement (Chen and Jungang, 2020) |
| Shaikh et al. (2022) | Qatar | 39 patients | Hypertension, diabetes mellitus, coronary artery disease, rheumatic arthritis, or cancer | Conjunctival hyperemia (33.3) eye pain (23.1) epiphora (20.5) burning sensation (10.3) photophobia (5.1) Conjunctivitis (5.1) |
N/A | N/A | N/A | no correlation between patients’ gender, comorbidities, and occurrence of ocular manifestations in COVID-19 patients |
| Sharma et al. (2022) | India | 658 (total) 162 (ocular) |
Diabetes mellitus followed by hypertension (18.42) | Lid swelling (8.64) Watering and irritation (25.30) Follicular conjunctivitis (7.40) blephritis, lid hyperemia, dry eye, foreign body sensation, photophobia, chemosis and blurring of the vision and peri-orbital pain |
mostly < 1 week after COVID-19 infection | N/A | 56.7 % relieved from ocular discomfort | The most significant ocular morbidity was black discoloration of lids and peri ocular skin, lid swelling, and redness and purulent discharge of conjunctivitis needed emergency ophthalmic reference |
| Shen et al. (2021) | China | Total 3198 Ocular 28 |
hypertension (28.6), Glaucoma (3.6), Nephritis (3.6), autoimmune anemia (3.6), diabetes (3.6), hepatitis B (3.6), cerebral infarction (3.6) |
Conjunctivitis (100 %) | N/A | Levofloxacin eye drop (15 = 53.6 %) Ganciclovir eye drop (2 = 7.1 %) sodium hyaluronate eye drop (1 = 3.6 %) artificial tears (1 = 3.6 %) observe (9 = 32.1 %) |
N/A | conjunctivitis was a rare and self-limited complication in adults with COVID-19 while the existence of coronavirus receptors on human ocular surface and mouse lacrimal glands indicated the risk of SARS-CoV-2 infection |
| Silveira et al. (2022) | Brazil | Total 104 Ocular 36 |
N/A | Burning (19.23), pain (11.54), foreign body sensation (7.7), hyperemia (7.7), and tearing (3.84) | concomitantly with general symptoms (77.7) one day before flu-like symptoms (11.11 %) after 3 days(11.11 %) |
eye drops for selfmedication (ketorolac trometamol and carmellose sodium)(5.71 %) | N/A | |
| Sindhuja et al. (2020) | India | Total 127 Ocular 12 |
Diabetes mellitus (Seah and Agrawal, 2020), hypertension (Renu et al., 2020), thyroid disorders (Khalili et al., 2020), pulmonary tuberculosis (Nora et al., 2020); parkinsonism (Nora et al., 2020); bronchial asthma (Nora et al., 2020), cardiovascular disorder (Nora et al., 2020) |
conjunctival congestion (66.6) ocular burning sensation (8.33), watering (8.33), hordeolum externum (8.33) |
Within 3 weeks of COVID symptoms (50 %) Before COVID symptoms (41.6 %) |
N/A | N/A | N/A |
| Stephan et al. (2021) | France | 20 | N/A | Unilateral corneal injury (Qu et al., 2021), Superficial punctate keratitis without ulcer (1 8 0), Bilateral subconjunctival hemorrhages (Chen and Jungang, 2020) | N/A | Vit A ointment (for corneal injury) | Fully resolved | Prone to eye damage because of sedation, no blinking, and poor eyelid occlusions are prone to eye damage |
| Meduri et al. (2020) | Italy | 29 patients | Hypertension, (86.2), Diabetes (62.1), Obesity (44.8), Coronary heart disease (27.5), Cerebrovascular disease, (24.1), Atrial fibrillation (24.1), Neurological disease (13.8), Cancer (Oren et al., 2021), BPCO (Oren et al., 2021), Chronic renal disease, (24.1) |
Hyperemia (24.1), Chemosis (3.4), Secretion (6.9), Lid margin hyperemia (34.5), Crusted eyelashes (24.1), Meibomian orifices abnormalities (20.7) |
N/A | N/A | Tear analysis did not reveal the presence of SARS-CoV-2. Ocular symptoms are common in patients with COVID-19 | N/A |
| Oncul et al. (2021) | Turkey | 359 | N/A | Various ocular diseases (4.5) conjunctivitis | N/A | N/A | N/A | N/A |
| Oren et al. (2021) | Turkey | Total 60 COVID-19 group 35 Control group 25 |
N/A | Macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements, each retinal layer thickness of all participants was done 14–30 days after COVID-19 symptom onset |
N/A | N/A | The mean value of central macular thickness and the mean values of the ganglion cell layer and inner nuclear layer thickness was significantly higher in the COVID-19 group |
N/A |
| Oren and Kocabas (2022) | Turkey | COVID-19 group 34 Control group 34 |
N/A | Corneal endothelial cell morphology, increase in CV value | N/A | N/A | N/A | N/A |
| Perez-Chimal et al. (2021) | USA | 15 newborns | N/A | Periorbital edema (1 0 0), Hemorrhagic conjunctivitis (73.3), Corneal edema (Ma et al., 2020), Hyaline secretion (1 0 0), Rubeosis (6.6) | N/A | N/A | N/A | N/A |
| Pirraglia et al. (2020) | Italy | 43 | N/A | No further retinal manifestation related to COVID-19 infection was found in our cohort |
ophthalmological screening was performed after a median of 21.5 days | N/A | N/A | N/A |
| Ranzenigo et al. (2021) | Italy | 53 patient | N/A | Conjunctivitis symptoms 37 Physician-assessed ocular signs 28 |
N/A | N/A | N/A | Plasma levels of Interleukin-6 were higher in patients with signs or symptoms in comparison with those without them: 43.5 pg/ml (19.7–49.4) vs. 8 pg/ ml (3.6–20.7) Red cell distribution width was also significantly higher |
| Riotto et al. (2022) | Switzerland | 172 patient | Arterial hypertension, or Dyslipidemia (Sen et al., 2021); Hypertension (10.5), Coronary disease (5.3), Diabetes (36.8) |
Cotton wool spots (CWS) and/or hemorrhages (Seah and Agrawal, 2020) | N/A | All subjects received 6 mg of dexamethasone daily since their admission | All patients were symptom-free 3 months after screening. | Diabetes history, overweight, and elevated C-reactive protein were more frequently observed among patients with retinal abnormalities, while a history of systemic hypertension was more frequently observed among patients without retinal findings |
| Rodriguez-Ares et al. (2021) | Spain | 56 patients | Hypertension (48.2), diabetes (28.6), cancer (23.2), heart disease (21.4), obesity (17.9), chronic lung disease (Khan et al., 2021) | Grittiness (16.1), ocular pain (7.1), photophobia (1.8), blurry vision (3.6), conjunctival hyperemia (3.6), itching (3.6), secretion (7.1) | Average of 7.1 days (range 1–20) before ocular testing |
N/A | No association was found between positive ocular samples and ocular symptoms | N/A. |
| Rokohl et al. (2020) | Germany | 108 patients | N/A | burning sensations (36.1), epiphora (34.3), redness (25.9) | 1.96 ± 3.17 days after the beginning of COVID-19 | N/A | Do not need treatment | N/A |
| Kumar et al. (2021) | India | 2742 | N/A | Bilateral viral conjunctivitis, orbital cellulitis secondary to pansinusitis | Ocular examinations were performed every 72 h | N/A | N/A | N/A |
| Ma et al. (2020) | China | 216 pediatric patients | N/A | Exhibited conjunctival discharge (12.5), eye rubbing (8.8), conjunctival congestion (2.3) |
N/A | Observation without treatment and minimal eye drop | Complete recovery for 41 patients and persistent eye rubbing for the other 8. | Children with systematic symptoms had a higher chance of developing ocular manifestations |
| Jiang et al. (2021) | China | 255 COVID-19 | N/A | Asthenopia (4.3), mild conjunctival congestion, and serous secretion (0.8) | ||||
| Hepokur et al. (2023) | Turkey | 16 COVID-19 17 control | N/A | Decrease in Subfoveal choroidal thickness (SFC), SFCT increase in late post-infectious period, peripapillary choroidal thickness, Decrease in choroidal stroma and blood vessels |
N/A | N/A | N/A | N/A |
| Zhou et al. (2020) | China | 243 patients | N/A | Exhibited ocular manifestations (6.6) | N/A | N/A | N/A | N/A |
| Wang et al. (2021) | China | 42 patients | N/A | Dry eye disease (61.9) | N/A | N/A | N/A | N/A |
| Dag Seker and Erbahceci Timur (2021) | Turkey | 32 COVID-19 36 control |
N/A | Thinner macular retinal nerve fiber layer (RNFL) of inner and outer nasal and outer inferior quadrants | Eye examination was performed after 60.5 ± 38.6 days after COVID-19 confirmation | N/A | N/A | Patients with ocular pain had Thinner Superonasal and inferotemporal sectors of the Peripapillary retinal nerve fiber layer |
| Layikh et al. (2021) | Iraq | 186 | N/A | Conjunctivitis (13.4) | N/A | No treatment | All symptoms disappear within a few days | No significant association between gender and conjunctivitis prevalence, significant association between conjunctivitis and severity of the disease |
| Sehgal et al. (2021) | India | 804 COVID-19 | Diabetes mellitus, hypertension, obesity (81.5) | Conjunctival hyperemia (Jin et al., 2020); follicular reaction in palpebral conjunctiva (65.6), chemosis (Bypareddy et al., 2021) |
4.52 ± 1.47 days from systemic manifestation to the onset of ocular manifestations | N/A | N/A | N/A |
| Reinhold et al. (2021) | Switzerland | 10 COVID-19 5 control |
N/A | swollen endothelial cells in congested choroidal vessels (Ma et al., 2020) |
N/A | N/A | N/A | N/A |
| Jidigam et al. (2022) | USA | 7 COVID-19 6 control group |
N/A | Hemorrhagic spots and increased vitreous, increased retinal thickness, changes in retinal microvasculature, increased inflammation, gliosis, localized density changes, and increased inflammation |
N/A | N/A | N/A | N/A |
| Wan et al. (2022) | China | 228 COVID-19 109 Control |
N/A | Meibomian gland dysfunction (MGD), ocular surface staining score, shorter Tear Break-up time in patients requiring supplementary oxygen during hospitalization | 1 new ocular manifestation, 1 week before the COVID-19 diagnosis (Maychuk et al., 2020), ocular symptoms 4 weeks following diagnosis of COVID-19 (21.5) Evaluation was done within 52.23 ± 16.12 days after their COVID-19 positive test |
N/A | N/A | N/A |
| Bayram et al. (2022) | Turkey-USA | 53 COVID-19 group 53 control group |
N/A | Outer plexiform layer thickness, choroidal thickness, low choroidal vascularity, increase in the stromal area to vascular area Significant increase in all quadrants of the peripapillary retinal nerve fiber layer (RNFL) thickness, significantly higher reflectivity of OCT echo of the choroid, and peripapillary RNFL |
Day of patient hospitalization and third month of follow-up after recovery | N/A | N/A | Enhance in the outer plexiform layer thickness, mean choroidal thickness, the stromal area to vascular area (S/V) ratio of the choroid, peripapillary retinal nerve fiber layer (RNFL) thicknesses, and The reflectivity of OCT echo of the was observed in patients compared to the control group while a decrease in choroidal vascularity was detected. |
| Abdelkader et al. (2021) | Egypt | 9 | renal failure on hemodialysis (11.1) | All patients: edema and erythema of eyelids, severe conjunctival and ciliary injection, subconjunctival hemorrhage, corneal edema and infiltration, dense inflammatory coagulum in the anterior chamber, axial proptosis, limitation of the ocular motility. Ocular B-scan ultrasonography: medium to highly reflective floaters and membranous echoes with loculated opacities in the vitreous cavity more condensed posteriorly with choroidal thickening and the retina was in place Orbital CT: mild proptosis, haziness of orbital fat, in all cases. Mucoperiosteal thickening (11.1) |
N/A | IV vancomycin, ceftazidime with oral metronidazole, Topical moxifloxacin hydrochloride 0.5 %, a topical combination of dexamethasone and tobramycin, and cycloplegic, Vitreous tap with intravitreal injection of vancomycin (1 mg/0.1 ml) and ceftazidime (2.25/0.1 ml) | 3 patients died, atrophia bulbs in 4 eyes and preserved eyeball with complete visual loss in 2 patients | N/A |
| Abrishami et al. (2020) | Iran | 142 | Cataract (7.7), diabetic retinopathy (6.3) | Tearing (23.2), red eyes (Oren et al., 2021); eye irritation (13.4), eye itching (8.5), foreign body sensation (2.8), periorbital pain (3.5), photophobia (0.7), blurred vision (0.7), conjunctival swelling (15.5), conjunctival hyperemia (28.9), Chemosis (15.5) | N/A | N/A | N/A | The percentage of patients with ≥ 1 ocular manifestations was significantly higher in those admitted to ICU compared to the non-ICU group. Among all patients, the most common finding was conjunctival hyperemia. Among ICU patients, the most common finding was chemosis. |
| Akturk Acar et al. (2022) | Turkey | 15 | N/A | Bilateral conjunctivitis (26.7), an avascular area in Zone-III (Han et al., 2020) | The first: During hospitalization following negative RT-PCR result The second: 1 month later |
Supportive treatments | N/A | N/A |
| Ahuja et al. (2020) | USA | 1 | N/A | Left eye irritation, upper eyelid swelling, erythematous, swollen and had to crust along the lashes, mild inflammation, and injection of the conjunctiva | Past 24 h | Doxycycline 100 mg to use if the symptoms worsened or did not improve | Clinically improved within six days of his initial presentation | N/A |
| Sezgin Akcay et al. (2021) | Turkey | 1083 | HTN (3 %), DM (1.3), allergic asthma (0.2 %), CHF (0.9 %), Hashimoto disease (0.3 %), CRF (0.2 %), RA (0.1), and lymphoma (0.1 %) | Sore eye or burning sensation (Jin et al., 2020), foreign body sensation ± burning sensation (3.6), red eye ± foreign body sensation, burning sensation, pain, itching (3.4) | Conjunctivitis symptoms manifested at the first and second week of disease onset in (28.5) and patients (71.4), respectively | N/A | N/A | The inpatient group had higher rates of comorbidity, ophthalmic medication, chronic ocular disease, and previous ocular surgery, but not contact lens wear compared to the outpatient group. |
| Boz et al. (2021) | Turkey | 50 | HTN (Maychuk et al., 2020), COPD (Wiersinga et al., 2020), Asthma (Wiersinga et al., 2020), DM (Khalili et al., 2020) |
Follicular conjunctivitis (Baig, 2020); Blepharoconjunctivitis (Renu et al., 2020), Blepharitis (Renu et al., 2020), Papillary conjunctivitis (7.5), Anterior uveitis (Wiersinga et al., 2020); Presence of cataract (Wiersinga et al., 2020), Presence of pterygium (Khalili et al., 2020) |
Within 2 weeks after COVID-19 infection had been confirmed | Symptomatic treatment (preservative-free artificial tears, cold compress, and lubricating ophthalmic ointment) | All resolved | N/A |
| Bypareddy et al. (2021) | India | 138 | N/A | A single streak of superficial retinal hemorrhage at the posterior pole of the fundus in the left eye of one patient (0.72) | 6 days from the infection symptoms onset | N/A | N/A | No lesions that can be attributed to COVID-19 were found in those with mild to moderate COVID-19 symptoms |
| Chen et al. (2020) | China | 535 | HTN (Chen et al., 2020), Hyperlipidaemia (1.1), DM (7.1), Cardiovascular and cerebrovascular diseases (3.3), Respiratory system disease (6.9), Hematological system disease (0.5), CKD (0.5), Chronic liver disease (4.7), Autoimmune disease (1.9) |
Without conjunctival congestion group: Conjunctival secretion (8.7), Ocular pain (3.5), Foreign body sensation (11.4), Photophobia (2.6), Blurred vision (12.8), Dry eye (20.1), Tearing (9.6), Itching (9.6), With conjunctival congestion group: Conjunctival secretion (29.6), Ocular pain (18.5), Foreign body sensation (18.5), Photophobia (11.1), Blurred vision (11.1), Dry eye (Rodriguez-Ares et al., 2021), Tearing (22.2), Itching (14.8) |
Conjunctival congestion 0–3 days in 7 patients, 4–7 days in 1 patient, 8–14 days in 6 patients, and 15–28 days in 6 patients after clinical symptoms | N/A | N/A | Conjunctival congestion lasted for an average of 5.9 ± 4.5 days. A significant association between hand–eye contact and conjunctival congestion appeared. |
| Scalinci and Trovato (2020) | Italy | 5 |
N/A | chemosis, epiphora, photophobia, Conjunctivitis | Initial presentation in all patients | Moxifloxacin eye drops four times a day for 5 more days. | Resolved | Conjunctivitis was the only sign and symptom of COVID-19 infection. |
| Gangaputra and Patel (2020) | USA | 144 COVID-19 positive 306 COVID-19 negative | N/A | Eye pain 19.4, Photophobia 13.9, flashes/floaters 11.8, blurry vision 11.1, red eyes 10.4 |
1 to 4 weeks following the results of 69 their COVID-19 testing |
N/A | 26.5 % of patients were suffering from ocular symptoms despite recovery from systemic infection |
Red eyes and epiphora were more likely to be found in COVID-19-negative patients relative to COVID-19 positive ones. |