Table 1.

Ocular findings of COVID-19 reported in the adult population

Reference	Type of study; location	Number of subjects	Age	Number of patients with visible ocular findings	RT-PCR results for SARS-CoV-2	Day of symptom presentation (if noted)	Symptomology and physical exam findings	Treatments (if noted)	Other important findings
Wu et al. [4]	Retrospective case series; Hubei province, China	38 (28 confirmed COVID+)	Mean 65.8	12 out of 38 (31.6%)	2 positive for both C and NP swabs	Not noted	Conjunctival hyperemia, chemosis, epiphora, or increased secretions
Guan et al. [10]	30 provinces in China	1099	Median 47	9 (0.8%)	All confirmed positive on NP swab	Not noted	Conjunctival congestion
Loffredo et al. [16]	Meta-analysis of 3 studies; China	1167	47–68	1.1%	In 2 studies, 3 out 68 had positive C swab	Not noted	Conjunctivitis		Patients with severe COVID-19 had increased incidence of conjunctivitis (P = 0.030)
Abrishami et al. [17]	Cross-sectional, observational study; Northeastern Iran	142	Mean 62.6 (range 23–96)	69	77 positive on NP swab	None detected as presenting complaint	Complaints included tearing, erythema, irritation, itching, foreign body sensation, periorbital pain, photophobia, and blurred vision On external exam, erythema and conjunctival swelling noted On SLE, conjunctival hyperemia and chemosis were noted
Poddar et al. [18]	Case report	1	65	1	Positive on NP swab	Day 7 after admission, day 30 after symptom onset	Unilateral conjunctival congestion with severe follicular reaction on lower palpebral conjunctiva with conjunctival prolapse	Lubricants and prophylactic preservative-free moxifloxacin 0.5%	Hyperemia resolved in 5 days; follicles resolved after 2 weeks
Seah et al. [22]	Prospective case study; Singapore	17	Median 37 (range 20–75)	1	All confirmed positive on NP swab, no positive C swabs	Day 17	Conjunctival hyperemia and chemosis
Colavita et al. [24]	Case report; traveler from Wuhan to Italy	1	65	1	Positive on NP swab until day 20, positive on C swab on day 3 and day 27	Initial	Bilateral conjunctivitis
Cheema et al. [25]	Case report	1	29	1	Positive NP swab, weakly positive on conjunctival swab with retrospective testing	Initial	Unilateral conjunctivitis, photophobia, watery discharge progressively worsened to sore, swollen lid, mucoid discharge, and eventually vision impairment; SLE showed follicular conjunctivitis, 2+ hyperemia, and positive for lymphadenopathy	Oral valacyclovir and moxifloxacin drops in right eye
Daruich et al. [26]	Case study; Argentina	1	27	1	Positive NP swab	Day 1	Foreign body sensation and redness of left eye; on exam unilateral eyelid edema, and moderate conjunctival hyperemia	Topical antihistamine and steroid
Khavandi et al. [27]	Case study	1	65	1	Positive NP swab twice	Initial	Burning eye and discharge; SLE showed mucoid discharge and follicular conjunctivitis	Oseltamivir and hydroxychloroquine
Salducci et al. [28]	Case study; Diamond cruise in Italy	1	72	1	Positive NP swab	Day 1	Bilateral conjunctivitis and photophobia with serous secretions, chemosis, pseudo membranes of fibrin on tarsal conjunctiva; this was his only symptom	Cold compress, artificial tears, local antiviral ganciclovir gel
Zhou et al. [29]	Retrospective cohort; Wuhan, China	67 patients	Mean 35.7 (range 22–78) Patient with conjunctivitis: 48	1	63 confirmed positive on NP swab. Of these, 1 positive and 2 probable positive C swabs	Initial	Conjunctivitis	Resolved without treatment	The patient with conjunctivitis did not have positive RT-PCR result on C swab
Sun et al. [30]	Cross-sectional; Tongji Hospital, China	102	Mean 58.68 Patient with positive conjunctival swab: 29	2	72 positive on NP swab, 1 positive C swab	Initial	Conjunctivitis; on exam conjunctival congestion and watery discharges in both eyes with normal visual acuity, normal corneal epithelium, quiescent anterior chamber, and no tenderness or enlargement of the preauricular lymph node
Xia et al. [31]	Prospective interventional case series study; Zhejiang University Hospital	30	53	1	30 confirmed positive on NP swab, 1 patient positive for tear swab, C swab, and sputum sample	Within 3 days, which was total disease course length	Viral conjunctivitis with conjunctival congestion and aqueous secretion
Atum et al. [32]	Prospective interventional case series; Sakarya University Education and Research Hospital	40	Mean 41.3	10	All positive on NP swab, 3 positives on C swab	Not noted	Conjunctivitis		Of the 10 with conjunctivitis, only 1 had positive C swab
Lomi et al. [33]	Retrospective cross-sectional observational study; North India	127	Median 38.8 (range 5–73)	8 with visible manifestation, 11 total with ocular complaints	All confirmed positive on NP swab	Initial: 5 out of 11 Late onset: 6 out of 11	Conjunctival congestion: 7 bilateral, 1 unilateral Other complaints: burning sensation and tearing
Chen et al. [34]	Case study; Shenzhen, China	1	30	1	Positive on C swab	Day 13	Bilateral conjunctivitis; SLE showed bilateral acute follicular conjunctivitis	Ribavirin eye drop
Guo et al. [35]	Case report; First Affiliated Hospital of Zhejiang University	1	53	1	Positive C swab during unilateral presentation of L eye. Negative C swab during bilateral presentation	Day 10	Unilateral L eye conjunctivitis lasted 6 days with complete resolution. Then, 5 days later the patient developed bilateral keratoconjunctivitis	First time, the L eye was treated with levofloxacin hydrochloride drops and 0.1% sodium hyaluronate Second time, bilateral eyes treated with ganciclovir ophthalmic gel, levofloxacin hydrochloride drops, and 0.1% sodium hyaluronate drops with no resolution 0.1% fluorometholone drops resulted in complete resolution
Marinho et al. [36]	Case series on retinal findings	12	Range 25–69	12	9 positive on NP swab, 2 positive for serum antibody	11–33 days after symptom onset	B-scan OCT: 12 patients with hyperreflective lesions at level of inner plexiform and ganglion cell layers Retinal fundoscopy: 4 patients with subtle CWS and microhemorrhages
Landecho et al. [37]	Case series on retinal findings	27	Median 56 (with CWS) Median 61 (without CWS)	6	Post-COVID infection: All negative NP swab, positive serum antibody	2 weeks following hospital discharge (mean 43 days after first symptom)	Retinal fundoscopy: CWS 5 unilateral, 1 bilateral	All patients were treated with prophylactic low molecular weight heparin during hospitalization

SARS-CoV-2 severe acute respiratory syndrome coronavirus 2, RT-PCR reverse transcription polymerase chain reaction test for RNA of virus, NP nasopharyngeal, C conjunctival, SLE slit lamp exam, CWS cotton wool spots, OCT ocular coherence tomography