A Review of Neuro-Ophthalmological Manifestations of Human Coronavirus Infection

Maria Elisa Luís; Diogo Hipólito-Fernandes; Catarina Mota; Diogo Maleita; Catarina Xavier; Tiago Maio; João Paulo Cunha; Joana Tavares Ferreira

doi:10.2147/EB.S268828

A Review of Neuro-Ophthalmological Manifestations of Human Coronavirus Infection

Eye Brain. 2020 Oct 30:12:129-137. doi: 10.2147/EB.S268828. eCollection 2020.

Authors

Affiliations

¹ Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
² Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal.
³ Ophthalmology Department, Hospital CUF Cascais, Lisbon, Portugal.
⁴ Escola Superior de Tecnologia da Saúde de Lisboa do Instituto Politécnico de Lisboa, Lisbon, Portugal.
⁵ Neuro-Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
⁶ Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.

Abstract

Introduction: Human coronavirus (HCoVs) are a group of viruses with recognized neurotropic and neuroinvasive capabilities. The reports on the neurological and ocular findings are increasing day after day and several central and peripheral neurological manifestations are already described. However, none specifically describes the neuro-ophthalmological manifestation of HCoVs. This is the first article specifically reviewing neuro-ophthalmological manifestations of HCoVs infection.

Methods: PubMed and Google Scholar databases were searched using the keywords: coronaviridae, coronavirus, COVID-19, SARS-CoV-2, SARS-CoV-1, MERS, ocular, ophthalmology, ophthalmological, neuro-ophthalmology, neurological, manifestations. A manual search through the reference lists of relevant articles was also performed. There were no restrictions concerning language or study type and publications not yet printed but available online were considered.

Results: Coronavirus eye involvement is not frequent and includes mostly a typical viral follicular conjunctivitis. Recently, retinal anatomical alterations were described using optic coherence tomography. Neuro-ophthalmological symptoms and signs can appear isolated or associated with neurological syndromes. The manifestations include headache, ocular pain, visual impairment, diplopia, and cranial nerve palsies secondary to Miller Fisher syndrome, Guillain-Barré syndrome, or encephalitis, and nystagmus.

Conclusion: Neurological and neuro-ophthalmological syndromes, symptoms, and signs should not be neglected and a complete ophthalmological examination of these patients should be performed to fully describe ocular manifestations related to HCoVs. We believe that major ocular and neuro-ophthalmological manifestations reports lack due to safety issues concerning detailed ophthalmological examination; on the other hand, in a large number of cases, the presence of life-threatening coronavirus disease hinders ocular examination and ophthalmologist's visit to the intensive care unit.

Keywords: human coronavirus; manifestations; neuro-ophthalmological; neurotropic; ophthalmology.

Publication types

Review

Grants and funding

There is no funding to report.