Ocular manifestations of COVID-19: systematic review and meta-analysis

Edward Tran; Vivian Phu; Riley Xu; Angela Teoderascu; Mohamed Aly; Nirmit Shah; Monali S Malvankar-Mehta

doi:10.1016/j.jcjo.2023.08.003

Ocular manifestations of COVID-19: systematic review and meta-analysis

Can J Ophthalmol. 2023 Sep 5:S0008-4182(23)00248-X. doi: 10.1016/j.jcjo.2023.08.003. Online ahead of print.

Authors

Edward Tran¹, Vivian Phu¹, Riley Xu¹, Angela Teoderascu¹, Mohamed Aly¹, Nirmit Shah², Monali S Malvankar-Mehta³

Affiliations

¹ Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
² Melbourne Medical School, University of Melbourne, Parkville, Australia.
³ Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON. Electronic address: Monali.Malvankar@schulich.uwo.ca.

PMID: 37683691
DOI: 10.1016/j.jcjo.2023.08.003

Abstract

Objective: Our study aims to build on our understanding of COVID-19 by detailing a comprehensive look at the prevalence of different ocular manifestations related to COVID-19 infection.

Design: Systematic review and meta-analysis.

Methods: Eligible studies published between June 20, 2021, and May 11, 2023, were retrieved from the MEDLINE, EMBASE, and CINAHL databases as well as grey literature. Covidence was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, a risk-of-bias assessment was carried out. Data were extracted, and a meta-analysis was performed using STATA 14.0. Fixed-effects and random-effects models were computed based on heterogeneity.

Results: Our meta-analysis included 43 articles with a total of 10,572 subjects. The results showed that COVID-19 patients had a significantly higher prevalence of conjunctivitis (effect size [ES] = 0.11; 95% CI, 0.07-0.15), ptosis (ES = 0.22; 95% CI, 0.15-0.30), and ophthalmoplegia (ES = 0.40; 95% CI, 0.06-0.74). Our results also indicate that COVID-19 patients have higher prevalence of cotton wool spots (ES = 0.06; 95% CI, 0.03-0.09), retinal hemorrhages (ES = 0.12; 95% CI, 0.06-0.18), and retinal vein tortuosity (ES = 0.19; 95% CI, 0.09-0.35).

Conclusion: COVID-19 can exhibit extrapulmonary manifestations, affecting both the anterior and posterior segments of the eye. Common anterior-segment findings include conjunctivitis, whereas posterior-segment findings may include cotton wool spots, retinal hemorrhages, and retinal vein tortuosity. Improving our understanding of the ocular manifestations of COVID-19 has the potential to facilitate quicker diagnosis and subsequent treatment.