COVID-19, delayed treatments contribute to ocular issues
The COVID-19 virus created several complications for patients within the systemic and ocular health care systems, including increased ocular manifestations and delayed treatments, according to a review in Clinical Ophthalmology.
“In the eyes, the SARS-CoV-2 virus has been found in the conjunctiva, tear film and retina, and it can cause conjunctivitis, microvascular disease and cranial neuropathies,” Ella H. Leung, MD, of Georgia Retina in Atlanta, and colleagues wrote. “Fortunately, most ocular issues resolved, with or without treatment.”
Researchers conducted a mini-review to summarize findings from studies on systemic and ocular health complications attributable to SARS-CoV-2 infection, as well as explore the efficacy of treatment regimens, the effects of delays in health care and the impact of the pandemic on providers, education and research.
They discovered that ocular complications manifest in only 6% to 12% of patients infected with the virus, and symptoms can precede systemic illness by 3 hours to 5 days in 13% of patients. The most common anterior segment signs and symptoms were conjunctivitis (86%), ocular pain (31% to 34%), dry eyes (33%), discharge (19%) and redness (11%), according to systemic reviews.
In the posterior segment, COVID-19 infection was associated with an 8.86-fold risk for retinal vascular micro-vasculopathy, with histopathologic analysis revealing presumed viral particles in the ganglion cell layer, inner plexiform, inner nuclear, outer plexiform, outer nuclear layer, retinal pigment epithelium and choroid of the retinas of deceased patients.
In addition, neuro-ophthalmic conditions such as optic neuritis and myelitis, ischemic optic neuropathy, Guillain-Barre syndrome, Miller-Fisher syndrome and cranial neuropathies were associated with COVID-19 infection, with Guillain-Barre syndrome found to be more prevalent in those infected than in the general population (0.15% vs .02%).
Compared with adults, children hospitalized with the coronavirus were up to 23% more likely to experience ocular manifestations, including conjunctival discharge and congestion, retinal hemorrhages, cotton-wool spots, dilated veins and tortuous vessels, according to the review.
Further, at the pandemic onset in March and April 2020, there was a 25% to 81% decrease in ophthalmic emergency room and outpatient office visits, compared with the same months in 2019. People who went to the ED for an ophthalmic emergency had more trauma and serious eye injuries, such as ruptured globes, lacerations and orbital fractures.
“During the initial wave of the pandemic and quarantine period, there was a significant reduction in the clinical and surgical volumes,” Leung and colleagues wrote. “Teleophthalmology helped to minimize the risks of in-person evaluations for nonurgent issues. Those who did present to the emergency departments tended to have more severe disease and worse visual outcomes, and patients who had delayed their routine outpatient ophthalmic care had difficulty returning to their baseline statuses even after restarting treatments.
“Resumption of ophthalmic treatments as soon as possible may therefore help decrease the risk of vision loss,” the authors added.
Perspective
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