SARS-CoV-2 and the Eye: Implications for the Retina Specialist from Human Coronavirus Outbreaks and Animal Models.

• Type of Material: Article
• Authors: Alasdair Kennedy FRCOphth, Brighton and Sussex Medical School, Brighton, United Kingdom.; Jessica Shantha, Emory University; Ji-Peng Olivia Li, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.; Lisa J Faia, Associated Retinal Consultants, Royal Oak, MI.; Caleb Hartley, Emory University Rollins School of Public Health, Atlanta, GA.; Sanjana Kuthyar, Emory Eye Center, Emory University School of Medicine, Atlanta, GA.; Thomas A Albini, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.; Henry Wu, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.; James Chodosh, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.; Daniel SW Ting, Singapore National Eye Center, Duke-NUS Medical School, Singapore.; Steven Yeh, Emory University
• Language: English
• Date: 2020-10
• Publisher: SAGE Publishing
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2020.
• Final Published Version (URL): http://dx.doi.org/10.1177/2474126420939723
• Title of Journal or Parent Work: J Vitreoretin Dis
• Volume: 4
• Issue: 5
• Start Page: 411
• End Page: 419
• Grant/Funding Information: This project was supported by the National Eye Institute/ National Institutes of Health core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), National Eye Institute of the National Institutes of Health under award number K23 EY030158 (Shantha) and RO1 EY029594 (Yeh). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.; This research was also supported an unrestricted departmental grant from Research to Prevent Blindness, Inc. to the Emory Eye Center, Emory University School of Medicine, Santen, Inc. and the Bayer Global Ophthalmology Awards Program.; This research was also supported an unrestricted departmental grant from Research to Prevent Blindness, Inc. to the Emory Eye Center, Emory University School of Medicine, Santen, Inc., the Bayer Global Ophthalmology Awards Program, and the Retina Research Foundation Mills and Margaret Cox Macula Society Research Award.
• Keywords: SARS-CoV-2; uveitis; retina; conjunctivitis; 2019-nCoV; eye; ophthalmology; animal models; COVID-19; Coronavirus

Abstract

PURPOSE: The current SARS-CoV-2 pandemic has escalated rapidly since December 2019. Understanding the ophthalmic manifestations in patients and animal models of the novel coronavirus may have implications for disease surveillance. Recognition of the potential for viral transmission through the tear film has ramification for protection of patients, physicians, and the public. METHODS: Information from relevant published journal articles was surveyed using a computerized PubMed search and public health websites. We summarize current knowledge of ophthalmic manifestations of SARS-CoV-2 infection in patients and animal models, risk mitigation measures for patients and their providers, and implications for retina specialists. RESULTS: SARS-CoV-2 is efficiently transmitted among humans, and while the clinical course is mild in the majority of infected patients, severe complications including pneumonia, acute respiratory distress syndrome, and death can ensue, most often in elderly patients and individuals with co-morbidities. Conjunctivitis occurs in a small minority of patients with COVID-19 and SARS-CoV-2 RNA has been identified primarily in association with conjunctivitis. Uveitis has been observed in animal models of coronavirus infection and cotton-wool spots have been reported recently. CONCLUSION: SARS-CoV-2 and other coronaviruses have been rarely associated with conjunctivitis. The identification of SARS-CoV and SARS-CoV-2 RNA in the tear film of patients and its highly efficient transmission via respiratory aerosols supports eye protection, mask and gloves as part of infection prevention and control recommendations for retina providers. Disease surveillance during the COVID-19 pandemic outbreak may also include ongoing evaluation for uveitis and retinal disease given prior findings observed in animal models and a recent report of retinal manifestations.