New Concept of Ocular Implications in COVID-19 Infection: A Brief Review


  •   Apen Hoddor Silaban


Coronavirus disease 2019 is a novel pneumonia-like respiratory disease caused by the infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus can invade the human body through various intermediaries, including through the eye. The presence of a coronavirus invasion in the eye may cause several ocular manifestations, which can be an initial clinical finding of a coronavirus infection in the host body. On the other hand, it can also cause systemic complications that may affect the eyes. This review will discuss in more detail how the coronavirus can infect humans through the eye, explain its manifestations, and briefly explain the proper and prompt management steps that must be taken.

Keywords: Coronavirus, eye, infection


World Health Organization. (August 2020). Coronavirus Disease (COVID-2019) Situation Report [Online]. Available: https://www.who .int/emergencies/diseases/novel-coronavirus-2019/situationreports/

World Health Organization. (February 2020). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Online]. Available: -the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)

Pan American Health Organization/World Health Organization. (October 2020). Epidemiological alert recurring waves and outbreaks of COVID-19 [Online]. Available: ments/epidemiological-alert-recurring-waves-and-outbreaks-covid-19

J.P.A. Ioannidis, “Global perspective of COVID-19 epidemiology for a full-cycle,” Eur J Clin Invest., vol. 50, pp. 1-9, 2020.

X. Xu, P. Chen, J. Wang, et al., “Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission,” Sci China Life Sci., vol. 63, no. 3, pp. 457-460, 2020.

Y. Wang, B. Detrick, Z.X. Yu, et al., “The role of apoptosis within the retina of coronavirus-infected mice,” Invest Ophthalmol Vis Sci., vol. 41, pp. 3011-3018, 2000.

W.J. Guan, Z.Y. Ni, Y. Hu, et al., “China medical treatment expert group for Covid-19: clinical characteristics of coronavirus disease 2019 in China,” N Engl J Med., vol. 382, pp. 1708-1720, 2020.

J.O. Li, D.S.C. Lam, Y. Chen, et al., “Novel coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear,” The British Journal of Ophthalmology, vol. 104, no. 3, pp. 297-298, 2020.

J. Xia, J. Tong, M. Liu, et al., “Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection,” J Med Virol., vol. 92, no. 6, pp. 589-594, 2020.

S. Perlman, “Another decade, another coronavirus,” N Engl J Med., vol. 382, pp. 760-762, 2020.

W. Wang, J. Tang, F. Wei, “Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China,” J Med Virol., vol. 92, no. 4, pp. 441-447, 2020.

C. Rothe, M. Schunk, P. Sothmann, et al., “Transmission of 2019-nCoV infection from an asymptomatic contact in Germany,” N Engl J Med., vol. 382, no. 10, pp. 970-971, 2020.

A.M. Abdullahi, “Virology and epidemiology of the 2019 coronavirus disease (COVID-19),” J Commn Med Pub Health Rep., vol. 1, no. 1, pp. 1-9, 2020.

T.H. Lai, E.W. Tang, S.K. Chau, et al., “Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong,” Graefe’s Archive for Clinical and Experimental Ophthalmology, pp. 1-7, 2020.

I. Seah, R. Agrawal, “Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals,” Ocul Immunol Inflamm., vol. 28, no. 3, pp. 391-395, 2020.

P. Wu, F. Duan, C. Luo, et al., “Characteristics of ocular finding of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China,” JAMA Ophthalmology, vol. 138, no. 5, pp. 575-578, 2020.

L. Loffredo, F. Pacella, E. Pacella, et al., “Conjunctivitis and COVID‐19: a meta‐analysis,” J Med Virol., pp. 1-2, 2020.

N. Hong, W. Yu, J. Xia, et al., “Evaluation of ocular symptoms and tropism of SARS‐CoV‐2 in patients confirmed with COVID‐19,” Acta Ophthalmol., pp. 1-7, 2020.

K. Aggarwal, A. Agarwal, N. Jaiswal, et al., “Ocular surface manifestations of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis,” PLoS ONE, vol. 15, no. 11, pp. 1-20, 2020.

Z.K. Ozturker, “Conjunctivitis as sole symptom of COVID-19: a case report and review of literature,” EJO, pp. 1-6, 2020.

K. Hu, J. Patel, B.C. Patel. January 2020. Ophthalmic manifestations of coronavirus (COVID-19). StatPearls (Online). Available https://

V. Navel, F. Chiambaretta, F. Dutheil, “Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2,” Am J Ophthalmol Case Rep., vol. 19, pp. 1-3, 2020.

M. Cheema, H. Aghazadeh, S. Nazarali, et al., “Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19),” Can J Ophthalmol., vol. 55, no. 4, pp. e125-e129, 2020.

C.W. Lu, X.F. Liu, Z.F. Jia, “2019-nCoV transmission through the ocular surface must not be ignored,” Lancet, vol. 395, no. 10224, pp. e39, 2020.

P. Senanayake, J. Drazba, K. Shadrach, et al., “Angiotensin II and its receptor subtypes in the human retina,” Invest Ophthalmol Vis Sci., vol. 48, no. 7, pp. 3301-3311, 2007.

S.L.L. Yan, X. Pan, M. Jing, “Mechanism of the action between the SARS-CoV S240 protein and the ACE2 receptor in eyes,” J Virol., vol. 6, pp. 783-786, 2006.

B.R.S. Torres, C.E.X. da Cunha, L.R. Castro, et al., “Ocular manifestations of COVID-19: a literature review,” Rev Assoc Med Bras., vol. 66, no. 9, pp. 1296-1300, 2020.

American Academy of Ophthalmology. March 2020. Alert: important coronavirus updates for ophthalmologists (Online). Available: www.

A. Invernizzi, A. Torre, S. Paruulli, et al., “Retinal findings in patients with COVID-19: result from the SERPICO-19 study,” EClinical Medicine, vol. 27, pp. 1-9, 2020.

R.W. Dal Negro, P. Turco, G. Santin, “Ocular venous thrombosis as the main manifestation of an otherwise pauci-symptomatic COVID-19,” Clin Case Rep Int., vol. 4, pp. 1-4, 2020.

I. Hammin, W. Timens, M.L.C. Bulthuis, et al., “Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus: a first step in understanding SARS pathogenesis,” J Pathol., vol. 203, no. 2, pp. 631-637, 2020.

J.F. Riordan, “Angiotensin-I-converting enzyme and its relatives,” Genome Biology, pp. 225, 2003.

M. Hoffman, H. Kleine-Weber, S. Schroeder, et al., “SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor,” Cell, vol.181, no. 2, pp. 271-278, 2020.

Y. Sun, L. Liu, X. Pan, et al., “Mechanism of the action between the SARS-CoV S240 protein and the ACE2 receptor in eyes,” Int J Ophthalmol., vol. 6, no. 4, pp. 783-786, 2006.

A. Milewska, P. Nowak, K. Owczarek, et al., “Entry of human coronavirus NL63 into the cell,” J Virol., vol. 92, no. 3, pp. e01933-17, 2018.

F. Colavita, D. Lapa, F. Carletti, et al., “SARS-CoV-2 isolation from ocular secretions of a patient with COVID-19 in Italy with prolonged viral RNA detection,” Ann Intern Med., pp. 1-3, 2020.

Y. Zhong, K. Wang, Y. Zhu, et al., “COVID-19 and the eye”, Journal of Infection, pp. 122-123, 2020.

Y. Zhou, Y. Zeng, Y. Tong, et al., “Ophthalmologic evidence against the interpersonal transmission of 2019 novel coronavirus through conjunctiva,” MedRxiv, pp. 1-16, 2020.

X. Zhang, X. Chen, L. Chen, et al., “The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study,” MedRxiv, pp. 1-12, 2020.

Z.A. Memish, J.A. Al-Tawfiq, H.Q. Makhdoom, et al., “Respiratory tract samples, viral load, and genome fraction yield in patients with Middle East respiratory syndrome,” J Infect Dis. Vol. 210, no. 10, pp. 1590-1594, 2014.

US Centers for Disease Control and Prevention. December 2020. Interim guidelines for collecting, handling, and testing clinical specimens from persons under investigation (PUIs) for coronavirus disease 2019 (COVID-19) (Online). Available: https://www.cdc. gov/coronavirus/2019-nCoV/lab/guidelinesclinicalspecimens.html.

P. Sarma, H. Kaur, H. Kumar, et al., “Virological and clinical cure in Covid-19 patients treated with hydroxychloroquine: a systematic review and meta-analysis,” J Med Virol., vol. 92, pp. 776-785, 2020.

M. Marmor, U. Kellner, T.Y. Lai, et al., “Recommendations on screening for chloroquine and hydroxy-chloroquine retinopathy (2016 revision),” Ophthalmology, vol. 123, no. 6, pp. 1386-1394, 2016.

The Center of Evidence-Based Medicine. April 2020. Lopinavir/ritonavir: a rapid review of effectiveness in COVID-19 (Online). Available:

D.M. Varu, M.K. Rhee, E.K. Akpek, et al., “Conjunctivitis Preferred Practice Pattern,” Ophthalmology, pp. 94-169, 2019.

R. Shetty, A. Ghosh, S.G. Honavar, et al., “Therapeutic opportunities to manage COVID‑19/SARS‑CoV‑2 infection: present and future,” Indian J Ophthalmol., vol.68, pp. 693-702, 2020.

M. Day, “Covid‑19: Ibuprofen should not be used for managing symptoms, say doctors and scientists,” BMJ, pp. 368:m1086, 2020.

A. Bhavsar, S. Bhavsar, S. Jain, “Evaluation of the effects of chloroquine phosphate eye drops in patients with dry eye syndrome,” Int J Biomed Adv Res, vol. 2, pp. 198‑214, 2011.

V. Navel, F. Chiambaretta, F. Dutheil, “Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2,” American Journal of Ophthalmology Case Reports, vol. 19, pp. 1-4, 2020.


Download data is not yet available.


How to Cite
Silaban, A. H. (2021). New Concept of Ocular Implications in COVID-19 Infection: A Brief Review. European Journal of Medical and Health Sciences, 3(1), 1-5.