In the acute phase of COVID-19 10 of 18 (55%) patients presented flame-shaped hemorrhages and ischemic pattern lesion like CWS and retinal pallor [40]. 2020;181(2):271280.e8. Two hospitalized patients (9.5%) received invasive ventilation. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. Findings In this prospective cross-sectional study, patients who had suffered from previous COVID-19 had no long-term side effects at 3 months after recovery. The site is secure. Color fundus pictures were obtained using Topcon TRC-50DX and Nikon D90 cameras. Sungnak W, Huang N, Bcavin C, Berg M, Queen R, Litvinukova M, Talavera-Lpez C, Maatz H, Reichart D, Sampaziotis F, Worlock KB, Yoshida M, Barnes JL. She said while I was sick, my brain had been deprived of oxygen and blood flow, which can cause long-term problems. N Engl J Med. One week after discharge from the hospital for a severe course of COVID-19, a 59-year-old male with a history of hypertension and hyperuricemia presented with painless vision loss in the left eye. J. Ophthalmol. 28, 922925. This study was approved by the ethics committee of Ludwig-Maximilians-University, Munich, Germany and adhered to the tenets of the Declaration of Helsinki. Slider with three articles shown per slide. Cite this article. Of these, 14 (66.6%) were hospitalized and 7 (33.3) were discharged home. COVID-19 Retinal Microangiopathy as an in Vivo Biomarker of Systemic Vascular Disease? https://www.nejm.org/doi/full/10.1056/nejmoa1211721 (Accessed 22 8 2020 ). The meanSD duration of hospitalization was 15.010.7 days. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. I was in severe pain and had frequent migraines. This study was approved by the ethics committee of Ludwig-Maximilians-University, Munich, Germany and adhered to the tenets of the Declaration of Helsinki. Based on clinical data, patients were classified into mild-to-moderate (7 patients, 10.9%); severe (33 patients, 51.5%); and critical (24 patients, 37.5%). The patients were inquired about the ocular signs and symptoms in the recovery phase of the disease and also responded to a short questionnaire with three items: 1. Increasing case reports note that conjunctivitis, or pink eye, can occur as a symptom of COVID-19. urine that's foamy or bloody. Our study presents some limitations. 93, 205207. However, only 31.2% reported that it appeared or worsened simultaneously with the acute phase of COVID-19. This study was approved by the ethics committee of Ludwig-Maximilians-University, Munich, Germany and held to the tenets of the Declaration of Helsinki 1964 or its later amendments. Regarding diabetic retinopathy, its frequency was 52.7% in our sample, which is a higher frequency than the overall prevalence of diabetic retinopathy in a previously diabetic population (34.6%)27. We would like to thank all patients and the study team of our Clinic of Ophthalmology. The remaining patients had unremarkable exams. Gascon P, Briantais A, Bertrand E, Ramtohul P, Comet A, Beylerian M, Sauvan L, Swiader L, Durand JM, Denis D. Covid-19-associated retinopathy: a case report. Question Do COVID-19 patients suffer from long-term ocular side effects after recovery? Most of the patients attending this ambulatory have been previously hospitalized in Hospital das Clnicas de Ribeiro Preto complex with severe or critical clinical picture. The sample size is limited, and the percentage of intensive care patients is low. https://doi.org/10.1038/s41591-020-0868-6. (1. In these first publications about PCS, we did not find any information about ocular manifestations persisting after COVID-19, and it is not possible to know if they were not there or if they were not reported, investigated or documented. In conclusion, our results suggest that long-term complications of the eye are unlikely after recovery from COVID-19, although receptors allowing for SARS-CoV-2 entry are present in the conjunctiva, limbal superficial cells, retina and aqueous humor. Presenting and DBCVA were significantly different (p0.03, Wilcoxon matched-pairs signed-rank test) in mild-to-moderate, severe, and critical groups, except for the left eyes (LE) in the mild-to-moderate group. The tear flow was measured by the Schirmer test without anesthesia and considered positive for dry eye if the worse eye showed5 mm of wetness). It's important to note that an eye issue in a person . Bloodretinal barrier breakdown in experimental coronavirus retinopathy: association with viral antigen, inflammation, and vegf in sensitive and resistant strains. We offered the opportunity to participate in this ophthalmologic cross-sectional study to patients attending the Post-Covid ambulatory care from July to November 2020. The higher frequency of personal history of dry eye or severe symptoms in mild-to-moderate cases needs other studies to be clarified due to a small number of patients in the sample. Hyperinflammation with cytokine storm and stasis with hypoxia that activates coagulation mechanisms could very well cause retinal vasculitis, thromboembolic events or venous congestion resulting in a COVID-19 associated retinal vein occlusion, papillophlebitis or retinopathy [30, 38, 39]. We looked for correlation between right and left eyes refractive errors using Pearson coefficient. Google Scholar. They were also asked about the presence of blurry vision and ocular pain at the moment of the ophthalmologic examination and if these symptoms were previous to COVID-19 diagnosis or if they appeared simultaneously with COVID-19 and persisted until the exam day. https://doi.org/10.1016/j.survophthal.2020.01.002 (2020). They show milder courses in malaria disease and appear to be protected against SARS-CoV-2. T. Kreutzer: Speaker honoraria from Alcon Pharma GmbH. 2003;362(9393):13538. Greenhalgh et al.15. How often do you feel your eyes dry? Further studies with a longer follow-up and a larger sample size are warranted. 8600 Rockville Pike Gascon P, Briantais A, Bertrand E, Ramtohul P, Comet A, Beylerian M, et al. Patients recovered from the acute phase of COVID-19 underwent a complete ophthalmological evaluation, including presenting and best-corrected visual acuity (BCVA), refractometry, biomicroscopy, tonometry, break-up time and Schirmer tests, indirect ophthalmoscopy, color fundus picture, and retinal architecture evaluation using optical coherence tomography. Sheth JU, Narayanan R, Goyal J, Goyal V. Retinal vein occlusion in COVID-19: a novel entity. But whether the eyes are a source of contagion is, as. https://doi.org/10.23750/abm.v91i1.9397 (2020). I had to take a month off work, unpaid, because I was unable to do my job safely. In conclusion, our results suggest that long-term complications of the eye are unlikely after recovery from COVID-19, although receptors allowing for SARS-CoV-2 entry are present in the conjunctiva, limbal superficial cells, retina and aqueous humor. And thirdly, the binding of the viral Spike protein via the ACE2 receptor and the transmembrane protease serine 2 (TMPRSS2), responsible of SARS-CoV-2 entry in to the host cell [16, 17], found both in tissue of the eye. 2020;0(0):15. A complete ophthalmological exam including functional and imaging end points (including optical coherence tomography (OCT), OCT angiography) was performed. Two hospitalized patients (9.5%) received invasive ventilation. People talk about brain fog, memory problems, and difficulty exercising. The most common findings are cough, low-grade fever, and fatigue, all of which may relapse and remit. The response to the questionnaire was considered positive for dry eye when the responses for questions 1 and 2 were Often or Constantly or the response for question 3 was Yes"18,19. Provided by the Springer Nature SharedIt content-sharing initiative, International Journal of Retina and Vitreous (2021). An important finding was that the HCW infection rate was 12% by July 2020, showing how highly contagious and how extremely important protective measures are in dealing with COVID-19 patients [9]. Never, 1. Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent lancet publication. She is passionate about teaching, so in addition to being an assistant professor, she now has fouirth-year optometry students rotating through her clinic. Long-term ocular damage after recovery from COVID-19: lack of evidence at three months, https://doi.org/10.1186/s12886-021-02179-9, COVID-19 retinal microangiopathy COVID-19 retina, https://doi.org/10.1016/s0140-6736(03)14630-2, https://www.nejm.org/doi/full/10.1056/nejmoa1211721, https://doi.org/10.1016/S0140-6736(20)30183-5, https://doi.org/10.3389/fpubh.2020.591900, https://doi.org/10.7196/SAMJ.2020.v111i11.15433, https://doi.org/10.1001/jamaophthalmol.2020.1291, https://doi.org/10.1038/s41586-020-2012-7, https://doi.org/10.1016/j.cell.2020.02.052, https://pubmed.ncbi.nlm.nih.gov/20117248/, https://doi.org/10.1038/s41591-020-0868-6, https://doi.org/10.3760/cma.j.cn112142-20200310-00170, https://doi.org/10.2174/1874364101509010028, https://doi.org/10.1080/09273948.2020.1738501, https://doi.org/10.1016/j.eclinm.2020.100550, https://doi.org/10.1016/S0140-6736(20)31014-X, https://doi.org/10.1038/s41433-020-1084-9, https://doi.org/10.1016/S0165-5728(01)00374-5, https://doi.org/10.1016/j.scitotenv.2020.139021, https://doi.org/10.1080/09273948.2020.1825751, https://doi.org/10.1136/bjophthalmol-2020-317576, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Invest Ophthalmol Vis Sci. [. BMC Ophthalmol. First studies on COVID-19 showed that ocular manifestations can occur during an acute infection with signs of keratoconjunctivitis in 15.631.6% and positive conjunctival swabs tests in only 3.35.2% [14, 15]. Another danger to the eyes is mucormycosis, or black fungus, that has been seen among several Covid patients. 1) and the other in the RE. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and Conjunctival secretions of patients with SARS-CoV-2 infection. The retina white-yellowish dots verified in two of our patients (both critical cases) are similar to the ones described by Zago Filho et al.28 Our lesions were mainly concentrated in the outer retina, while in the former study, there were hyperreflective points observed in the vitreous and hyperreflective lesions in the level of inner plexiform and ganglion cell layers, in addition to outer retina changes. TFOS DEWS II diagnostic methodology report. Among all, 57 (89.0%) required hospitalization and oxygen support, 29 (45.3%) required intensive care, and 23 (35.9%) needed invasive mechanical ventilation. People talk about its impact on their mental health, their ability to breathe and their ability to make it through the day without a nap. Therefore, this prospective cross-sectional study sought to examine potential long-term functional and morphological impairment in eyes of COVID-19 patients 3 months after recovery. And thirdly, the binding of the viral Spike protein via the ACE2 receptor and the transmembrane protease serine 2 (TMPRSS2), responsible of SARS-CoV-2 entry in to the host cell [16, 17], found both in tissue of the eye. retinal vessels [34]. Nature. Selective neuronal mitochondrial targeting in SARS-CoV-2 infection affects cognitive processes to induce brain fog and results in behavioral changes that favor viral survival. All data and examination findings are stored in accordance with the data protection guidelines of the LMU. The ACE2 receptor is found in many different tissues such as nasal mucosa, lung, stomach colon and many more showing the multiple points to attack during infection [21]. de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C, Enjuanes L, et al. Comparison of the parafoveal vessel density a TOPCON Display Grid parafoveal showing 5 parts b+c Box plots showing the comparison of each part of 14 not hospitalised (middle, cross-striped) and 26 hospitalised (right, lengthwise-striped) eyes compared to 50 control eyes (left, clear). Nat Med. The role of apoptosis within the retina of coronavirus-infected mice. The frequency (n=63) of myopia (sph eq<-0.50D) and hyperopia (sph eq>+0.50D) was respectively 31.7% and 41.2% and seems not to be different when compared to prevalence data on refractive errors. Case report details. Nature. 15, 539574. 2020. J Virol. Research suggests that between one month and one year after having COVID-19, 1 in 5 people ages 18 to 64 has at least one medical condition that might be due to COVID-19. Balachandar V, Mahalaxmi I, Subramaniam M, Kaavya J, Senthil Kumar N, Laldinmawii G, et al. Two patients (9.5%) had a history of glaucoma disease, one (4.8%) of optic disc drusen and one (4.8%) of retinal detachment in one eye. I did these treatments five days a week and have seen improvement. This study with a small prospective cohort of 21 patients indicates that there might be no evidence of ocular complications at 3months after recovery from COVID-19, without previous eye involvement. In humans, beside of keratoconjunctivitis, retinal involvement like Cotton wool spots [28] (CWS), microhaemorrhages [29], vascular occlusions [30] or hyperreflective foci [31] has been reported in COVID-19 patients. Gene polymorphisms in angiotensin I converting enzyme (ACE I/D) and angiotensin II converting enzyme (ACE2 C-->T) protect against cerebral malaria in Indian adults - PubMed https://pubmed.ncbi.nlm.nih.gov/20117248/ (Accessed 11 2 2021). Springer Nature. de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C, Enjuanes L, Fouchier RAM, Galiano M, Gorbalenya AE, Memish ZA, Perlman S, Poon LLM, Snijder EJ, Stephens GM, Woo PCY, Zaki AM, Zambon M, Ziebuhr J. CAS JAMA Ophthalmol. Together, they were able to work through a treatment plan to help Mark on his road to recovery. J Med Virol. The mean age (SD) of the patients was 48.7 (18.3) years. Travel reimbursement from D.O.R.C. https://doi.org/10.1128/JVI.01244-13. As the Pearson correlation for refractive errors between RE and LE was 0.85, we analyzed only the RE. 2020;395(10223):497506. 2020;98(3):e388. These include difficulty getting through normal activities . 2020. By using this website, you agree to our Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrae 8, 80336, Munich, Germany, Victor Brantl,Benedikt Schworm,Gregor Weber,Johannes Schiefelbein,Thomas C. Kreutzer,Stylianos Michalakis,Jakob Siedlecki&Siegfried G. Priglinger, You can also search for this author in Eye-related symptoms of coronavirus can include burning eyes, itchy eyes, red eyes, sore eyes, puffy eyes, swollen eyelids and watery eyes. PubMed The most common symptom of an eye stroke is sudden, painless vision loss. Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia | NEJM. Article Have you ever been diagnosed (by a clinician) as having dry eye syndrome? Not hospitalized patients were examined a mean of 123.444.7days after their first positive COVID-19 test or positive test for IgG against SARS-CoV-2. Expression analysis of 2019-nCoV related ACE2 and TMPRSS2 in eye tissues. Insausti-Garca A, Reche-Sainz JA, Ruiz-Arranz C, Lpez Vzquez , Ferro-Osuna M. Papillophlebitis in a COVID-19 patient: inflammation and Hypercoagulable state. Inflamm. CAS Mendelson M, Nel J, Blumberg L, Madhi SA, Dryden M, Stevens W, et al. Due to the randomized recruitment of patients, unfortunately no patients with acute phase ocular lesions were included in this study. PubMed https://doi.org/10.1038/s41591-021-01283-z (2021). Our data shows a higher previous diagnosis of dry eye or severe symptoms, especially in women (38.7%), which may be due to a more advanced age of the female patients (54.214.7 years) in this sample. 2000;41(10):30118. 10.1038/s41433-020-1084-9. 2020;729:139021. https://doi.org/10.1016/j.scitotenv.2020.139021. Arq. First studies on COVID-19 showed that ocular manifestations can occur during an acute infection with signs of keratoconjunctivitis in 15.631.6% and positive conjunctival swabs tests in only 3.35.2% [14, 15]. Silva LS, Silva-Filho JL, Caruso-Neves C, Pinheiro AAS. Considering that there were 19 patients with diabetes mellitus, the frequency of non-proliferative diabetic retinopathy in this sample was (10/19) 52.7%. Correspondence to The authors declare no competing interests. These authors contributed equally: Fernando Bellissimo-Rodrigues and Rosalia Antunes-Foschini. Mendelson M, Nel J, Blumberg L, Madhi SA, Dryden M, Stevens W, Venter FWD. Highest levels of inflammation markers were seen in two hospitalized patients (9.5%) who received intensive care ventilation in mean (SD) for 8.5 (0.7) days because of ARDS. Long-COVID: an evolving problem with an extensive impact. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://www.nejm.org/doi/full/10.1056/nejmoa1211721, https://pubmed.ncbi.nlm.nih.gov/20117248/. https://doi.org/10.1002/jmv.26229 (2020). 2004;203(2):6317. But it'll still take time to recover. Other reported systemic symptoms include shortness of breath, chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thromboembolic conditions, depression, and other mental health conditions10,11,12. Symptoms may include: Tearing or watery eyes These lesions showed hyporreflectivity of the retinal pigment epithelium and ellipsoid layers and discontinuation of photoreceptors outer segments in SD-OCT, and transmission hyperfluorescence in fluorescein angiography. J. Thromb. Hoffmann M, Kleine-Weber H, Schroeder S, Krger N, Herrler T, Erichsen S, et al. We included 64 patients (128 eyes). Immunol. As a library, NLM provides access to scientific literature. Coronavirus can certainly enter the body through the eyes (as well as the nose and mouth). JMIR Public Health Surveill 6, e19462. CAS Expression analysis of 2019-nCoV related ACE2 and TMPRSS2 in eye tissues. And it can be spread by coughs and sneezes. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, Peoples republic of China, in February, 2003. Interestingly, none of our patients reported ocular complaints like conjunctivitis, eye redness or visual impairment during or after COVID-19 infection. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Article Interestingly, one not hospitalized patient experienced extended loss of olfactory sensation for at least 1.5months. Ophthalmol. A first step in understanding SARS pathogenesis. ISSN 2045-2322 (online). They were classified into mild-to-moderate (mild symptoms, no need for oxygen support or hospitalization); severe (severe symptoms, required hospitalization, most of them requiring oxygen support); and critical (severe symptoms, required hospitalization and intensive care, intubation and/or had specific complications)14. Seah I, Agrawal R. Can the Coronavirus Disease 2019 (COVID-19) affect the eyes? https://doi.org/10.1056/NEJMsb2005114. Li Wenliang, a face to the frontline healthcare worker The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak. Benito-Pascual, B. et al. https://doi.org/10.5935/0004-2749.20170005 (2017). Terms and Conditions, Article Patients who had been tested positive for SARS-CoV-2 or for anti-SARS-CoV-2 IgG serum antibodies in the Hospital of the Ludwig Maximilians University, Munich between May and September. At first, diabetic retinopathy might cause no symptoms or only mild vision problems. Mean visual acuity was 1.040.2 on the right and 1.010.2 on the left eye. Before contracting COVID-19 I wore glasses, but the difficulty I had seeing was unlike anything Id experienced before. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, Si H-R, Zhu Y, Li B, Huang C-L, Chen H-D, Chen J, Luo Y, Guo H, Jiang R-D, Liu M-Q, Chen Y, Shen X-R, Wang X, Zheng X-S, Zhao K, Chen Q-J, Deng F, Liu L-L, Yan B, Zhan F-X, Wang Y-Y, Xiao G-F, Shi Z-L. A pneumonia outbreak associated with a new coronavirus of probable bat origin. All data and examination findings are stored in accordance with the data protection guidelines of the LMU. Wolffsohn, J. S. et al. Long-COVID: an evolving problem with an extensive impact. Surv. Possibly a percentage of this complaint may be related to previous uncorrected refractive errors since presenting visual acuity and DBCVA statistically improved in all the groups, except for the LE in the mild-to-moderate group. Compared to control (mean age 52.0 SD 16.4) the non hospitalized group show a significant higher central vessel density. Article https://doi.org/10.1016/j.plipres.2021.101092 (2021). 2020. https://doi.org/10.1001/jamaophthalmol.2020.1291. Therefore, this prospective cross-sectional study sought to examine potential long-term functional and morphological impairment in eyes of COVID-19 patients 3 months after recovery. 2016;5:103. https://doi.org/10.3389/fcimb.2015.00103. For OCT, 3D-Scan mode was used, covering the central 6mm of the macula equalling 320320 pixels. Sci Total Environ. A cluster of cases of severe acute respiratory syndrome in Hong Kong. Recently, the post-COVID syndrome (PCS) or post-COVID condition13 has been proposed, taking into account the high frequency (from 10 to 35%) of people affected by SARS-CoV-2 that persist with symptoms after the disease's acute phase14.

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