Pooled Prevalence Estimate of Ocular Manifestations in COVID-19 Patients: A Systematic Review and Meta-Analysis

• Published in: Iranian journal of medical sciences 2022-01, Vol.47 (1), p.2-14
• Main Authors: Soltani, Saber, Zandi, Milad, Ahmadi, Seyed-Esmaeil, Zarandi, Bahman, Hosseini, Zeinab, Akhavan Rezayat, Sara, Abyadeh, Morteza, Pakzad, Iraj, Malekifar, Pooneh, Pakzad, Reza, Mozhgani, Sayed-Hamidreza
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - therapy; Diplopia; Disease transmission; Epidemiology; Eye Diseases - epidemiology; Eye Diseases - virology; eye manifestations; Health aspects; Humans; Medical Subject Headings-MeSH; Meta-analysis; Ocular manifestations of general diseases; Prevalence; Public health; Research centers; Review; sars-cov-2; Science; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Systematic review; Virology; Viruses
• ISSN: 0253-0716; 1735-3688
• DOI: 10.30476/ijms.2021.89475.2026

There are reports of ocular tropism due to respiratory viruses such as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Various studies have shown ocular manifestation in coronavirus disease-2019 (COVID-19) patients. We aimed to identify ophthalmic manifestations in COVID-19 patients and establish an association between ocular symptoms and SARS-CoV-2 infection. A systematic search of Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted for publications from December 2019 to April 2021. The search included MeSH terms such as SARS-CoV-2 and ocular manifestations. The pooled prevalence estimate (PPE) with 95% confidence interval (CI) was calculated using binomial distribution and random effects. The meta-regression method was used to examine factors affecting heterogeneity between studies. Of the 412 retrieved articles, 23 studies with a total of 3,650 COVID-19 patients were analyzed. The PPE for any ocular manifestations was 23.77% (95% CI: 15.73-31.81). The most prevalent symptom was dry eyes with a PPE of 13.66% (95% CI: 5.01-25.51). The PPE with 95% CI for conjunctival hyperemia, conjunctival congestion/conjunctivitis, and ocular pain was 13.41% (4.65-25.51), 9.14% (6.13-12.15), and 10.34% (4.90-15.78), respectively. Only two studies reported ocular discomfort and diplopia. The results of meta-regression analysis showed that age and sample size had no significant effect on the prevalence of any ocular manifestations. There was no significant publication bias in our meta-analysis. There is a high prevalence of ocular manifestations in COVID-19 patients. The most common symptoms are dry eyes, conjunctival hyperemia, conjunctival congestion/conjunctivitis, ocular pain, irritation/itching/burning sensation, and foreign body sensation.