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

Purpose: The current severe acute respiratory syndrome coronavirus 2 (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 tear film has ramifications for 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 knowledge of ophthalmic manifestations of SARS-CoV-2 infection in patients and animal models, risk-mitigation measures for patients and providers, and implications for retina specialists. Results: SARS-CoV-2 is efficiently transmitted among humans, and although the clinical course is mild in most infected patients, severe complications including pneumonia, acute respiratory distress syndrome, and death can ensue, most often in elderly patients and individuals with comorbidities. Conjunctivitis occurs in a minority of patients with COVID-19, and SARS-CoV-2 RNA has been identified primarily with conjunctivitis. Uveitis has been observed in animal models of coronavirus infection, and cotton-wool spots have been reported recently. Conclusions: SARS-CoV-2 and other coronaviruses have been rarely associated with conjunctivitis. 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 specialists. Disease surveillance during the COVID-19 pandemic may also include ongoing evaluation for uveitis and retinal disease given prior findings from animal models and a recent report of retinal manifestations.