Ocular transmission and manifestation for coronavirus disease: a systematic review

Int Health. 2022 Mar 2;14(2):113-121. doi: 10.1093/inthealth/ihab028.


Background: There is currently a lack of information regarding ocular tropism and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Globally, the cumulative number of coronavirus disease 2019 (COVID-19) cases is increasing daily. Thus the potential for ocular transmission and manifestations of SARS-CoV-2 requires more investigation.

Methods: A systematic search of electronic databases for ocular transmission and manifestations of SARS-CoV-2 was performed. Pooled cross-sectional studies were used for conducting a meta-analysis to estimate the prevalence of ocular transmission of SARS-CoV-2 to the respiratory system and ocular manifestations (associated symptoms) of SARS-CoV-2.

Results: The highest prevalence of SARS-CoV-2-positive tears using reverse transcription polymerase chain reaction was found to be 7.5%. However, the highest prevalence of ocular conjunctivitis associated with SARS-CoV-2 was 32%. Thus, SARS-CoV-2 can evidently infect the eye, as revealed in the conjunctival secretions of COVID-19 patients.

Conclusion: The available data reflect the influence of the ocular structure on SARS-CoV-2. The analysis showed that ocular manifestation is an indication for SARS-CoV-2, particularly conjunctivitis. Moreover, there is no evidence that the ocular structure can be an additional path of transmission for SARS-CoV-2, however, it warrants further investigation.

Keywords: COVID-19; SARS-CoV-2; conjunctival swabs; conjunctivitis; coronavirus; nasopharyngeal swabs; ocular manifestation; ocular transmission; tears.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • COVID-19*
  • Conjunctiva
  • Cross-Sectional Studies
  • Humans
  • SARS-CoV-2
  • Tears