Pupil responses in patients with COVID-19

Manifestations of coronavirus infection disease-19 in anterior eye segment: An up-to-date review

Coronavirus infection disease-19 (COVID-19) is a worldwide catastrophic emergency that first appeared in late 2019, in Wuhan, China. COVID-19 is a multitropism disease that first affects lung tissue. However, extrapulmonary manifestations have been suspected from the first COVID-19 cases. The ocular signs and symptoms were from the early changes that occur during the course of the disease. Changes in the anterior eye segment have a relatively higher incidence than the posterior eye segment. Of which, conjunctivitis, COVID-19 pharyngioceratoconjuctivitis, iridocyclitis, corneal punctate epitheliopathy, and pathomorphological changes in the physio-anatomy of the anterior eye segment. The potential pathogenesis includes direct penetration of the virus into the eye (conjunctiva, lumbus, and cornea) or due to a systemic pathway through viremia, as well as due to autoimmune antibodies against the ocular structure (immune privilege). The presence of ocular manifestations of the external anterior fibrous layer suggests a mild course of the disease.

Virtual reality for assessing stereopsis performance and eye characteristics in Post-COVID

In 2019, we faced a pandemic due to the coronavirus disease (COVID-19), with millions of confirmed cases and reported deaths. Even in recovered patients, symptoms can be persistent over weeks, termed Post-COVID. In addition to common symptoms of fatigue, muscle weakness, and cognitive impairments, visual impairments have been reported. Automatic classification of COVID and Post-COVID is researched based on blood samples and radiation-based procedures, among others. However, a symptom-oriented assessment for visual impairments is still missing. Thus, we propose a Virtual Reality environment in which stereoscopic stimuli are displayed to test the patient's stereopsis performance. While performing the visual tasks, the eyes' gaze and pupil diameter are recorded. We collected data from 15 controls and 20 Post-COVID patients in a study. Therefrom, we extracted features of three main data groups, stereopsis performance, pupil diameter, and gaze behavior, and trained various classifiers. The Random Forest classifier achieved the best result with 71% accuracy. The recorded data support the classification result showing worse stereopsis performance and eye movement alterations in Post-COVID. There are limitations in the study design, comprising a small sample size and the use of an eye tracking system.

Refractive error changes and associated asthenopia observed after COVID-19 infection: Case reports from two continents

COVID-19 infection has been linked to various ocular complications and complaints, but not to refractive errors. In this case report, we present ethnically diverse patients who reported asthenopic symptoms shortly after recovering from COVID-19 infection. The hyperopic shift in the refractive error, post-COVID could indicate the ciliary body muscle's inability to sustain accommodation, resulting in asthenopia. Hence, refractive errors should also be considered as a post-COVID complication, even if the magnitude is small, especially when patients have a headache and other asthenopic symptoms. Performing dynamic retinoscopy and cycloplegic refraction will also aid in the better management of these patients.

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.