Ocular manifestations of COVID-19: A systematic review of current evidence

Introduction

COVID-19 caused by SARS-CoV-2, commonly presents with symptoms such as fever and shortness of breath but can also affect other organs. There is growing evidence pointing to potential eye complications. In this article, we aim to systematically review the ocular manifestations of COVID-19.

Methods

We conducted a systematic review to explore the ocular manifestations of COVID-19. We searched online databases including PubMed, Embase, Scopus, and Web of Science up to September 4, 2023. After a two-stage screening process and applying inclusion/exclusion criteria, eligible articles were advanced to the data extraction phase. The PRISMA checklist and Newcastle-Ottawa Scale (NOS) were used for quality and bias risk assessments.

Results

We selected and extracted data from 42 articles. Most of the studies were cross-sectional (n = 33), with the highest number conducted in Turkey (n = 10). The most frequent ocular manifestation was conjunctivitis, reported in 24 articles, followed by photophobia, burning, chemosis, itching, and ocular pain. Most studies reported complete recovery from these manifestations; however, one study mentioned visual loss in two patients.

Conclusion

In general, ocular manifestations of COVID-19 appear to resolve either spontaneously or with supportive treatments. For more severe cases, both medical treatment and surgery have been employed, with the outcomes suggesting that complete recoveries are attainable.

Cat-scratch disease manifesting as uveitis and binocular fundus nodular lesions: a case report

BACKGROUND

Cat-scratch disease typically presents with various ocular manifestations such as uveitis, vitritis, retinitis, retinochoroiditis, and optic neuritis. However, fundus nodular lesions was rarely reported. In our study, we reported a case of Cat-Scratch disease with binocular fundus nodular lesions.

CASE PRESENTATION

An 11-year old male presented with uveitis in the right eye and bilateral fundus nodular lesions after indirect contact with unvaccinated cats. Comprehensive ancillary examinations including wide-angle fundus photography, ultrasonography, fluorescein fundus angiography, optical coherence tomography, and orbital magnetic resonance imaging were performed to elucidate the multidimensional features of the binocular lesions. Metagenomics next-generation sequencing was utilized to confirm the diagnosis of Cat-scratch disease. The patient's condition showed improvement after a 6-month combination treatment regimen involving systemic administration of doxycycline hyclate and methylprednisolone tablets, as well as local application of mydriatic and corticosteroid eye drops.

CONCLUSIONS

We firstly reported a case of Cat-scratch disease presenting simultaneously with uveitis and fundus nodular lesions caused by Bartonella henselae infection in a child. Timely diagnosis and treatment with antibiotics and corticosteroids showed promising outcomes for the prognosis of these ocular disorders.

Autoimmune Inflammatory Eye Disease: Demystifying Clinical Presentations for the Internist

PURPOSE OF REVIEW

Provide a framework for recognizing key symptoms and clinical findings in patients with autoimmune inflammatory eye disease.

RECENT FINDINGS

The most common manifestations of autoimmune inflammatory eye disease are episcleritis, scleritis, uveitis (anterior, intermediate, posterior, and panuveitis), and keratoconjunctivitis sicca. Etiologies can be idiopathic or in association with a systemic autoimmune condition. Referral of patients who may have scleritis is critical for patients presenting with red eyes. Referral of patients who may have uveitis is critical for patients presenting often with floaters and vision complaints. Attention should also be directed to aspects of the history that might suggest a diagnosis of a systemic autoimmune condition, immunosuppression, drug-induced uveitis, or the possibility of a masquerade condition. Infectious etiologies should be ruled out in all cases. Patients with autoimmune inflammatory eye disease may present with ocular or systemic symptoms alone, or in combination. Collaboration with ophthalmologists and other relevant specialists is vital to optimal long-term medical care.

Ocular manifestations in IgA nephropathy

Immunoglobulin A nephropathy (IgAN) is a rare but important systemic disease with or without ocular manifestations. We describe 4 cases of IgAN presenting with scleritis and review the various ocular manifestations in patients with IgAN. We found 55 cases with ocular manifestations in patients with prior or newly-diagnosed IgAN described in 38 publications. The most common ocular manifestations of IgAN were episcleritis (23.6%), scleritis (16.4%), hypertensive retinopathy or retinal vasculopathy (20.0%), and uveitis (14.5%). The median age at presentation was 36.5 years, with 54.5% female patients. 61.8% had history of IgAN prior to ocular involvement, while 29.1% had ocular presentations as the first manifestation of IgAN. The majority received systemic corticosteroids and/or immunosuppressants. Additionally, we report 4 women with anterior scleritis and previous diagnosis of IgAN. All 4 were treated with topical and systemic corticosteroids. Three out of 4 patients had no recurrence for at least 1 year since the first presentation. IgAN is a rare but important systemic association to be considered in ocular inflammatory conditions. Timely recognition and comanagement of the disease with nephrologist could reduce disease morbidity.

Treatment of ocular-involving monkeypox virus with topical trifluridine and oral tecovirimat in the 2022 monkeypox virus outbreak

Purpose

To report a case of ocular involving monkeypox infection in the United States during the 2022 outbreak, and to review the literature regarding its clinical manifestations and management known to date.

Observations

A 36-year-old man with well controlled HIV presented to the emergency department with anal pain, diffuse rash, right eye pain, and right eye redness after he tested positive for monkeypox one week prior. Ocular examination showed bilateral periorbital vesicular lesions, right eye conjunctival injection, and a single white plaque on his right medial bulbar conjunctiva. Macular, vesicular, and pustular lesions were noted throughout his body, including the genital and perianal region. His ocular and systemic symptoms completely resolved after treatment with a ten-day course of 1% trifluridine and moxifloxacin drops in both eyes, as well as two weeks of oral tecovirimat.

Conclusion and Importance

In July of 2022, monkeypox virus was declared a global health emergency by the World Health Organization; however, there are no standard guidelines for monkeypox treatment. Data on its clinical presentation and course, especially pertaining to ocular manifestations, is limited. We highlight the importance of recognizing ophthalmic manifestations of monkeypox virus and a possible therapeutic approach to help guide the management of these patients.

A Review of Monkeypox Ocular Manifestations and Complications: Insights for the 2022 Outbreak

Monkeypox (MPVX) infection has been associated with multiorgan presentations. Thus, monkeypox infection's early and late complications are of particular concern, prompting health systems to decipher threatening sequels and their possible countermeasures. The current article will review the clinical signs and symptoms of the present and former outbreaks, differential diagnoses, workup and treatment of the ocular manifestations of MPXV infection in detail. One of the uncommon yet considerable MPXV complications is ocular involvement. These injuries are classified as (1) more frequent and benign lesions and (2) less common and vision-threatening sequels. Conjunctivitis, blepharitis and photophobia are the most uncomplicated reported presentations. Moreover, MPXV can manifest as eye redness, frontal headache, orbital and peri-ocular rashes, lacrimation and ocular discharge, subconjunctival nodules and, less frequently, as keratitis, corneal ulceration, opacification, perforation and blindness. The ocular manifestations have been less frequent and arguably less severe within the current outbreak. Despite the possibility of underestimation, the emerging evidence from observational investigations documented rates of around 1% for ocular involvement in the current outbreak compared to a 9-23% incidence in previous outbreaks in the endemic countries. The history of smallpox immunization is a protective factor against these complications. Despite a lack of definite and established treatment, simple therapies like regular lubrication and prophylactic use of topical antibiotics may be considered for MPXV ocular complications. Timely administration of specific antivirals may also be effective in severe cases. Monkeypox usually has mild to moderate severity and a self-limited course. However, timely recognition and proper management of the disease could reduce the risk of permanent ocular sequelae and disease morbidity.

COVID-19 and ocular complications: A review of ocular manifestations, diagnostic tools, and prevention strategies

Background

The novel severe acute respiratory syndrome coronavins 2 (SARS-CoV-2) led to the severe Corona Virus Disease 2019 (COVID-19) outbreak that started in December 2019 in China and caused enormous health and economic problems worldwide. Over time, SARS-CoV-2 has demonstrated the capacity for mutation. As the most prevalent new coronavirus variety worldwide, the Omicron variant has supplanted the Delta variant. The COVID-19 primarily damages the immune system and the lungs, but it can also harm other organs secondarily, depending on the patients' co-existing conditions.

Main Text

COVID-19 is associated with ophthalmic manifestations such as conjunctival congestion, tear overflow, and conjunctival edema, with the majority of eye complications occurring in patients with severe infection. The virus may make a patient more susceptible to thrombotic conditions that affect venous and arterial circulation. Meanwhile, it can lead to efferent complications and mucormycosis which is more common in patients with diabetes or who have critical or severe SARS-CoV-2 infection. Significantly, there are a number of ocular side effects following the COVID-19 vaccination, such as herpetic keratitis and facial nerve palsy, which have been reported. These side effects may be caused by the vaccinations' propensity to trigger autoimmune symptoms or thromboembolic events. At present, large-scale nucleic acid testing mainly relies on nasopharyngeal swabs and throat swabs. Tear samples and conjunctival swabs may be helpful samples for the diagnosis of ocular SARS-CoV-2 infection. The eye could be a new route of infection, and finding ways such as effective environmental disinfection, scientific administrative control management, qualified personal protection and other measures to protect the eyes could further reduce the risk of infection.

Conclusions

This review aims to sum up the ocular complications of COVID-19, the possible pathogenesis, and preventive strategies to protect ophthalmology practitioners and patients by reviewing the currently available literature on the topic.

Covid-19 and its relation to the human eye: transmission, infection, and ocular manifestations

BACKGROUND

The world is suffering from a new strain of the coronavirus family-Covid-19. This virus strain affected different organs in the human body with a wide range of mild symptoms and moderate signs to severe and deadly ones. Multiple organs can be infected, and one of these organs is the eye. The eye is a vital organ that consists of vascular tissues and is connected to the respiratory tract through the tears and the nasolacrimal duct.

METHODS

Recent papers and research from PubMed, Researchgate, and Google Scholar were cited and thoroughly discussed. These papers were chosen based on their relevancy, reliability, publication year, published journal, and ease of accessibility to the paper itself.

RESULTS

The theory concluded that the ocular surface might consider a pathway for the virus attack and infection causation through the tears and the angiotensin-converting enzyme 2 located in the eye. This article thoroughly reviewed the history, the existing aspects of Covid-19, the ocular system features, and the claims about the possible involvement of the eye in the virus transmission along with the eye infection. There was no consensus on the eye's involvement theory.

CONCLUSION

The authors highlighted the extra work and research needed to be conducted to prove or deny these claims to provide a better understanding of the immune response of the eye to Covid-19 infection.

An observational study on ocular manifestations in patients of psoriasis in a tertiary care hospital in western India

Background

The aim of the study is to observe the ocular manifestation in patients of psoriasis.

Methods

All the diagnosed cases of Psoriasis by the dermatology department of this tertiary care hospital were included in this study. Relevant details of the history pertaining to disease duration, type of psoriasis, and treatment undertaken including ocular symptoms were obtained. Disease severity was quantified using the PASI score. Complete ocular examination including intraocular pressure, Schirmer I and II tests, Tear Film Breakup Tme (TBUT); was carried out for all the patients.

Results

Of 126 patients of psoriasis, ocular manifestations were seen in 76 patients (60.3%). Dry eyes (27%) and blepharitis (15.9%) were the most common ocular manifestations. Uveitis was seen in 3.2% of the patients of which 75% patients were HA B27-positive psoriatic arthritis, which was statistically significant (p = 0.001). There was no statistical correlation between duration of the disease and ocular manifestations (p value is 0.077 using chi square test). The ocular manifestations were more common in patients with PASI score 10 when compared with the patients with PASI score 10 (p value = 0.028) which was statistically significant.

Conclusions

In our study, prevalence of ocular manifestation was 60.3% which increased with the increasing PASI score. Dry eyes and blepharitis were the most common manifestations. Hence, routine ocular examination is recommended in patients with psoriasis.

The Association of Clinical Symptoms and Coexistent Clinical Conditions with Ophthalmic Manifesting in COVID-19 Patients

Background

The ocular symptoms are common manifestations in coronavirus infectious disease 2019 (COVID-19), which faces secondary complications and therapeutic challenges. Underlying diseases actuate the body to infectious diseases and their related manifestations through the aberration of metabolism and suppressing the immune system. This study aimed to investigate the correlation of underlying diseases and ocular manifestations in COVID-19 patients.

Methods

This cross-sectional study was held on 108 hospitalized COVID-19 patients (confirmed by molecular detection) admitted to Rouhani hospital, Babol, Iran. Upon hospitalization, all clinical symptoms and underlying diseases were registered. Detailed clinical examinations regarding ophthalmological protocols were used to investigate the ocular symptoms. All analyses were performed by SPSS, version 25.

Results

Our results showed that 26.67% of patients with at least one ocular symptom had hyperlipidemia, while 10.42% of patients without any ocular symptoms had hyperlipidemia (P=0.049). In this study, 97.81% of COVID-19 patients without epiphora had no thyroid disorders (hyper-/hypo-thyroidism), while 82.35% of COVID-19 patients with epiphora had not any thyroid disorders (P=0.012). Also, 75.00% of patients with blurred vision had diabetes mellitus, while 35.00% of patients without blurred vision suffered from diabetes mellitus. This difference was borderline significant (P=0.051). Other results showed that 13.04% of COVID-19 patients with eye redness suffer from myalgia, while 35.29% of patients without eye redness had myalgia (P=0.044). Also, 35.11% of COVID-19 patients without photophobia had myalgia, while none of the patients with photophobia had myalgia (P=0.005). Finally, 70.00% of patients with respiratory distress had at least one ocular symptom, while 43.10% of patients without respiratory distress had at least one ocular symptom (P=0.007).

Conclusion

Some underlying diseases, e.g., hyperlipidemia, diabetes mellitus, and thyroid disorders, and some clinical symptoms in hospitalized patients, e.g., myalgia and respiratory distress, are correlated with ocular manifestations in COVID-19 patients.

Retinopathy in newly-diagnosed systemic lupus erythematosus: should we screen for ocular involvement?

Background

Ocular manifestations are common in systemic lupus erythematosus (SLE). Retinopathy has previously been linked to disease severity and might have a significant impact on the patient’s quality of life and has also been associated with a poor prognosis in SLE. This study aimed to determine the prevalence of retinopathy among patients who are newly diagnosed with SLE.

Methods

In a cross-sectional study, patients diagnosed with SLE at a tertiary referral clinic were assessed for inclusion between March 2016 and March 2017. Patients who had received treatment for SLE at any time were excluded, as well as patients with hypertension, diabetes mellitus, and coagulopathy. Clinical findings and laboratory test results were recorded, and patients were examined by an ophthalmologist for evidence of retinal pathologies. SLE disease activity index was also calculated for all patients.

Results

With 114 patients included in the final analysis, we found a prevalence of 15.8% for retinopathy among newly-diagnosed SLE patients. Cotton-wool spots were the most common finding (78%). Patients with retinopathy had significantly lower hemoglobin levels, C3 and C4 concentrations, and higher ANA and Anti-dsDNA levels. Also, patients with retinopathy had a significantly higher SLE DAI score.

Conclusions

We found a relatively high rate of retinopathy in SLE patients at the time of their initial diagnosis. Our findings suggest that retinopathy is an early manifestation of the disease. Ophthalmologic screening might be considered for SLE patients at the time of diagnosis, especially for those with severe disease. We also encourage researchers to further evaluate the correlation between retinopathy and disease activity, and the prognosis of ocular involvement.

New Insights into Ocular Complications of Human Immunodeficiency Virus Infection

HIV/AIDS continues to be a major global public health issue, affecting multiple organs such as the eyes. With the advent of highly active antiretroviral therapy (HAART), the incidence has dropped but HIV ocular complications still remain a major cause of vision impairment in HIV-positive individuals. Since modern medical interventions nowadays can change this previously fatal infection into a chronic disease and enable people living with HIV for relatively long and healthy lives, recent studies update the incidence of HIV-related ocular manifestations which has reached 70% among HIV patients. The primary ocular disorders induced by HIV are various and the clinical ocular findings are similar which may be a problem to diagnose in the setting of disease. In our discussion, these complications are classified by etiology, for example noninfectious microvasculopathy resulting from direct invasion of the HIV, HIV-associated opportunistic infections caused by virus such as cytomegalovirus and varicella-zoster virus, fungus for example candida and cryptococcus, bacteria like mycobacterium, parasites such as toxoplasma and pneumocystis, and other pathogens, and infiltration lesions like lymphoma and Kaposi sarcoma. In order to get a better understanding of HIV ocular complications, we focus on HIV-related ocular complications in the HAART era with an emphasis on current incidence, clinical manifestations, ocular examination findings, differential diagnosis, treatment, and prognosis. In addition, we discuss the possibility of virus reservoir in eyes which makes HIV-related oculopathy still ubiquitous even after successful systemic treatment.

Ocular manifestation of rickettsial disease in South Indian population

Purpose

The aim of this work was to study the ocular manifestations and its management in spotted fever and typhus group of rickettsial disease.

Methods

A retrospective analysis of 50 patients with serologically confirmed Rickettsial disease. In all patients, relevant history, investigations and treatment details were collected and they underwent complete ophthalmic evaluation including measurement of best-corrected visual acuity, anterior segment examination and dilated fundus examination.

Results

Mean age was 12.5 ± 8.99 years. Of the 50 patients, 40 patients were ≤18 years of age and 27 (54%) had ocular involvement. Out of 27 patients, bilateral involvement was seen in 10 patients. Most of the patients had no ocular symptoms. Ocular findings included, Retinal vasculitis 6 (22.22%); macular edema 4 (14.81%); vasculitis with macular edema 1 (3.7%); Retinitis 7 (25.92%); Papilloedema 6 (22.22%); Papilloedema with 6^th cranial nerve palsy 1 (3.7%); Isolated 6^th cranial nerve palsy 1 (3.7%) and optic neuritis 1 (3.7%). Ocular involvement was more common in double antigen group (68%) than spotted fever group (50%) or Scrub typhus group (21%) (P = 0.01). Ocular involvement was seen in 94% of the patients with CNS involvement. Cases with bilateral involvement (P = 0.01), pediatric age group (P = 0.01) and CNS involvement (P = 0.02) had poor visual outcome.

Conclusion

Rickettsioses patients can have ocular manifestations with predominant posterior segment involvement during acute phase of illness. Ocular involvement was more common in the double antigen group. For any patient who presents with fever and rash living in endemic area, ophthalmic evaluation should be part of routine checkup during the acute phase of illness associated with less frequent ocular symptoms.

Current concepts in the diagnosis and management of antiphospholipid syndrome and ocular manifestations

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with obstetrical complications, thrombotic complications involving both arteries and veins, and non-thrombotic manifestations affecting multiple other systems presenting in various clinical forms. Diagnosis requires the presence of antiphospholipid antibodies. The exact pathogenesis of APS is not fully known. However, it has recently been shown that activation of different types of cells by antiphospholipid antibodies plays an important role in thrombosis formation. Ocular involvement is one of the important clinical manifestations of APS and can vary in presentations. Therefore, as an ophthalmologist, it is crucial to be familiar with the ocular findings of APS to prevent further complications that can develop. Furthermore, the ongoing identification of new and specific factors contributing to the pathogenesis of APS may provide new therapeutic options in the management of the disease in the future.

Acute and Chronic Ophthalmic Involvement, Severity, and Sequelae in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Purpose

To study the ocular manifestations, its severity and sequelae in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Methods

Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. Patients were evaluated by dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailed history taking, visual acuity, ophthalmic evaluation (lid margin, corneal, conjunctival changes, tear film and ocular surface). Ocular severity score (OSS) was assessed at baseline (acute) and at 6 months (chronic / OSS6), graded as mild, moderate and severe.

Results

Mean age was 28.15 ± 15.78 years. Sixty-five eyes of 33 patients were included for final analysis. Thirty-eight patients (86.4%) had ocular manifestations. Drugs were the most common causative factor (95.4%). At base line mild, moderate, and severe OSS was seen in 43.1%, 44.6%, and 12.3% eyes. At 6 months mild, moderate, and severe OSS was seen in 44.6%, 7.7%, and 6.2% of eyes. There was a significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger age had higher chronic OSS. Patients with TEN had higher acute (p = 0.001) and chronic (p = 0.001) OSS than SJS. Three mucosal surface involvement associated with higher acute and chronic OSS (p = 0.001). No long-term ocular complications observed in 27 / 65 (41.5%) eyes. Acute OSS correlated significantly with chronic OSS, at 1 and 6 months (p = 0.001).

Conclusions

Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlated with more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement in acute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated with severity of ocular sequelae.

Ocular manifestations of SARS-CoV-2: Literature review

In this review, a summary is presented of the main reports regarding the potential ocular manifestations of the new coronavirus disease (COVID-19). Scientific evidence is based on letters to the editor, clinical cases and case series, cross-sectional, and a few longitudinal studies. To date, it includes viral conjunctivitis, immune conjunctivitis, and oculomotor palsies (OCP) due to the novel coronavirus. Retinopathy is discussed. A viral conjunctivitis outbreak can be isolated or associated with the systemic picture, mainly pulmonary, before or after the onset of respiratory symptoms. It can be both unilateral and bilateral, follicles are typical, and duration is variable between 5 and 21 days. Immune-mediated conjunctivitis consists of eye redness, together with erythroderma and fever. It appears more frequently in children, and has been associated with a «Kawasaki-like» disease and toxic shock syndrome. OCP can present on its own, or as part of Miller-Fisher syndrome, along with ataxia, and hyporeflexia. Ophthalmologists have a considerable risk of developing COVID-19 due to close contact with the patient, exposure to tears and eye secretions, and the use of various pieces of equipment and devices susceptible to contamination.

Ocular Manifestations: Are They Significant in Hypertensive Disorders of Pregnancy?

Background

Hypertensive disorders of pregnancy lead to pathological changes in various organ systems of mother and fetus which contributes to maternal and fetal morbidity and mortality. It is a multisystem disorder which can involve end organs like kidneys, liver, eyes, hemopoietic system and placenta. Retinal involvement, though quite common, is rarely investigated. It is a unique site where the blood vessels can be directly observed. Observing retinal vasculature may provide clue to status of similar vessels in other parts of body including placental circulation.

Methods

Hospital-based descriptive study which included 150 patients diagnosed as preeclampsia/eclampsia, who were admitted in the intensive care unit. Written consent was obtained from study subjects. Data were collected by history taking and examination of the subjects using pre-structured questionnaire. Ocular examination was carried out by ophthalmologist, which included anterior segment examination, visual acuity and dilated fundus examination. Multiple qualitative and quantitative parameters were studied. Data were analyzed by SPSS 14.0 software.

Results

Ocular symptoms were seen in 22% of severe preeclampsia and in 100% of eclampsia patients. Blurred vision was the most common ocular complaint. Fundus changes were seen in 48.7% total study subjects. Arteriolar narrowing was the most common finding on fundus examination. Systolic blood pressure and serum creatinine were found predictive of changes in fundus (p = .000). Incidence of fetal growth restriction was found to be significantly associated with fundus involvement (p value .000).

Conclusion

Ophthalmic examination including fundus examination should be a routine in the investigational armamentarium of hypertensive disorders of pregnancy.

Study of Ocular Manifestations of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Background:

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent different ends of the spectrum of the same clinical entity causing severe mucocutaneous reactions, usually to drugs, characterized by intraepidermal cell death leading to blistering and epidermal sloughing. The severe cutaneous manifestations of this disease spectrum may often lead to overlooking of the ocular sequelae, which are very common and may lead to loss of visual acuity.

Aim:

The present research is an attempt to study the ocular manifestations seen in association with SJS/TEN.

Materials and Methods:

Patients having ocular manifestations of SJS/TEN attending the outpatient and inpatient department of skin and VD in a tertiary care hospital, were included in the study. Ophthalmologic examination of all patients was observed and recorded.

Results:

A total of 30 patients were included in the study. Among all, 27 patients had ocular involvement and among them 7 patients (25.9%) had mild, 17 patients (62.9%) had moderate, and 3 patients (11.1%) had severe ocular manifestations. Corneal involvement was found in 12 patients (44.4%), conjunctival involvement was found in 22 patients (81.4%), and eyelid involvement was found in 20 patients (74.0%). All patients were managed medically.

Window to the circulatory system: Ocular manifestations of cardiovascular diseases

The changes in the cardiovascular system are associated with ocular manifestations, often as a consequence of pathological alteration in the ocular vasculature. The ease of visualization of these retinal changes makes the eye a window to the cardiovascular system. Certain congenital cardiac defects lead to changes in the retinal vascularity due to increased tortuosity and dilatation. In adults, the arterial dissection of internal carotid and vertebral arteries present as amaurosis fugax with or without oculo-sympathetic palsy. The patients with untreated infective endocarditis present with Roth spots, retinitis, embolic retinopathy, or sub-retinal abscesses. Hypoperfusive, hypertensive, or "mixed" retinopathy is a hallmark sign in patients of untreated infective endocarditis. Giant cell arteritis can present with ischemic ocular symptoms that may precipitate in irreversible vision loss. Systemic vascular manifestations such as coronary artery disease may manifest in a wide range of symptoms from amaurosis fugax to vision loss depending upon the size and location of retinal emboli. Rare cardio-oncological pathologies such as myxomas result in vision loss secondary to central retinal artery occlusion. A high clinical suspicion in patients with history of cardiovascular diseases can help in early diagnosis and management of impending, adverse cardiovascular and cerebrovascular events. In this review, we comprehensively discuss the spectrum of cardiac and vascular diseases with ocular manifestations as well as highlight the typical ocular presentations associated with these pathologies.

Routes of Spread to Eye from the Notorious Neighbour i.e. Nose, Sinuses and Nasopharynx

Due to close anatomical relationship of eye with nose and sinuses it is liable to get involved secondary to sinonasal and nasopharyngeal pathology. Sinonasal and nasopharyngeal pathology may present with varied ophthalmic manifestations. Ocular involvement from sinonasal diseases occur due to direct spread to orbit, venous spread due to valveless nature of veins, cranial nerve involvement, nasolacrimal apparatus involvement and intracranial spread. The present study is to determine the sociodemographics, ocular manifestations due to sinonasal and nasopharyngeal pathology, etiological factors and routes of spread. The most common etiology in present study was sinonasal squamous cell carcinoma followed by nasal vestibulitis. The most common ocular pathology was proptosis followed by preseptal cellulitis. The most common route was erosion followed by compression and vascular. To conclude sinonasal and nasopharyngeal pathology can spread to orbit and increase the mortality and morbidity.

Pediatric liver diseases and ocular changes: What hepatologists and ophthalmologists should know and share with each other

Several rare pediatric liver disorders are accompanied by ophthalmic signs whose awareness and early identification may be of value in confirming/accelerating their diagnosis. Many of these signs are asymptomatic and can only be detected with an ophthalmological examination. Corneal signs are described in patients with Wilson's disease, Alagille's syndrome and some liver storage diseases. Cataract plays an important role to diagnose galactosemia. Retinal involvement is seen in some peroxisomal disorders (e.g. Zellweger's syndrome), in mucopolysaccharidoses (pigmentary retinopathy), and in Niemann-Pick disease (macular cherry red spot). In mucopolysaccharidoses optic nerve can be involved as optic atrophy secondary to pigmentary retinopathy or to chronic papilledema. Children with neonatal cholestasis due to hypopituitarism may present septo-optic dysplasia. Several infectious agents have an ophthalmological/hepatic involvement in the fetal life and/or thereafter. Some mitochondrial liver diseases, such as Pearson's syndrome, present pigmentary retinopathy and a chronic progressive external ophthalmoplegia. Finally, some drugs while protecting the liver may damage the ocular system as seen with long-term glucocorticoids and Nitisinone administration. This review provides a synopsis of those conditions that hepatologists and ophthalmologists should share among themselves to better take care of patients. Synoptic tables are presented to facilitate the mutual understanding of the issues.

Study of ocular manifestations in tuberculosis and its association with HIV AIDS in a tertiary care hospital

OBJECTIVE

To assess and understand the prevalence and clinical presentation of ocular morbidity in patients suffering from tuberculosis and compare it with ocular involvement in patients coinfected with tuberculosis and HIV AIDS.

MATERIALS AND METHODS

This was a non-comparative, observational, cross sectional study done on 580 patients, who were diagnosed cases of tuberculosis, pulmonary or extrapulmonary, on or off treatment, visiting the Ophthalmology OPD, Tuberculosis OPD and ART Centre of the institute in the period from March 2015 to March 2018, screened for ocular morbidity.

RESULTS

Out of 580, 408 patients had only tuberculosis and 172 had tuberculosis with HIV AIDS. 108 patients were found to have ocular involvement (18.6%) out of which 63 were males and 45 were females. The prevalence of ocular morbidity in patients with only tuberculosis was found to be 16.4% and in those having both tuberculosis and HIV AIDS was found to be 23.8%.

CONCLUSION

Our study concludes that posterior uveitis, pan uveitis, periphlebitis and vitritis are the most common ocular manifestations in tuberculosis. In patients with both tuberculosis and HIV most common ocular findings included vitritis and herpes zoster ophthalmicus. Our study also concludes that lower CD4 counts (less than 200) in HIV AIDS patient is significantly associated with ocular involvement.

Ocular manifestations of rheumatic diseases

PURPOSE

Our aim was to summarize key aspects of the pathomechanism and the ocular involvements of rheumatic and systemic autoimmune diseases.

METHODS

Apart from a paper in French (Morax V, Ann Oculist 109:368-370, 1893), all papers referred to in this article were published in English. All the materials were peer-reviewed full-text papers, letters, reviews, or book chapters obtained through a literature search of the PubMed database using the keywords ocular manifestations; pathogenesis; systemic inflammatory rheumatic diseases; rheumatoid arthritis; osteoarthritis; fibromyalgia; systemic lupus erythematosus; seronegative spondyloarthritis; ankylosing spondylitis; reactive arthritis; enteropathic arthritis; psoriatic arthritis; systemic sclerosis; polymyalgia rheumatica and covering all years available. Some statements articulated in this paper reflect the clinical experience of the authors in their tertiary-referral center.

RESULTS

Ophthalmic disorders are categorized by anatomical subgroups in all rheumatic diseases. The most common ocular manifestations are diverse types of inflammations of different tissues and dry eye disease (DED).

CONCLUSION

The eye could be a responsive marker for the onset or aggravation of an immune reactivation in many rheumatic diseases, furthermore, ocular findings can antedate the diagnosis of the underlying rheumatic disease. By recognizing ocular manifestations of systemic rheumatic diseases it might be possible to avoid or at least delay many long term sequelae.

The impact of ocular manifestations of rheumatoid arthritis on the health-related quality of life and the functional ability of black Africans

Objectives To determine the patterns, predictors and overall impact of ocular manifestations of rheumatoid arthritis (RA) on the health-related quality of life and disability index.

METHODS

A total of 50 Nigerian patients with RA were studied. Full ocular evaluation was done to determine the presence of each defined ocular manifestation of RA. All patients completed the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires.

RESULTS

The mean ± SD age of the patients was 47.2 ± 12.5 years. A total of 42 cases of ocular diseases were found in 23 (46%) patients. Keratoconjunctivitis sicca was found in 15 (30%) patients; cataract, 13 (26%); scleritis/episcleritis, 4 (8%); disk edema, 4 (8%); glaucoma, 3 (6%); ulcerative keratitis, 1 (2%); vitreitis, 1 (2%); and macula edema, 1 (2%) patient. There is an association of the presence of ocular manifestations with the physical component summary (PCS) [T = - 3.398, P = 0.001] and the mental component summary (MCS) [T = - 2.616, 0.012] of the SF-36 but not with the HAQ-DI (T = 1.685, 0.099). Following multiple regression analysis, the predictors of the presence of ocular manifestations were age greater than 45 years and positive anti-citrullinated protein antibody. Following linear regression analyses, Steinbrocker's functional class independently predicted the PCS while both Steinbrocker's functional class and female sex predicted the MCS.

CONCLUSIONS

The development of ocular disorders associated with RA is associated with a significant negative impact on the quality of life of the patients.

Arboviruses and the eye

Arthropod-borne viruses, or arboviruses, are viruses that are transmitted through the bites of mosquitoes and ticks. There are numerous arboviruses throughout the world capable of causing human disease spanning different viral families and genera. Recently, dengue, chikungunya, and zika viruses have emerged as increasingly important arboviruses that can cause human disease, however no specific treatment or vaccine is available for them. In addition, ocular manifestations of these diseases have become more prevalent over the past few years. This review highlights the current understanding on the pathogenesis, systemic changes and ocular findings, emphasizing the retinal manifestations related to dengue, chikungunya, and zika viruses.

Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital

Purpose

Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center.

Methods

This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes.

Results

Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%).

Conclusions

Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

[Ocular manifestations in rheumatoid arthritis: 24 cases in Abidjan]

OBJECTIVE

Determine the prevalence and the main ocular manifestations in rheumatoid arthritis in Abidjan.

PATIENTS AND METHODS

Prospective and descriptive study of 24 patients with rheumatoid arthritis fulfilling the criteria of the American College of Rheumatology, views from September 2003 to August 2004 in department of rheumatology at the University Hospital of Cocody. The patients performed an eye examination including: visual acuity examination at the slit lamp, ocular fundus, color vision and visual field.

RESULTS

Ocular manifestations were observed in 9 of 24 patients representing a prevalence of 37.5%. There were 03 cases of decreased visual acuity, 03 cataract, 02 keratitis cases and 01 cases of anterior uveitis. No fundus abnormality in color vision and visual field was highlighted. These manifestations were found between 5 and 10 years (04 cases) and after 10 years (05 cases) of evolution of the disease. The term rheumatoid arthritis influenced the occurrence of ocular manifestations (P = 0.00).

CONCLUSION

Ocular manifestations in rheumatoid arthritis are rare in our practice and were mainly affected by visual acuity, annexes and anterior segment of the eye.

Ocular manifestations in 321 male consecutive cases of human immunodeficiency virus infection/acquired immunodeficiency syndrome at an HIV-referral centre

BACKGROUND

Most studies on the ocular manifestations of human immunodeficiency virus (HIV) infection are on cases of acquired immunodeficiency syndrome (AIDS), not including asymptomatic carriers of HIV. With this background, we proceeded to study all the HIV-infected individuals attending our centre, with the aim: a. To study the ocular manifestations of HIV. b. To correlate those manifestations with the CD4+ T-lymphocyte counts. c. To compare our findings with other studies.

METHOD

A cross-sectional study involving a detailed ocular examination of 321 cases of HIV/AIDS was done. Automated perimetry, digital fundus photography and fundus fluorescein angiography were done for relevant cases. The last 125 cases were subjected to Schirmer's test and tear film break-up time.

RESULTS

We studied 321 male HIV cases (642 eyes), with a mean age of 36.78 years, mean CD4+ count of 276.54 cells/μL, 78.82% of them being on anti-retroviral therapy. Ocular manifestations were seen in 87 out of 321 cases, 72.41% of them being asymptomatic carriers of HIV. The ocular findings seen were conjunctival microvasculopathy, molluscum contagio-sum, dry eye, neuro-ophthalmic manifestations, anterior uveitis, posterior uveitis, and HIV retinopathy, only the last three of which had a significant association with CD4+ counts. The overall prevalence of ocular lesions also had a significant association with CD4+ counts.

CONCLUSION

Ocular manifestations are common in asymptomatic carriers of HIV. Anterior uveitis, posterior uveitis and HIV retinopathy have a significant association with CD4+ counts and are reliable indicators of low CD4+ count.