Eyes can be infected by COVID-19: 4 things to know

Authors: Gabrielle Masson – Wednesday, May 19th, 2021 Print 

Cells in the eye can be directly infected by SARS-CoV-2, the virus that causes COVID-19, according to findings published May 17 by ScienceDirect. 

Below are four things to know about COVID-19 infections of the eye:

1. Researchers exposed adult human eyes to SARS-CoV-2 in an in vitro stem cell model and then studied them after 24 hours. The virus is able to infect surface cells of the eye, the researchers found. Ocular surface cells, particularly the limbus, were particularly susceptible to infection, while the central cornea was less vulnerable.

2. Researchers are currently trying to determine if the virus can be spread through the eyes, Timothy Blenkinsop, PhD, study author and assistant professor of cell, developmental and regenerative biology at New York City-based Mount Sinai Health System, told Becker’s. While aerosol transmission is thought to be the primary route of spread, viral particles detected in ocular fluid suggest the eye may be a vulnerable point of viral entry. However, scientists don’t have evidence to back the theory up yet, in part because it is difficult to develop experiments where nasal infections don’t complicate the results. 

3. To prevent the transmission of COVID-19, people in dense areas that aren’t well ventilated would benefit from eye protection. Front-line providers should definitely have eye protection, Dr. Blenkinsop said, which is already fairly standard in the U.S.  

4. Other studies have found a significant number of patients with severe COVID-19 experience abnormal nodules of the eye. Three recent reports showed retinal findings, such as hemorrhages, cotton wool spots, dilated veins or tortuous vessels, are possibly tied to COVID-19.

Severe COVID-19 Linked With Changes in Eyes

Authors: By Ernie Mundell and Robert Preidt HealthDay Reporters WEDNESDAY, Feb. 17, 2021 (HealthDay News)

Severe eye abnormalities have been found in the eyes of some COVID-19 patients, a new study out of France contends.

The findings show the need for eye screening, as well as appropriate treatment and management of potentially serious eye problems in these patients, experts say.

“We showed that a few patients with severe COVID-19 from the French COVID-19 cohort had one or several nodules of the posterior pole of the [eye’s] globe,” explained study lead author Dr. Augustin Lecler, a neuroradiologist at the Foundation Adolphe de Rothschild Hospital in Paris.

One U.S. ophthalmologist unconnected to the study explained that these nodules appeared in a portion of the eye’s globe called the macula.

“The macula is the area of the retina responsible for central vision,” said Dr. Mark Fromer, who practices at Lenox Hill Hospital in New York City. “The retina is easily evaluated by a retina specialist using magnifying lenses at the bed side.”

At this point in time, he said it’s not yet clear whether the eye changes are directly linked to COVID-19 or to its treatment, such as intubating severely ill patients and putting them on a ventilator.

As the Paris team explained, while the coronavirus that causes COVID-19 primarily affects the lungs, it’s been linked with an increased risk for eye conditions such as conjunctivitis (pink eye) and retinopathy, a disease of the retina that can result in vision loss.

There have been reports of eye abnormalities detected on MRI exams of COVID-19 patients, but there’s only been limited investigation into the types and rates of such eye problems.

To learn more, the French Society of Neuroradiology conducted a study of 129 patients with severe COVID-19 who underwent brain MRIs.

Nine (7%) of the patients had one or more nodules in the back part of the eyeball. All had nodules in the macular region, and eight had nodules in both eyes. Eight of the nine patients had COVID-19 so severe that they had to spend time in ICUs.

COVID-19 linked to potentially dangerous eye abnormalities

Peer-Reviewed Publication: RADIOLOGICAL SOCIETY OF NORTH AMERICA NEWS RELEASE 16-FEB-2021

OAK BROOK, Ill. – Researchers using MRI have found significant abnormalities in the eyes of some people with severe COVID-19, according to a study published in the journal Radiology. The study results support the need for eye screening in these patients to provide appropriate treatment and management of potentially severe ophthalmological manifestations of COVID-19.

The COVID-19 pandemic has affected more than 100 million people since it began early in 2020. While the virus primarily attacks the lungs, it has been linked with eye abnormalities like conjunctivitis, also known as pink eye, and retinopathy, a disease of the retina that can result in a loss of vision. Eye abnormalities visible on MRI exams have been reported but there is limited research on the nature and frequency of these abnormalities.

To find out more, the French Society of Neuroradiology (SFNR) initiated a study of 129 patients with severe COVID-19 who underwent brain MRI.

Of the 129 patients, nine (7%) had abnormal MRI findings of the globe, or eyeball. The MRI scans showed one or more nodules in the back part, or posterior pole, of the eyeball. Eight of the nine patients had spent time in the intensive care unit (ICU) for COVID-19.

“We showed that a few patients with severe COVID-19 from the French COVID-19 cohort had one or several nodules of the posterior pole of the globe,” said study lead author Augustin Lecler, M.D., Ph.D., associate professor at the University of Paris and neuroradiologist from the Department of Neuroradiology at the Foundation Adolphe de Rothschild Hospital in Paris. “This is the first time these findings have been described using MRI.”

All nine patients had nodules in the macular region, the area in the back of the eye responsible for our central vision. Eight had nodules in both eyes.

The results suggest that screening should be considered in all patients with severe COVID-19 to detect these nodules. In clinical practice, this screening could include dedicated exploration of the eyes with high-resolution MRI, the researchers said. Additional recommended exams include fundoscopy, which uses a magnifying lens and a light to check the back of the inside of the eye, and optical coherence tomography, a noninvasive test that provides a 3D picture of the structure of the eye.

Dr. Lecler noted that severe eye problems might largely go unnoticed in the clinic, as COVID-19 patients hospitalized in the ICU are often being treated for much more severe, life-threatening conditions.

“Our study advocates for screening of all patients hospitalized in the ICU for severe COVID-19,” Dr. Lecler said. “We believe those patients should receive specific eye-protective treatments.”

The mechanism behind nodule formation remains unknown, the researchers said, although it could be related to inflammation triggered by the virus. Inadequate drainage of the veins of the eyes, a problem found in patients who spend time in the ICU in the prone position or intubated, may also be a factor. Seven of the nine patients with eye abnormalities in the study had been placed in a prone position in the ICU for an extended time.

The researchers are performing follow-up clinical and MRI examinations in the survivors to monitor the nodules and see if they carry any clinical consequences such as vision loss or visual field impairment.

They are also performing MRI examinations in new patients with severe COVID-19 from the second and third waves of the pandemic, using more comprehensive ophthalmological tests to correlate with the MRI results.

The effects on patients with moderate COVID-19 are currently under investigation.

“We have launched a prospective study with dedicated high-resolution MR images for exploring the eye and orbit in patients with light to moderate COVID,” Dr. Lecler said. “Therefore, we will be able to know whether our findings were specific to severe COVID patients or not.”

The findings support previous research that showed COVID-19 exacts a greater toll in people with existing health problems. Of the nine patients with eye nodules, two had diabetes, six were obese and two had hypertension.

“Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study.” Collaborating with Dr. Lecler were François Cotton, M.D., Ph.D., François Lersy, M.D., Stéphane Kremer, M.D., Ph.D., and Françoise Héran, M.D., on behalf of the SFNR’s COVID study group.

Radiology is edited by David A. Bluemke, M.D., Ph.D., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and owned and published by the Radiological Society of North America, Inc.

RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)