OPHTHALMOLOGICAL MANIFESTATIONS IN COVID-19: one of the multifacets of the disease.
Keywords: Ophthalmology, Coronavirus Infections, Coronavirus and Conjunctivitis.
Coronavirus are part of a family of viruses whose characteristics are to be enveloped, with single-stranded RNA and which are common causes of infection in wild animals, birds and mammals. The current pandemic is caused by a beta coronavirus that has come to be called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As it is a relatively new infection, with rapid spread throughout the world, much information has been discovered with the course of worldwide contamination. Thus, the objective of this study is to synthesize the information that already exists about the ocular transmission of the new SARS-CoV-2, ophthalmological disorders and strategies adopted for the protection of ophthalmologists. In order to carry out this review, the following health descriptors were used: Ophthalmology, Coronavirus Infections, Coronavirus and Conjunctivitis in a search in magazines, newspapers and Medical Literature Analysis and Retrieval System Online (MEDLINE). After reading the abstracts, full studies and applying the inclusion and exclusion criteria, 14 articles were selected for the preparation of this review. The results found were diverse. In relation to contamination and transmission by the conjunctiva, some theories explain the entrance of SARS-CoV-2 through the ocular surface through the angiotensin 2 receptor (ACE2), however the transmission by tears and conjunctival fluids has not yet been proven. Other studies show that patients who developed conjunctivitis had the virus in these fluids whereas in patients who did not develop conjunctivitis, the virus was not found in conjunctival secretions. The development of ocular signs and symptoms is inconclusive and several external factors must be taken into account. The main ocular manifestation reported was conjunctivitis but there are some biases such as the prevalence of dry eye in the population, notification of confirmed cases with coronavirus infection, among others. Another important point is the possibility of the occurrence of future chronic ophthalmic complications due to coronavirus infection such as vasculitis, optic neuritis and neuro-ophthalmological diseases due to the tropism of the virus by the nervous system. In relation to the new recommendations and safety measures for ophthalmologists, several approaches can be taken in an attempt to reduce transmission and avoid contamination. Mild involvement, without risk of complications, must be attended to via telemedicine and the need for presencial assistance assessed. In addition to screening for possible suspicions of patients infected with coronavirus, it is also recommended to decrease the number of people in the waiting room. In addition, personal protective equipment is essential. The use of masks, gloves, goggles and breath shield in the slit lamp are some of the recommendations to try to prevent SARS-CoV-2 infection. Thus, although many aspects are still not completely elucidated, studies show a higher prevalence of the virus in conjunctival secretions in patients with conjunctivitis. Transmission and contamination by the conjunctiva is still being studied. The ocular symptomatology caused by SARS-CoV-2 is also not defined due to several aspects that influence it. The use of personal protective equipment is necessary as in all spheres of society and many aspects of the infection are being studied concurrently with the pandemic.
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