Vol. 12 No. 3 (2020): Archives of Public Health

COVID-19 and ophthalmic manifestations: review of the literature

Emilija Gjoshevska-Dashtevska
University Clinic for eye diseases; Medical Faculty, University Ss Ciril and Methodius, Skopje, Republic of Macedonia
Natasha Trpevska-Shekerinov
University Clinic for eye diseases; Medical Faculty, University Ss Ciril and Methodius, Skopje, Republic of Macedonia
Maja Ivanova
University Clinic for eye diseases; Medical Faculty, University Ss Ciril and Methodius, Skopje, Republic of Macedonia

Published 2020-12-15


  • COVID-19,
  • ophthalmic manifestations,
  • conjunctivitis,
  • transmission,
  • prevention

How to Cite

Gjoshevska-Dashtevska E, Trpevska-Shekerinov N, Ivanova M. COVID-19 and ophthalmic manifestations: review of the literature. Arch Pub Health [Internet]. 2020 Dec. 15 [cited 2021 Dec. 7];12(3):68-75. Available from: https://id-press.eu/aph/article/view/5636


The epidemics of COVID-19 started in December 2019 in Wuhan, China, and the World Health Organization (WHO) officially declared a pandemic in March 2020. COVID-19 can also affect the eyes.  Ophthalmic manifestations of the virus are not so frequent; the prevalence is about 3% up to now. Recognizing the possibility of ophthalmic transmission and manifestation of the virus is of significant importance for ophthalmologists and health workers. According to published studies, the most common ophthalmic manifestation is follicular conjunctivitis with all the symptoms and signs of viral conjunctivitis.  It is usually bilateral, and patients present adenoviral-like symptoms, discomfort, foreign body sensation, redness, or they have no subjective symptoms. The symptoms are more pronounced in patients with a more severe clinical picture of the disease. One of the described non-specific manifestations of COVID-19 as an initial manifestation is keratoconjunctivitis. The effects of the virus on the retina and blood vessels have not been fully investigated, yet. It has been proven that COVID-19 can be isolated from tears and from ocular surface by PCR conjunctival swab. The most common mode of transmission is through direct contact and through aerosols. Through the nasolacrimal system, the eyes can be the entrance for respiratory infection and hematogenous spread of the virus can occur through the lacrimal gland. Early recognition of the ophthalmic symptoms by ophthalmologists as well as the other health workers during this pandemic is necessary because sometimes they can be the only manifestation of COVID-19, and on the other hand, it will lead to greater protection and prevention of the virus spreading. Prevention measures should be focused on the application of administrative protocols, personal protection and environmental control.


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