Ocular Immunology and Inflammation

The main purpose of this study was to investigate ocular clinical findings in patients with confirmed COVID-19 infection, of various levels of disease severity, who required mechanical ventilation and admission to intensive care units or specialized wards.

Longitudinal, observational study conducted from March 2020 to June 2020. Color fundus and red-free photography were performed in both eyes following pupillary dilation. 104 participants were recruited from 2 different centers: 60 (58%) from the Hospital Municipal de Barueri intensive care unit (ICU) and 44 (42%) from specialized wards for patients with COVID-19 at the Hospital São Paulo.

21.9% presented with eye lesions, in 3% these lesions were vision compromising. Our results have shown similar rate of intraocular lesions in patients in both the ward or intensive care unit, regardless of medication use, including anticoagulant drugs.

This study demonstrated that up to 25% of patients with COVID-19 in the acute phase have eye abnormalities detectable by fundus photography, regardless of disease severity. Most of the cases had ocular lesions, without visual loss. From our experience, 3% of patients, all from the ICU, had changes which impacted vision (occlusion of the central retinal vein and 2 patients with vitreous hemorrhage). Whether these events are related to the use of anticoagulants or are associated with COVID-19-related thromboembolic events, remains unclear. Intraretinal hemorrhages and hard exudates were the most frequent findings. These changes are frequent in patients with diabetic and hypertensive retinopathy, and the worsening of the systemic comorbidities during hospitalization may also be related to these results. There was no difference in frequency in the groups with or without diabetes and high blood pressure in this specific study.