The Prevalence of ocular manifestations and ocular samples polymerase chain reaction positivity in patients with COVID 19 - a systematic review and meta-analysis

ObjectiveTo estimate the prevalence of ocular manifestations and ocular samples polymerase chain reaction (PCR) positivity among COVID-19 patients. MethodsA systematic literature review was performed using search engines (PubMed, Google Scholar, Medrixv and BioRixv) with keywords "SARS-CoV-2", "novel coronavirus", "COVID-19", "ocular manifestations", "conjunctival congestion", "Ocular detection", "Polymerase chain reaction", and "conjunctivitis". The measure of heterogeneity was evaluated with the I2 statistic. The pooled proportion of patients presenting with symptoms and ocular samples PCR positivity was estimated. ResultsA total of 20 studies (14 studies and 6 case-reports) were included in the systematic review and 14 studies were included in the meta-analysis. The pooled prevalence of conjunctivitis was 5.17% (95% CI: 2.90-8.04). Conjunctivitis was reported as an initial symptom of the disease in 0.858 % (95% CI: 0.31-1.67). Common associated features include itching, chemosis, epiphora. Seven patients (29 %) with conjunctivitis showed positive results in ocular samples, whereas 13 patients (54%) showed positive only in their nasopharyngeal samples (NPs) or sputum samples and 4 patients (16 %) were negative for both NPs and Sputum as well as ocular samples. The pooled prevalence of ocular PCR positivity was 2.90 % (95% CI: 1.77 - 4.46) vs. NPs 89.8% (95% CI: 78.80-79.0). ConclusionThe prevalence of conjunctivitis and ocular samples PCR positivity among COVID-19 patients was low indicating that the eye is a less affected organ. However, conjunctivitis may present as the first symptom of the disease making the patient seek medical care at the earliest. SynopsisViral conjunctivitis was the only symptom reported. The prevalence of conjunctivitis and ocular samples polymerase chain reaction positivity among COVID-19 patients was low indicating the eye is a less effected organ.