Covid 19 and its impact on eyes

Dr Suraj Munjal, MS Ophthalmology with 17 years of experience. Dr Munjal is the founder and chairman of The Sight Avenue and has Clinical inclination towards Robotic surgeries, refractive surgeries, corneal transplants with complicated cataract and squint.

It is an established fact that Corona viruses colonize mucosal surfaces including ocular mucosa. The involvement of eye in not just seen during the acute phase; it is now associated with complications/ sequelae of COVID infections.

COVID- 19 Manifestations in Eye:

Ocular manifestations of COVID occur anywhere between 1-14 days of onset of clinical symptoms. In some cases that may in fact be the first symptom seen.

Conjunctivitis or ‘PINK EYE’ in common man’s language is the most common manifestation. The patients normally present with pricking sensation, redness, pain and excessive watering. Redness without other features of Conjunctivitis, swollen eye, Excess watering, Lid edema, increased corneal sensitivity to light- can be few other symptoms seen.

It has also been reported that patients with ocular symptoms are more likely to have neutrophilia, elevated inflammatory markers like CRP (C-Reactive Protein), LDH (Lactate Dehydrogenase). 

  

Dr Suraj Munjal

Ophthalmologist

COVID-19 sequelae in eye:

Our responsibility as Clinicians don’t end with a COVID negative test and hospital discharge of patients after improvement of their systemic condition. With an increase in the usage of high potent systemic steroids in moderate to severe COVID patients during the inflammatory phase, we have begun seeing patients with sequelae. Sequelae are common, but not limited, to COVID patients who have associated co-morbidities causing immune suppression like Diabetes Mellitus and other conditions causing low immunity. In these patients, Steroids and Immunosupressants act as a double edge sword in the management of COVID-19. They definitely prevent the severity of the cytokine storm of COVID -19, in turn, further suppress the immunity of these patients to sometimes alarmingly low levels. In such conditions, the patients are prone to opportunistic infections involving but not limited to eye like Mucormycosis, Herpes Zoster.

Orbital Mucormycosis may be one of the earliest manifestations of systemic Mucormycosis. Mucormycosis is an opportunistic fungal infection caused by the fungus, Mucor which enters the body through naso-oral route or through a breach in the skin. This is a fulminant infection with about 50% mortality and morbidity even with the best of treatments. The common ocular manifestations are: loss of eye movements, sudden drop/loss of vision, protrusion of eyeball, eyelid edema, chemosis and eye congestion, eye pain, loss of eye sensations. The progression of Orbital Mucormycosis is rapid and the outcome is often disastrous without an early and aggressive Management.

 In the current backdrop of re-surgence of COVID, Patients and Clinicians alike, are open to the usage of electronic media and telemedicine services for safer, convenient, comfortable consultations. Tele/Video consultations have become important and resourceful in bridging the issues of distance, safety and expert opinions in these testing times.

In the backdrop of the previous studies and our own clinical experiences, I can safely conclude that Ophthalmologist consultations for COVID patients would make a significant contribution towards patients’ comfort and their physical well-being.

Through this short write up, I wish to draw the attention of Clinicians and patients, towards an important but less attended to manifestation of COVID-19.

Dr Anu Prasad – Co writer & HOD Ophthalmology TSA (Fortis escort –Okhla)

Stay safe. Stay Healthy…!!!

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