The intraocular pressure (IOP) was statistically different when comparing severe and critical groups, both in RE (p=0.022) and LE (p=0.038). As a library, NLM provides access to scientific literature. Sheth JU, Narayanan R, Goyal J, Goyal V. Retinal vein occlusion in COVID-19: a novel entity. 1 is composed of six individual photographs, using the Microsoft PowerPoint for Mac software, version 16.47 (21,031,401), author IFC). Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent lancet publication. 2020;68(11):237883. For OCT angiography, the central 6mm fixated on the fovea were examined. In total, 21 patients were examined. https://doi.org/10.1056/NEJMoa030747. https://doi.org/10.1111/aos.14412. Ocular findings and proportion with conjunctival SARS-COV-2 in COVID-19 patients. https://doi.org/10.1056/NEJMsb2005114. S. Priglinger: Speaker honoraria and travel reimbursement from Carl Zeiss Meditec AG, Novartis Pharma GmbH, Bayer AG, Pharm-Allergan GmbH, Oculentis OSD Medical GmbH, rtli GmbH, B&L, Vitreq. Google Scholar. Visual acuity was the same as pre-COVID-19 in all eyes, and no traces of ocular inflammation, infiltration or microvascular insult could be found on OCT and OCT angiography. CAS Hyperinflammation with cytokine storm and stasis with hypoxia that activates coagulation mechanisms could very well cause retinal vasculitis, thromboembolic events or venous congestion resulting in a COVID-19 associated retinal vein occlusion, papillophlebitis or retinopathy [30, 38, 39]. Color fundus pictures of both eyes showing white-yellowish dots (arrows). 2020. https://doi.org/10.1136/bjophthalmol-2020-317576. We also performed biomicroscopy and dry eye tests. However, a subsequent article and several letters to the authors raised serious doubts about the data interpretation in this publication, as the suggested pathologic changes most likely represent normal physiological variations and/or imaging artifacts, e.g. Silva LS, Silva-Filho JL, Caruso-Neves C, Pinheiro AAS. 1968;220(5168):6500. After being rear-ended, Catherine spent the next two years trying to get relief from her traumatic brain injury symptoms. Jakob Siedlecki and Siegfried G. Priglinger contributed equally to this work. Login to gain access to member-only content. Dr. Dunn recommended a treatment called Syntonics, a light therapy used to balance the nervous system. https://doi.org/10.1167/iovs.18-25864. Not hospitalized patients were examined a mean of 123.444.7days after their first positive COVID-19 test or positive test for IgG against SARS-CoV-2. J. Med. R.A.F. Immunol. Nature. Due to the randomized recruitment of patients, unfortunately no patients with acute phase ocular lesions were included in this study. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. 2020;26(5):6817. This study with a small prospective cohort of 21 patients indicates that there might be no evidence of ocular complications at 3months after recovery from COVID-19, without previous eye involvement. Struggling with symptoms including light sensitivity, pain and poor depth perception, Mark didnt know what was wrong with his eyes. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. 2020. https://doi.org/10.1001/jamaophthalmol.2020.1291. Terms and Conditions, Thrombolysis https://doi.org/10.1007/s11239-020-02297-z (2020). Hamming I, Timens W, Bulthuis M, Lely A, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. Interestingly, one not hospitalized patient experienced extended loss of olfactory sensation for at least 1.5months. The hospitalized patients were examined a mean of 111.423.2days after their recovery and discharge. They were evaluated with a complete ophthalmological examination that included presenting and distant best-corrected visual acuity (DBCVA) displayed in logMAR. Interestingly, none of our patients reported ocular complaints like conjunctivitis, eye redness or visual impairment during or after COVID-19 infection. PubMed Pink eye typically presents with redness, swelling, and soreness of the eye, likely because SARS . Due to the small sample size, future studies with more participants, with and without ocular symptoms combined with a long follow up are necessary to provide further evidence. Nature. Google Scholar. Translation and validation of the Portuguese version of a dry eye disease symptom questionnaire. Therefore, this prospective cross-sectional study sought to examine potential long-term functional and morphological impairment in eyes of COVID-19 patients 3 months after recovery. Covid-19-associated retinopathy: a case report. Also, the frequency of personal history of dry eye or severe symptoms was statistically different concerning the systemic severity of the disease and sexthe frequency was higher in mild-to-moderate cases (p=0.011, two-tailed Fishers exact test) and in women (males: 4/33 (12.1%); females 12/31 (38.7%), p=0.041, two-tailed Fishers exact test). https://doi.org/10.1001/jama.2020.12603 (2020). At first, diabetic retinopathy might cause no symptoms or only mild vision problems. swollen ankles and feet. Find out about possible causes of post-COVID-19 conditions and ways to manage symptoms. By Mayo Clinic Staff. Recently, the post-COVID syndrome (PCS) or post-COVID condition13 has been proposed, taking into account the high frequency (from 10 to 35%) of people affected by SARS-CoV-2 that persist with symptoms after the disease's acute phase14. JMIR Public Health Surveill 6, e19462. To improve the accuracy of OCT data, the automatic delineation of the internal and external limits of the sensorineural retina, generated by the equipment's software, was verified for each of the scans. Cite this article. J Clin Med. Angiotensin II and its receptor subtypes in the human retina. Only two eyes of two patients presented DBCVA>0.5 logMAR due to cataract diagnosis. 8600 Rockville Pike Further studies with a longer follow-up and a larger sample size are warranted. No microaneurysms, areas of non-perfusion or other microvascular anomalies were found in any of the eyes. Concerning the posterior pole findings associated with previous comorbidities, the three main findings were: 10 (15.6%) were diagnosed as non-proliferative diabetic retinopathy, 11 (17.2%) presented increased retinal vascular tortuosity and 3 (4.7%) had glaucoma diagnosis. Napoli PE, Nioi M, Fossarello M. The Quarantine Dry Eye: the lockdown for coronavirus disease 2019 and its implications for ocular surface health. Retinal findings in hospitalised patients with severe COVID-19. I.F.C., L.P.B. Prog. Categorical variables were analyzed using 2-sided Fishers exact test. These authors contributed equally: Fernando Bellissimo-Rodrigues and Rosalia Antunes-Foschini. Sci. New concepts in malaria pathogenesis: the role of the renin-angiotensin system. Rosalia Antunes-Foschini. Research suggests that between one month and one year after having COVID-19, 1 in 5 people ages 18 to 64 has at least one medical condition that might be due to COVID-19. Follow-up studies in COVID-19 recovered patients - is it mandatory? 1 New research shows that Covid-19 causes eye problems, leading to hazy vision or black spots as the virus attacks the retina Credit: Getty In very rare cases, acute inflammatory retinal vein occlusion, papillophlebitis or retinopathy have been observed. S. Michalakis Co-founder and shareholder of ViGeneron GmbH. Benito-Pascual, B. et al. Together, they were able to work through a treatment plan to help Mark on his road to recovery. To obtain Lipid Res. Approximately 1 in. Immunol. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. A review of coronaviruses and ocular implications in humans and animals. J. Infect. 2003;348(20):197785. 1) the hospitalized group show a lower vessel density compared to non hospitalized and control. Greenhalgh et al.15. Non of the patients had initially ocular symptoms. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Gascon P, Briantais A, Bertrand E, Ramtohul P, Comet A, Beylerian M, et al. Among them, 46 (71.8%) used long-term medications. Expression analysis of 2019-nCoV related ACE2 and TMPRSS2 in eye tissues. Bloodretinal barrier breakdown in experimental coronavirus retinopathy: association with viral antigen, inflammation, and vegf in sensitive and resistant strains. 2020;9(5):1269. https://doi.org/10.3390/jcm9051269. For OCT angiography, the central 6mm fixated on the fovea were examined. Case report details. Gangaputra, S. S. & Patel, S. N. Ocular symptoms among nonhospitalized patients who underwent COVID-19 testing. Google Scholar. Landecho, M. F. et al. Coronavirus can certainly enter the body through the eyes (as well as the nose and mouth). Since COVID-19 shows more severe courses in older patients, findings of decreased vessel density might not be due to past inflammatory processes, but rather represent normal age related alterations [41]. We included 64 patients (128 eyes). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Of the seven patients (10.9%) who reported ocular pain at the moment of eye examination, all of them had this complaint previously to the COVID-19, and only one reported worsening pain in the acute phase. The long-term visual recovery in these cases is variable, ranging from complete recovery to significant visual loss," said the doctor. n/a (n/a). The macular architecture was evaluated using a standard 2015 tracking protocol, consisting of 19 horizontal sections (each from 25 frames) with a distance of 240 m between each scan, covering the 2015 quadrilateral in the retina, centered on the fovea. Google Scholar. Angiotensin II and its receptor subtypes in the human retina. COVID-19 has been linked to cases of conjunctivitis, but this is the first time researchers have . volume11, Articlenumber:11085 (2021) Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, et al. Scientific Reports (Sci Rep) Post-acute COVID-19 syndrome. The authors declare no competing interests. Part of https://doi.org/10.3390/jcm9041138. Bahkir FA, Grandee SS. https://doi.org/10.1016/j.survophthal.2020.01.002 (2020). Before Jakob Siedlecki or Siegfried G. Priglinger. A first step in understanding SARS pathogenesis. For example, in one case . During the infection, 14 of the 21 patients (66.6%) were in regular care whereas 2 patients (9.5%) received intensive care ventilation for 8.5 (SD) (0.7) days on average in the COVID ICU. PubMed Central Not only because of its acute impact on emergency care, COVID-19 represents an unprecedented challenge for health care-providers, also due to several long-lasting symptoms recently termed long COVID [11]. https://www.who.int/publications/i/item/global-covid-19-clinical-platform-case-report-form-(crf)-for-post-covid-conditions-(post-covid-19-crf-) (2021). The sample size is limited, and the percentage of intensive care patients is low. An official website of the United States government. July 29, 2021. Virology: coronaviruses. Hypoxia, minor perfusion or vein occlusions can lead to Cotton Wool Spots (CWS), which had been also reported by another study 1 month after illness in 6 of 27 (22%) patients, pointing to an expired inflammation in the posterior segment of the eye in some patients [28]. Inflamm. World Health Organization. Vis. In conclusion, our results suggest that long-term complications of the eye are unlikely after recovery from COVID-19, although receptors allowing for SARS-CoV-2 entry are present in the conjunctiva, limbal superficial cells, retina and aqueous humor. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. OCT scans showed no hyperreflective foci in the retina or vitreous. https://doi.org/10.3760/cma.j.cn112142-20200310-00170. Most people who get COVID-19 will have mild illness. Med. https://doi.org/10.2196/19462 (2020). At about the same time, the first outbreak occurred in Italy, which drew the attention of the scientific community to the political, health and therapeutic management of this crisis [9]. The sample size is limited, and the percentage of intensive care patients is low. When I was sick, getting through to the other side without being hospitalized was my only goal. Compared to control (mean age 52.0 SD 16.4) the non hospitalized group show a significant higher central vessel density. In animal experiments (cat, mice), various eye diseases such as uveitis, retinitis and optic neuritis could be triggered by betacoronaviruses indicating an direct uptake into the eye [27]. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and Conjunctival secretions of patients with SARS-CoV-2 infection. The Doornik-Hansen for multivariate normality test was used to look for Gaussian distribution. This study was approved by the ethics committee of Ludwig-Maximilians-University, Munich, Germany and held to the tenets of the Declaration of Helsinki 1964 or its later amendments. https://doi.org/10.1038/s41591-021-01283-z (2021). ARUUU is a Muslim American content creator and Twitch streamer. By submitting a comment you agree to abide by our Terms and Community Guidelines. Ocul Immunol Inflamm. https://doi.org/10.1016/j.cell.2020.02.052. Future studies are needed to investigate whether diabetic retinopathy is a predictor for the severity of COVID-19. Once I recovered and was no longer contagious, I expected to feel back to normal. Li Wenliang, a face to the frontline healthcare worker The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak. Stefano GB, Ptacek R, Ptackova H, Martin A, Kream RM. Bining Z, Qun W, Ting L, Shengqian D, Xia Q, Hui J, et al. The author(s) read and approved the final manuscript. Our sample showed a higher percentage (46.8%) of patients complaining of blurry vision when compared to a previous study5. Prior to 2019, coronaviruses, first discovered in 1968 [1], caused two epidemic outbreaks: In Hong Kong in 2003, in the form of the Severe Acute Respiratory Syndrome (SARS) [2,3,4] and in Saudi Arabia in 2012, in form of the Middle East Respiratory Syndrome (MERS) [5, 6]. Zhong NS, Zheng BJ, Li YM, Null P, Xie ZH, Chan KH, et al. Manage cookies/Do not sell my data we use in the preference centre. Third, we did not control our data for climate factors, which may have influenced the results related to dry eye signs and symptoms. Ophthalmology 127, 982983. CAS The virus poses a deadly threat to the elderly, as well as those who have pre-existing conditions. 2020. In the meantime, to ensure continued support, we are displaying the site without styles Further studies with more participants with and without acute ocular symptoms are necessary for final evidence. 10.1038/s41433-020-1084-9. The absence of previous signs of uveitis in the anterior and posterior segments, associated with mean tonometry varying from 12.00 to 14.37 mmHg, reinforces a few ocular inflammation cases associated with COVID-19 that only occasionally leave eye sequelae24,25. The virus can lead to hazy vision and black spots, known as floaters. People talk about its impact on their mental health, their ability to breathe and their ability to make it through the day without a nap. Most often, eye symptoms are associated with systemic symptoms of COVID, including the typical features of the respiratory illness we're familiar with including cough, fever, and fatigue." When the eyes are exposed to the virus, a person can develop conjunctivitis symptoms, often appearing like pink eye. In humans, beside of keratoconjunctivitis, retinal involvement like Cotton wool spots [28] (CWS), microhaemorrhages [29], vascular occlusions [30] or hyperreflective foci [31] has been reported in COVID-19 patients. We looked for correlation between right and left eyes refractive errors using Pearson coefficient. Continuous variables were analyzed using the one-way ANOVA test, the Wilcoxon rank-sum (MannWhitney test), the KruskalWallis test, and the Wilcoxon matched-pairs signed rank test. Virol. https://doi.org/10.4103/jfmpc.jfmpc_1572_20 (2020). 2020. Bilateral anterior uveitis as a part of a multisystem inflammatory syndrome secondary to COVID-19 infection. official website and that any information you provide is encrypted Only subtle retinal changes with a good visual prognosis may be directly related to COVID-19 infection in the medium-term. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. All examined patients gave their written consent to the examination and publication of the anonymized data. https://doi.org/10.1080/09273948.2020.1825751. Visual acuity, slit lamp, bio microscopy and fundoscopy, multimodal imaging findings. EClinicalMedicine. All statistical analyses were performed using Stata (Stata/IC 15.1, College Station, TX). It's possible that ocular migraine could persist even after recovery from COVID-19 in some people. Nioi M, Napoli PE, Lobina J, Fossarello M, dAloja E. COVID-19 and Italian healthcare workers from the initial sacrifice to the MRNA vaccine: pandemic Chrono-history, epidemiological data, ethical dilemmas, and future challenges. For the purpose of this prospective cross-sectional case study, 21 patients who had recovered from a COVID-19 infection were recruited. Fair allocation of scarce medical resources in the time of Covid-19. A new study suggests that some patients with long COVID have lasting nerve damage that appears to be caused by infection-triggered immune dysfunction, which is potentially treatable. 2013;87(14):77902. PubMed Color fundus pictures were obtained using Topcon TRC-50DX and Nikon D90 cameras. Nalbandian, A. et al. Rep. 8, 2076. https://doi.org/10.1038/s41598-018-20273-9 (2018). Either via the tear film and the draining tear ducts into the upper respiratory tract and the gastrointestinal tract, or theoretically via the conjunctiva into limbal superficial cells into the inner eye, where distribution via the blood or nervous system seems possible [26]. Due to the small sample size, future studies with more participants, with and without ocular symptoms combined with a long follow up are necessary to provide further evidence. Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrae 8, 80336, Munich, Germany, Victor Brantl,Benedikt Schworm,Gregor Weber,Johannes Schiefelbein,Thomas C. Kreutzer,Stylianos Michalakis,Jakob Siedlecki&Siegfried G. Priglinger, You can also search for this author in Invernizzi A, Torre A, Parrulli S, Zicarelli F, Schiuma M, Colombo V, et al. Long-COVID: an evolving problem with an extensive impact. All authors revied the manuscript. Retinal findings in patients with COVID-19: results from the SERPICO-19 study. It's important to note that an eye issue in a person . Pereira, L. A. et al. CAS 9, 8. https://doi.org/10.1186/1471-2415-9-8 (2009). https://doi.org/10.1016/j.ophtha.2020.04.028 (2020). Jakob Siedlecki and Siegfried G. Priglinger contributed equally to this work. https://doi.org/10.12659/MSM.930886. The present study identified higher IOP among critical cases, when compared to severe cases, and discrete outer retina changes 80 days after COVID-19 infection. BMJ. (International) B.V. B. Schworm: Speaker honoraria and travel expenses from Novartis Pharma GmbH and Topcon Corporation. The break-up time (BUT) assessment (BUT was considered positive for dry eye if<7 s on the worse eye), corneal fluorescein staining (the corneal area was divided into five zones, one central area and four peripheric ones, each region was classified as no stain (=0), 1, 2 or 3 (great stain), and a total score varying from 0 to 15 was calculated for the entire cornea, following the Dry eye workshop guidelines20. Presenting and DBCVA were significantly different (p0.03, Wilcoxon matched-pairs signed-rank test) in mild-to-moderate, severe, and critical groups, except for the left eyes (LE) in the mild-to-moderate group. https://doi.org/10.1056/NEJMoa030666. Wolffsohn, J. S. et al. Sore eyes - 16% of COVID-19 patients in the study reported this symptom. Using OCT-A to test for microvascular disorders, we did not find any pathologies related to a vascular or inflammatory response (Table 1). Even people with relatively mild infections can be left with . N Engl J Med. FOIA Patients who had tested positive were either hospitalized or discharged into home quarantine via the emergency room. J. Fam. Prevalence and causes of visual impairment in a Brazilian population: The Botucatu Eye Study. 10.1136/bjophthalmol-2020-317576. Global COVID-19 Clinical Platform Case Report Form (CRF) for Post COVID condition (Post COVID-19 CRF). Greenhalgh, T., Knight, M., ACourt, C., Buxton, M. & Husain, L. Management of post-acute covid-19 in primary care. This study is nested within a large cohort study named RECOVIDA, aimed to comprehensively describe the clinical picture of the post-COVID-19 condition. 2016;5:103. https://doi.org/10.3389/fcimb.2015.00103. https://doi.org/10.1016/j.ophtha.2020.06.037 (2020). [. Received 2021 May 26; Accepted 2021 Nov 16. urine that's foamy or bloody. Get the most important science stories of the day, free in your inbox. The examination included the following methods: complete ophthalmological examination including evaluation of best-corrected visual acuity using an ETDRS chart at 4m with habitual correction, slit-lamp biomicroscopy, dilated funduscopy by indirect ophthalmoscopy and optical coherence tomography (OCT) imaging and OCT angiography (Triton DRI OCT, Topcon Corporation, Itabashi, Japan). https://doi.org/10.23750/abm.v91i1.9397 (2020). Further studies with a longer follow-up and a larger sample size are warranted. Optical coherence tomography (OCT) of the right eye shows hyporreflectivity in the retinal pigment epithelium and ellipsoid layers, and discontinuation of photoreceptors outer segments (arrow). Acta Biomed. Ophthalmological examination of the previously hospitalized group took place 111.4 (23.2) days after recovery and discharge from the hospital, while non-hospitalized patients were examined after mean 123.4 (44.7) days. 65, 458472. 2020;729:139021. https://doi.org/10.1016/j.scitotenv.2020.139021. Sheehy, L. M. Considerations for postacute rehabilitation for survivors of COVID-19. Regarding refractive errors, as the Pearson correlation between RE and LE was 0.85, we used only the RE for the refractive error data analysis. While Covid-19 is commonly associated with infection of the lungs, heart and other vital organs, a growing body of evidence suggests that infection can also impact the eye. Personal consultation fees from Novartis Pharma GmbH and Bayer AG. 2020:15. For the superior, inferior, nasal and temporal quadrants 48.12.1 vs. 46.13.4, 48.22.5 vs. 48.14.9, 46.61.6 vs 44.33.0 and 46.51.7 vs 44.41.3 (Fig. An important finding was that the HCW infection rate was 12% by July 2020, showing how highly contagious and how extremely important protective measures are in dealing with COVID-19 patients [9]. In Serpico-19 diameters of the retinal vessels were examined unveiling higher vessel diameters compared to severity of the covid infection [29]. A. the contents by NLM or the National Institutes of Health. The possibility of COVID-19 transmission from eye to nose. We would like to thank all patients and the study team of our Clinic of Ophthalmology. https://doi.org/10.1038/s41586-020-2012-7. Article PubMed Central We offered the opportunity to participate in this ophthalmologic cross-sectional study to patients attending the Post-Covid ambulatory care from July to November 2020. Their diagnosis was based either on positive polymerase chain reaction for SARS-CoV-2 obtained on throat swab samples or nasopharyngeal specimen obtained before admission. Possibly a percentage of this complaint may be related to previous uncorrected refractive errors since presenting visual acuity and DBCVA statistically improved in all the groups, except for the LE in the mild-to-moderate group. CAS To describe the medium-term ophthalmological findings in patients recovering from COVID-19. The meanSD duration of hospitalization was 15.010.7 days. 35, 1927. Concerns about the interpretation of OCT and fundus findings in COVID-19 patients in recent lancet publication. Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. 2021;14:162936. Hospital of the Ludwig Maximilians University, Munich. Fritz Gerald P. Kalaw, Alexandra Warter, William R. Freeman, Emine Kaya-Guner, Aslihan Sahin, Dilek Yilmaz, Usanee Tungsattayathitthan, Narisa Rattanalert & Wantanee Sittivarakul, Dinah Zur, Michaella Goldstein, Zohar Habot-Wilner, Yu-Chun Cheng, Eugene Yu-Chuan Kang, Ching-Hsi Hsiao, Alessandro Invernizzi, Marco Schiuma, Giovanni Staurenghi, Irmak Karaca, Gunay Uludag, Quan Dong Nguyen, Haya H. Al-Ani, Joanne L. Sims & Rachael L. Niederer, Rana Khalil, Harry Petrushkin, Mark Westcott, Scientific Reports Long Covid is not just people taking time to recover from a stay in intensive care. Once youve recovered from Covid-19 make sure to get your eyes checked; its an important part of taking care of yourself and getting back to who you were. -Mark from Oregon, When a friend told me they had COVID-19 I said, As soon as youre fine you need to go get your eyes checked. Struggling with the issues with my eyes, and all the things I couldnt do because my vision wasnt the same was frustrating and lonely. https://doi.org/10.2337/dc11-1909 (2012). In conclusion, our results suggest that long-term complications of the eye are unlikely after recovery from COVID-19, although receptors allowing for SARS-CoV-2 entry are present in the conjunctiva, limbal superficial cells, retina and aqueous humor. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Travel reimbursement from D.O.R.C. The ACE2 receptor is found in many different tissues such as nasal mucosa, lung, stomach colon and many more showing the multiple points to attack during infection [21]. In these first publications about PCS, we did not find any information about ocular manifestations persisting after COVID-19, and it is not possible to know if they were not there or if they were not reported, investigated or documented. The vitreous and inner retina changes may be related to the acute phase of the infection since the reported patient had only 12 days of symptoms, while in the present study, patients were examined 128 and 110 days after the first symptoms. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R. Retinal findings in patients with COVID-19. Article The higher frequency of personal history of dry eye or severe symptoms in mild-to-moderate cases needs other studies to be clarified due to a small number of patients in the sample. https://doi.org/10.1016/j.jtos.2017.05.001 (2017). Insausti-Garca A, Reche-Sainz JA, Ruiz-Arranz C, Lpez Vzquez , Ferro-Osuna M. Papillophlebitis in a COVID-19 patient: inflammation and Hypercoagulable state. J. Ophthalmol. Article Hashemi, H. et al. Nasiri, N. et al. 2001;119(2):17582. The site is secure. 1968;220(5168):6500. Thus, two possible routes of infection emerge by which SARS-CoV 2 can enter the body via the eyes. Hamming I, Timens W, Bulthuis M, Lely A, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus.