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Exploring the degree of retinal involvement in COVID-19 patients: A narrative review.

Noon A. H. Mahgoub*, Noun E. A. Abdulgader, Abdelrahman H. Abdelmoneim, Alia F. B. Mansoor, Musab M. A. Elhadi, Raneem A. Ali, Mahmoud M. A. Mohamed, Mohammed k. A. Yagoob, Mohamed S. I. Zaroug, Rawan K. A. Galil

Background: In December 2019, Coronavirus disease turned into a global pandemic that is caused by the highly contagious severe acute respiratory syndrome (coronavirus). Above all, eye redness and irritation were found in COVID-19 patients. Therefore true challenge was made by ophthalmologists as they were the first medical professionals to assess a patient with COVID-19 and initiate a concern, as respiratory illness could be transmitted through the eye. Up until that point, only HCoV-NL63 and SARS-COV has been confirmed to cause ocular abnormalities (cotton wool spot, retinal hemorrhage and conjunctivitis). Moreover, Reports continue to emerge on further associations of COVID-19 and the frequency is correlated to the severity of the disease. It has provided an expanding proof that provocative cytokine storm and viral evasion of cellular resistant reactions play an essential part in infection seriousness and progression. As a result, the virus is capable of targeting the endothelium cells in the retina, causing secondary damage to the retinal microvasculature. Aim: This paper was designated to: (i) Summarize the retinal findings and the degree of retinal involvement in COVID-19 patients. (ii) Describe the risk factors relating to retinal landings. (iii) To explain the retinal changes found in COVID-19 patients. Methodology: Firstly, a systemic electronic database search was used to investigate for articles and reviews providing the information on retinal entanglement in COVID-19 patients. Eight papers were found related to our review, finally PubMed and Google Scholar were used as they were easily accessible, and papers related to our topic found were open access. Other data bases such Scopus, Cochrane and web of sciences were involved in the search, but most of the related papers were found to be closed access. Lastly, the quality of each report study was evaluated using Pierson’s 5- component scheme. Result: Data bases search provided a total of eight papers were attached. Four case reports, two cross sectional studies, one cohort study and one case series study with mild to severe COVID-19 were involved in this review. In addition, retinal hemorrhage has been reported in three out of eight papers. Eventually, retinal artery and vein occlusion were observed, in more than two of these studies hypertension and diabetes were common risk factors. Conclusion: As a result, the study infers that the retinal alterations due to COVID-19 have been established through several previous studies, that is to say exaggerated immune response is more likely the mechanism. Adult patients with risk factors are affected by the hypercoagulable state more than the exaggerated immune response, especially in patients with anti-coagulants’ deficiency. The outstanding result that has been observed in various studies was retinal vascular diameter enlargement, which has been mainly linked to impaired venous drainage and reduction of oxygen supply.