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

  1. Soumen Sadhu
  2. Sushmitha Arcot Dandapani
  3. Deepmala Mazumdar
  4. Sangeetha Srinivasan
  5. Jyotirmay Biswas

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Abstract

Objective

To estimate the prevalence of ocular manifestations and ocular samples polymerase chain reaction (PCR) positivity among COVID-19 patients.

Methods

A 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 I 2 statistic. The pooled proportion of patients presenting with symptoms and ocular samples PCR positivity was estimated.

Results

A 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).

Conclusion

The 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.

Synopsis

Viral 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.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.29.20142414: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Literature search strategy, screening and data extraction: A comprehensive literature search was performed using four search engines PubMed
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    , Google scholar, BioRixv and Medrixv till 10th June 2020.
    Google scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    The keywords used for the literature search were “SARS-CoV-2”, “novel coronavirus”, “COVID-19”, “ocular manifestations”, “conjunctival congestion”, “Ocular detection”, “Polymerase chain reaction”, and “conjunctivitis”,using bullion characters “AND”, “OR”, “NOT”, and the vocabulary search strategy (MeSH terms).
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    The extracted data were recorded in a data extraction template provided by the Cochrane library, which was then customized for our study.
    Cochrane library
    suggested: (Cochrane Library, RRID:SCR_013000)
    The data were entered in the Microsoft Excel sheet; any disagreements were resolved by further discussions among the investigators.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    After verification, the data were entered into the Med Calc Software (MedCalc Statistical Software version 19.3.1
    MedCalc
    suggested: (MedCalc, RRID:SCR_015044)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We came across few limitations in the studies: 1) The Majority of the studies had a small sample size, except for a few, 2) The time of ocular sampling differed among each study 3) The substantial heterogeneity can influence the results in few cases. 4) The study was carried-out during the peak stage of the on-going pandemic; therefore less serious conditions including ocular complications may be overlooked.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.06.29.20142414v1 on medRxiv