Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctiva
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REVIEW
Novel Insights into the Transmission of SARS-CoV-2 Through the Ocular Surface and its Detection in Tears and Conjunctival Secretions: A Review ¨ emes-Villahoz . Barbara Burgos-Blasco . Beatriz Vidal-Villegas . Noemi Gu Julia´n Garcia-Feijoo . Pedro Arriola-Villalobos . Jose Marı´a Martı´nez-de-la-Casa . David Diaz-Valle . Anastasios G. Konstas
Received: May 26, 2020 Ó The Author(s) 2020
ABSTRACT SARS-CoV-2 is a highly transmissible virus that spreads mainly via person-to-person contact through respiratory droplets, or through contact with contaminated objects or surfaces from an infected person. At present we are passing through a phase of slow and painful understanding of the origin, epidemiological profile, clinical spectrum, and risk profile of the virus. To the best of our knowledge there is only limited and contradictory evidence concerning SARS-CoV-2 transmission through other routes. Importantly, the eye may constitute not only a
potential site of virus replication but also an alternative transmission route of the virus from the ocular surface to the respiratory and gastrointestinal tract. It is therefore imperative to gain a better insight into the potential ophthalmological transmission route of the virus and establish directions on best practice and future models of care for ophthalmological patients. This review article critically evaluates available evidence on the ophthalmological mode of viral transmission and the value of earlier identification of the virus on the eye. More evidence is urgently needed to better evaluate the need for protective measures and reliable ocular diagnostic tests to diminish further pandemic spread.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12601931. ¨ emes-Villahoz B. Burgos-Blasco N. Gu B. Vidal-Villegas Department of Ophthalmology, Instituto de Investigacio´n Sanitaria del Hospital Clı´nico San Carlos (IdISSC), Madrid, Spain J. Garcia-Feijoo P. Arriola-Villalobos J. M. Martı´nez-de-la-Casa D. Diaz-Valle Department of Ophthalmology, Instituto de Investigacio´n Sanitaria del Hospital Clı´nico San Carlos (IdISSC) IIORC, Universidad Complutense de Madrid, ISCIII (OFTARED), Madrid, Spain A. G. Konstas (&) 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece e-mail: [email protected]
Keywords: ACE-2; Conjunctivitis; Coronavirus; COVID-19; Eyewear protection; SARS-CoV-2; TMPRSS2; Transmission
Adv Ther
Key Summary Points The presence of SARS-CoV-2 receptors in the eye may explain the viral tropism to the ocular tissue. Although SARS-CoV-2 RNA has been detected in tear and conjunctival secretion specimens, accurate and consistent detection of ophthalmic involvement with conjunctival swaps remains problematic. Importantly, the virus load in RT-PCR testing of tears and conjunctival samples often lies below detection threshold and consequently testing shows low sensitivity. Future controlled studies are warranted to evaluate the precise rat
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