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Ophthalmology and COVID-19: Long-term Surveillance Needed

Radke, Nishant MS; Ruamviboonsuk, Paisan MD; Tham, Clement C.Y. FRCS; Jonas, Jost B. MD§,¶; Lam, Dennis S.C. MD∗,||

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Asia-Pacific Journal of Ophthalmology: November-December 2021 - Volume 10 - Issue 6 - p 519-520
doi: 10.1097/APO.0000000000000449
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Since the coronavirus disease 2019 (COVID-19) was first reported in December 2019, the number of individuals affected by the disease and the number of virus variants have increased globally. Recent updates indicate that out of 240 million people infected, nearly 4.9 million patients died. Various ocular manifestations of COVID-19 have been reported, including a primary involvement by the virus itself as well as sequels resulting from treatment regimens and vaccinations.

The ocular involvement ranges from simple conjunctivitis to secondary effects such as chemosis, infectious keratitis, or exposure keratopathy.1

Vision-threatening complications such as orbital cellulitis in the pediatric age group and rhino-orbital mucormycosis have been reported to occur in immunocompromised or diabetic patients treated by broad-spectrum antibiotics and steroids.2–5 Another serious condition leading to vision loss is retinal vascular occlusion. Central retinal artery occlusion has been diagnosed in patients affected by COVID-19 and was associated either with hypercoagulability or with a secondary fungal vessel invasion.6,7

In this issue, there is a comprehensive update on ocular involvement by COVID-19 infection, treatments, and vaccinations. The article covers the various ocular structures affected by the infection, and the various ocular adverse events of using different treatment regimens and different vaccines.

As compared to severe acute respiratory syndrome (SARS), the COVID-19 is truly a pandemic. The COVID-19 virus as compared to the SARS virus mutates faster, and compared with the SARS virus and the Middle East respiratory syndrome (MERS) virus, the COVID-19 virus has the highest infectivity with a basic reproductive number estimated to be between 3.3 and 6.6.8

During the peaks of the outbreak, the pandemic forced us to accept a new normality, with scheduling emergency surgeries according to priority and deferring elective surgeries, and resorting to the use of new technologies like video consultation, artificial intelligence–based decision making, and online teaching.9

The key takeaways are that the eye could be the primary site or route of infection, or could become secondarily infected. Hence, maintaining strict vigilance in the coming few years is quintessential, alongside ramping up vaccination drives so that herd immunity is established. The demanding situation makes the ophthalmic and medical fraternity roll up their cerebral sleeves and not lose sight of the pandemic and local situations alike. Eradication seems unlikely, but at the same time, all the exciting new possibilities from this pandemic mean that we should not be pessimistic either. Although molnupiravir, an oral antiviral agent, is shown to reduce the risk of hospitalization and death by half if administered early in patients with COVID-19,10 exercising guarded and cautious optimism with ophthalmologists maintaining a careful watch are very much the need of the time.


1. Wong RLM, Ting DSW, Wan KH, et al. COVID-19: ocular manifestations and the APAO prevention guidelines for ophthalmic practices. Asia Pac J Ophthalmol (Phila) 2020; 9:281–284.
2. Turbin RE, Wawrzusin PJ, Sakla NM, et al. Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19. Orbit 2020; 39:305–310.
3. Garg R, Bharangar S, Gupta S, Bhardwaj S. Post COVID-19 infection presenting as rhino-orbital mycosis. Indian J Otolaryngol Head Neck Surg 2021; 1–8. doi:10.1007/s12070-021-02722-6.
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8. Lam DSC, Wong RLM, Lai KHW, et al. COVID-19: special precautions in ophthalmic practice and FAQs on personal protection and mask selection. Asia Pac J Ophthalmol (Phila) 2020; 9:67–77.
9. Khor WB, Yip L, Zhao P, et al. Evolving practice patterns in Singapore's public sector ophthalmology centers during the COVID-19 pandemic. Asia Pac J Ophthalmol (Phila) 2020; 9:285–290.
10. Fischer W, Eron JJ, Holman W, et al. Molnupiravir, an oral antiviral treatment for COVID-19. medRxiv 2021; Published online June 17, 2021. doi:10.1101/2021.06.17.21258639.
Copyright © 2021 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.