Ocular manifestations of COVID-19: a systematic and narrative literature review

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, presents with a broad clinical spectrum extending beyond respiratory symptoms to include ocular manifestations. Increasing evidence indicates that the virus may affect the ocular surface, leading primarily to conjunctivitis, tearing, itching, and dry eye, while in rarer cases causing retinal and neuro-ophthalmic complications. The expression of angiotensin-

converting enzyme 2, transmembrane protease serine 2, and CD147 receptors in ocular tissues supports the hypothesis of direct viral tropism and possible transmission via conjunctival secretions. A review of 62 studies published between 2020 and 2025 including original research, meta-analyses, systematic reviews, and case reports revealed that ocular symptoms occur in approximately

5–20% of COVID-19 patients. Retinal microangiopathy, vascular occlusions, and optic nerve neuropathies were less frequent but clinically significant. In certain cases, ocular signs were the first or sole manifestation of infection. Although relatively uncommon, ocular involvement in COVID-19 carries diagnostic and epidemiological importance, emphasizing the need for ophthalmologic vigilance and further prospective studies to elucidate underlying mechanisms, prevalence, and long-term consequences.