Qu Jing-Yu, Xie Hua-Tao, Zhang Ming-Chang
Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.
Clin Ophthalmol. 2021 Feb 18;15:687-696. doi: 10.2147/OPTH.S295283. eCollection 2021.
Currently, the coronavirus disease 2019 (COVID-19) pandemic is raging around the world. However, the transmission of its pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is not fully clear. It is still controversial whether the ocular transmission of SARS-CoV-2 exists. This review aimed to summarize the evidence of SARS-CoV-2 ocular transmission.
Online articles were searched till October 23, 2020 in Pubmed, Embase, and websites of World Health Organization, Centers for Disease Control and Prevention COVID-19, American Academy of Ophthalmology, and American Society of Cataract and Refractive Surgery under the search strategy of (((("COVID-19"[Mesh]) OR ("SARS-CoV-2"[Mesh])) OR (2019 novel coronavirus)) OR (2019-nCoV)) AND (((("Conjunctivitis"[Mesh]) OR (Ocular Surface)) OR ("Eye"[Mesh])) OR ("Ophthalmology"[Mesh])). The language was not restricted. After screening, 1445 records were excluded and 168 references original articles were finally included.
Cells of ocular surface express both the receptor of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2), offering molecular bases for the ocular susceptibility to SARS-CoV-2. Accumulated COVID-19 patients presented conjunctivitis as the initial or the only symptom. Whether COVID-19 patients had ocular symptoms or not, SARS-CoV-2 was detectable on the ocular surface, and the isolated virus was infectious, proving that the ocular surface can not only be a reservoir but also a source of contagion. SARS-CoV-2 may reach the ocular surface by hand-eye contact and aerosols. Once SARS-CoV-2 reaches the ocular surface, it may transfer to other systems through the nasolacrimal system or hematogenous metastasis.
The ocular surface can serve as a reservoir and source of contagion for SARS-CoV-2. SARS-CoV-2 can be transmitted to the ocular surface through hand-eye contact and aerosols, and then transfer to other systems through nasolacrimal route and hematogenous metastasis. The possibility of ocular transmission of SARS-CoV-2 cannot be ignored.
目前，2019冠状病毒病（COVID-19）大流行正在全球肆虐。然而，其病原体严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的传播途径尚未完全明确。SARS-CoV-2是否存在眼部传播仍存在争议。本综述旨在总结SARS-CoV-2眼部传播的证据。
截至2020年10月23日，在Pubmed、Embase以及世界卫生组织、美国疾病控制与预防中心COVID-19、美国眼科学会和美国白内障与屈光手术学会的网站上，按照检索策略（(((“COVID-19”[主题词])或(“SARS-CoV-2”[主题词]))或(2019新型冠状病毒))或(2019-nCoV))与(((“结膜炎”[主题词])或(眼表))或(“眼”[主题词]))或(“眼科学”[主题词]))进行在线文章检索。语言不限。筛选后，排除1445条记录，最终纳入168篇参考文献原文。
眼表细胞同时表达血管紧张素转换酶2（ACE2）受体和跨膜丝氨酸蛋白酶2（TMPRSS2），为眼对SARS-CoV-2的易感性提供了分子基础。越来越多的COVID-19患者以结膜炎作为初始或唯一症状。无论COVID-19患者是否有眼部症状，在眼表均可检测到SARS-CoV-2，且分离出的病毒具有传染性，证明眼表不仅可以是病毒储存库，还可以是传染源。SARS-CoV-2可能通过手眼接触和气溶胶到达眼表。一旦SARS-CoV-2到达眼表，它可能通过鼻泪系统或血行转移转移到其他系统。
眼表可作为SARS-CoV-2的病毒储存库和传染源。SARS-CoV-2可通过手眼接触和气溶胶传播至眼表，然后通过鼻泪途径和血行转移转移至其他系统。SARS-CoV-2眼部传播的可能性不容忽视。
