Ophthalmic manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the aetiological agent of the most dramatic pandemic of the new millennium, the well-known Coronavirus Disease 2019 (COVID-19). It is characterized by many clinical-pathological facets, which can be summarized as follows: pulmonary (oedema, interstitial pneumonia, fungal superinfection, diffuse alveolar damage, scarring fibrosis), vascular (endotheliitis, vasculitis, thrombosis, disseminated intravascular coagulation), cardiac (myocarditis, pericarditis, infarction), hemolymphatic (spleen white pulp depletion, immunodepression, herpetic reactivations, naked megakaryocyte nuclei increase, hemophagocytosis, leukoerythroblastic reaction), hepatic (fulminant hepatitis, microvesicular steatosis), pancreatic (autoimmune pancreatitis), renal (acute tubular damage), and neuronal (stroke, olfactory epithelium shedding, demyelination). Even the visual apparatus can be a target of the infection in some circumstances. These ophthalmic manifestations include conjunctivitis, blepharoconjunctivitis, keratitis, Herpes Zoster ophthalmicus, rhinoorbital mucormycosis, fungal and bacterial endophthalmitis, posterior ischemic optic neuropathy, acute macular neuroretinopathy, ciliary madarosis, sub-retinal abscess, and Purtscher-like retinopathy. Surprisingly, similar alterations can also occur after COVID-19 vaccination, such as central retinal artery occlusion, retinal venous occlusion, retinal detachment, retinal vasculitis, herpetic keratitis, acute maculopathy, panuveitis, bilateral papillitis, optic neuritis, scleritis, multifocal choroiditis, multiple evanescent white dot syndrome, and eyelid oedema. Therefore, ophthalmologists should be aware of the possible manifestations of the disease and the potential adverse events of vaccination to prevent it.