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      Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals

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          ABSTRACT

          In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus – 2 (SARS-CoV-2) emerged from China. This virus causes the coronavirus disease 2019 (COVID-19). Since then, there have been anecdotal reports of ocular infection. The ocular implications of human CoV infections have not been widely studied. However, CoVs have been known to cause various ocular infections in animals. Clinical entities such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been documented in feline and murine models. In this article, the current evidence suggesting possible human CoV infection of ocular tissue is reviewed. The review article will also highlight animal CoVs and their associated ocular infections. We hope that this article will serve as a start for further research into the ocular implications of human CoV infections.

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          Most cited references35

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          Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus

          The recent emergence of Wuhan coronavirus (2019-nCoV) puts the world on alert. 2019-nCoV is reminiscent of the SARS-CoV outbreak in 2002 to 2003. Our decade-long structural studies on the receptor recognition by SARS-CoV have identified key interactions between SARS-CoV spike protein and its host receptor angiotensin-converting enzyme 2 (ACE2), which regulate both the cross-species and human-to-human transmissions of SARS-CoV. One of the goals of SARS-CoV research was to build an atomic-level iterative framework of virus-receptor interactions to facilitate epidemic surveillance, predict species-specific receptor usage, and identify potential animal hosts and animal models of viruses. Based on the sequence of 2019-nCoV spike protein, we apply this predictive framework to provide novel insights into the receptor usage and likely host range of 2019-nCoV. This study provides a robust test of this reiterative framework, providing the basic, translational, and public health research communities with predictive insights that may help study and battle this novel 2019-nCoV.
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            Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes

            ABSTRACT In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral–fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral–fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
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              2019-nCoV transmission through the ocular surface must not be ignored

              Chaolin Huang and colleagues 1 reported the epidemiology, symptoms, and treatment of patients infected by the 2019 novel coronavirus (2019-nCoV) in Wuhan, China. As ophthalmologists, we believe that transmission of 2019-nCoV through the eyes was ignored. On Jan 22, Guangfa Wang, a member of the national expert panel on pneumonia, reported that he was infected by 2019-nCoV during the inspection in Wuhan. 2 He wore an N95 mask but did not wear anything to protect his eyes. Several days before the onset of pneumonia, Wang complained of redness of the eyes. Unprotected exposure of the eyes to 2019-nCoV in the Wuhan Fever Clinic might have allowed the virus to infect the body. 2 Infectious droplets and body fluids can easily contaminate the human conjunctival epithelium. 3 Respiratory viruses are capable of inducing ocular complications in infected patients, which then leads to respiratory infection. 4 Severe acute respiratory syndrome coronavirus (SARS-CoV) is predominantly transmitted through direct or indirect contact with mucous membranes in the eyes, mouth, or nose. 5 The fact that exposed mucous membranes and unprotected eyes increased the risk of SARS-CoV transmission 4 suggests that exposure of unprotected eyes to 2019-nCoV could cause acute respiratory infection. Thus, Huang and colleagues 1 should have analysed conjunctival scrapings from both confirmed and suspected 2019-nCoV cases during the onset of symptoms. The respiratory tract is probably not the only transmission route for 2019-nCoV, and all ophthalmologists examining suspected cases should wear protective eyewear.
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                Author and article information

                Journal
                Ocul Immunol Inflamm
                Ocul. Immunol. Inflamm
                IOII
                ioii20
                Ocular Immunology and Inflammation
                Taylor & Francis
                0927-3948
                1744-5078
                2020
                16 March 2020
                : 0
                : 0
                : 1-5
                Affiliations
                [a ]Department of Ophthalmology, National University Hospital , Singapore, Singapore
                [b ]Yong Loo Lin School of Medicine, National University of Singapore , Singapore, Singapore
                [c ]NHS Foundation Trust, Moorfields Eye Hospital , London, UK
                [d ]National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore, Singapore
                Author notes
                CONTACT Rupesh Agrawal Rupesh_agrawal@ 123456ttsh.com.sg National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng , Singapore 308433
                Author information
                http://orcid.org/0000-0001-7843-1917
                http://orcid.org/0000-0002-6662-5850
                Article
                1738501
                10.1080/09273948.2020.1738501
                7103678
                32175797
                674e6707-320a-48fa-acd7-ebe4537f7631
                © 2020 Taylor & Francis Group, LLC

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                : 23 February 2020
                : 02 March 2020
                : 02 March 2020
                Page count
                References: 50, Pages: 5
                Funding
                Funded by: this manuscript
                No funding sources were required for the production of this manuscript.
                Categories
                Review

                Immunology
                coronavirus,coronavirus disease 2019,covid-19,novel coronavirus,severe acute respiratory syndrome coronavirus-2

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