Acute and sub-acute ocular manifestations in pediatric patients with COVID-۱۹: A systematic review

Abstract Background: The coronavirus disease ۲۰۱۹ (COVID-۱۹) pandemic has been the most challenging health problem in the last ۲ years. Post-COVID-۱۹ multisystem inflammatory syndrome of children (MIS-C) is a severe post-COVID-۱۹ complication in pediatric patients. Ocular manifestations may be the first presentation of MIS-C, wherein prompt treatment may improve outcomes. In this systematic review, we aimed to summarize the acute and sub-acute ocular manifestations in pediatric patients with laboratory-confirmed COVID-۱۹. Methods: We included all online primary studies, with no language restriction and published between January ۱, ۲۰۱۹ and November ۱۸, ۲۰۲۰, reporting any acute or sub-acute ocular manifestations in children with laboratory-confirmed COVID-۱۹. PubMed/MEDLINE was searched using the following MeSH and Emtree terms: “eye,” “ophthalmologic,” “ocular,” “vision,” “conjunctivitis,” “severe acute respiratory syndrome coronavirus ۲,” “SARS-CoV-۲,” “corona,” “۲۰۱۹-nCoV,” “COVID۱۹,” and “COVID.” The eligibility and quality of the selected records were assessed by two independent reviewers as per the Cochrane Handbook for Systematic Review. Results: A total of ۱,۱۹۲ records were identified electronically. Seven papers were extracted from the reference lists of the eligible records. Thirty-six papers met the inclusion criteria and were categorized into two subgroups according to acute or sub-acute presentation of ocular manifestations. Among ۴۶۳ pediatric patients with COVID-۱۹, ۷۲ (۱۵.۵%) had acute ocular manifestations. There was one patient with central retinal vein occlusion and another with photophobia and diplopia associated with meningoencephalitis. Among ۸۹۵ pediatric patients with post-COVID-۱۹ MIS-C, ۴۶۹ (۵۲.۴%) had ocular manifestations, which only included non-purulent conjunctivitis. Conclusions: Ocular manifestations have been reported in less than one-fifth of pediatric patients with acute COVID-۱۹. Furthermore, conjunctivitis was the only ocular manifestation reported in half of the patients with MIS-C, and it may be missed easily due to its non-purulent nature. During the COVID-۱۹ pandemic, pediatricians and health workers must remain vigilant for early detection of signs of this potentially fatal post-COVID-۱۹ inflammatory syndrome.