pooled prevalence estimate of ocular manifestations in covid-19 patients: a systematic review and meta-analysis

Background: there are reports of ocular tropism due to respiratory viruses such as severe acute respiratory syndromecoronavirus- 2 (sars-cov-2). various studies have shown ocular manifestation in coronavirus disease-2019 (covid-19) patients. we aimed to identify ophthalmic manifestations in covid-19 patients and establish an association between ocular symptoms and sars-cov-2 infection. methods: a systematic search of medline, scopus, web of science, embase, and cochrane library was conducted for publications from december 2019 to april 2021. the search included mesh terms such as sars-cov-2 and ocular manifestations. the pooled prevalence estimate (ppe) with 95% confidence interval (ci) was calculated using binomial distribution and random effects. the meta-regression method was used to examine factors affecting heterogeneity between studies. results: of the 412 retrieved articles, 23 studies with a total of 3,650 covid-19 patients were analyzed. the ppe for any ocular manifestations was 23.77% (95% ci: 15.73-31.81). the most prevalent symptom was dry eyes with a ppe of 13.66% (95% ci: 5.01-25.51). the ppe with 95% ci for conjunctival hyperemia, conjunctival congestion/conjunctivitis, and ocular pain was 13.41% (4.65-25.51), 9.14% (6.13-12.15), and 10.34% (4.90-15.78), respectively. only two studies reported ocular discomfort and diplopia. the results of meta-regression analysis showed that age and sample size had no significant effect on the prevalence of any ocular manifestations. there was no significant publication bias in our meta-analysis. conclusion: there is a high prevalence of ocular manifestations in covid-19 patients. the most common symptoms are dry eyes, conjunctival hyperemia, conjunctival congestion/ conjunctivitis, ocular pain, irritation/itching/burning sensation, and foreign body sensation.