OCULAR MANIFESTATIONS OF SYSTEMIC VIRAL INFECTIONS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.71000/aaxd5e80Keywords:
Ocular manifestations, COVID-19, Dengue virus, Herpes simplex virus, Systemic viral infections, Systematic reviewAbstract
Background: Systemic viral infections can lead to a broad spectrum of ocular manifestations, which are often overlooked in clinical settings. Although previous reports have documented these associations individually for viruses such as SARS-CoV-2, Dengue, and Herpes simplex virus, a comprehensive synthesis comparing their ocular involvement is lacking.
Objective: This systematic review aims to analyze and categorize the range of ocular complications associated with COVID-19, Dengue virus, and Herpes simplex virus infections, highlighting prevalence, clinical patterns, and implications for eye care.
Methods: A systematic review was conducted in accordance with PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science, and Cochrane Library for studies published between 2020 and 2025. Inclusion criteria comprised observational studies, cohort studies, and case series reporting ocular findings in patients with confirmed COVID-19, Dengue, or Herpes simplex virus infections. Data extraction included study design, sample size, type of ocular involvement, and prevalence. Risk of bias was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist. Quantitative synthesis was conducted where applicable, and a forest plot was constructed for COVID-19-related findings.
Results: Twelve studies met inclusion criteria, encompassing a range of ocular complications including conjunctivitis, episcleritis, retinal hemorrhages, maculopathy, and keratitis. COVID-19-related ocular symptoms showed prevalence rates ranging from 12% to 30%. Dengue and Herpes simplex virus were associated with more posterior segment and vision-threatening findings. A forest plot demonstrated variability in prevalence among COVID-19 cohorts. The strength of evidence varied, with some studies limited by small sample sizes and heterogeneity in diagnostic criteria.
Conclusion: Ocular complications are increasingly recognized as clinically relevant manifestations of systemic viral infections. While most are self-limiting, others may cause significant visual morbidity. Findings underscore the need for routine ocular evaluation in affected patients and encourage future prospective studies to establish causality, long-term outcomes, and treatment protocols.
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Copyright (c) 2025 Muhammad Israr, Bilal Safdar, Ayesha Saleem, Rida Fatima Aslam, Zohaib Ali , Kiran Shakeel Alvi , Mansoor Ali (Author)
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