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  • Could the eye be an entry point for SARS-CoV-2?

    Comprehensive Ophthalmology

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    Review of: ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection

    Zhou L, Xu Z, Castiglion G, et al. bioRxiv, preprint

    The authors investigated whether ocular surface cells possess the key factors required for cellular susceptibility to SARS-CoV-2, the virus that causes COVID-19.

    Study design

    Human postmortem eyes as well as surgical specimens were analyzed for the expression of ACE2 (the receptor for SARS-CoV-2) and TMPRSS2, a cell surface-associated protease that facilitates viral entry following binding of the viral spike protein to ACE2

    Outcomes

    The results of the study reveal that the ocular surface tissue from non-SARS-CoV-2 does contains both the ACE2 receptor and the TMPRSS2 protease. This new finding raises important concerns about the necessity of eye protection to prevent COVID-19 infections.

    Limitations

    This study only includes a small sample size of ocular tissue from healthy live patients and from post-mortem eyes.

    Clinical significance

    This study is pending publication and undergoing peer review as of May 30, 2020. These preliminary results suggest that the eye is susceptible to infection to SARS-CoV-2, a very contagious coronavirus.

    To be clear, at this time, we still do not know if someone can become ill from exposure to SARS-CoV-2 to their eyes. However, we do know from other studies that SARS-CoV-2 can be present on the surface of the eye. Since the eye has direct communication to the nasal passages via the nasolacrimal duct, the virus has access to the respiratory system. These new findings add to the body of evidence that the eye can be a source of both transmission and infection in asymptomatic/symptomatic carriers. Therefore, eye protection that protects against droplets and aerosols is prudent especially for eye doctors.