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Ocular Manifestations of COVID-19: A Systematic Review and Meta-Analysis

Published date: Jan 20 2021

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: January–March 2021, Volume 16, Issue 1

Pages: 103 - 112

DOI: 10.18502/jovr.v16i1.8256

Authors:

Naser NasiriHIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Hamid SharifiHIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Azam BazrafshanNeuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

Atefeh NooriDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

Mohammad KaramouzianHIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Ali Sharifia_sharifi@kmu.ac.irDepartment of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

Abstract:

Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed randomeffects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71–17.72). In the studies that reported the details of observed ocular symptoms, the most common ocular manifestations were dry eye or foreign body sensation (n = 138, 16%), redness (n = 114, 13.3%), tearing (n = 111, 12.8%), itching (n = 109, 12.6%), eye pain (n = 83, 9.6%) and discharge (n = 76, 8.8%). Moreover, conjunctivitis had the highest rate among reported ocular diseases in COVID-19 patients (79 out of 89, 88.8%). The results suggest that approximately one out of ten COVID-19 patients show at least one ocular symptom. Attention to ocular manifestations, especially conjunctivitis, can increase the sensitivity of COVID-19 detection among patients.

Keywords: Conjunctivitis, COVID-19, Meta-analysis, Ocular Manifestations, Systematic Review

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Titik Haryati, Oktaviani Adhi Suciptaningsih, Novianto Adhi Sucipta (2024)

Cultural Education of Children of Indonesian Workers in Sabah, Malaysia, KnE Social Sciences

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Stephen T. Armenti, Dena Ballouz, Shahzad I. Mian (2021)

Updated safety precautions and guidance on eye banking procedures during the coronavirus disease 2019 pandemic, Current Opinion in Ophthalmology

Volume: 32, Issue: 4, First Page: 338

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Ílen Ferreira Costa, Livia Pimenta Bonifácio, Fernando Bellissimo-Rodrigues, Eduardo Melani Rocha, Rodrigo Jorge, Valdes Roberto Bollela, Rosalia Antunes-Foschini (2021)

Ocular findings among patients surviving COVID-19, Scientific Reports

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Umberto Rosani, Claudia del Vecchio, Elisa Franchin, Paola Brun, Stefano Ferrari, Diego Ponzin, Andrea Leonardi (2022)

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Hashem Abu Serhan, Husam Abu Suilik, Amr K. Hassan, Jehad Feras AlSamhori, Abdul Rhman Hassan, Abdelmonem Siddiq, Rehab Sabry Helal, Sudha Metilda, Ayman G Elnahry (2025)

The Characteristics of White Dot Syndromes Following SARS-COV-2 Infection: A Systematic Review, European Journal of Ophthalmology

Volume: 35, Issue: 1, First Page: 40

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Abolfazl Rafati Zomorodi, Maryam Mohammadi, Zahra Gholizadeh Farshi, Mohammad Hassan Parvizi Mashhadi, Sasan Pourbagher Benam, Mohammad Motamedifar (2025)

Prevalence and antimicrobial susceptibility pattern of coagulase-negative Staphylococci isolated from ocular infections: A systematic review and meta-analysis, The Ocular Surface

Volume: 37, First Page: 227

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Qi Zhang, Zifan Ye, Bo Cheng, Kaijun Wang, Min Chen (2024)

The spike of acute angle closure after the epidemic downgrade of COVID-19 management: a hospital-based comparative study from China, International Ophthalmology

Volume: 44, Issue: 1

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Mashael Al-Namaeh (2022)

Ocular manifestations of COVID-19, Therapeutic Advances in Ophthalmology

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Serdar Ozates, Basak Bostanci Ceran (2021)

Keeping an eye on the many symptoms of COVID-19, Graefe's Archive for Clinical and Experimental Ophthalmology

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Charles O’Donovan, Neel Vyas, Faruque Ghanchi (2023)

Retinal Vein Occlusion with COVID-19: A Case Report and Review of Literature, Ocular Immunology and Inflammation

Volume: 31, Issue: 3, First Page: 594

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Bahareh Ebrahimi, Hossein Kargar Jahromi, Nazanin Shafiei Jahromi, Mina Molayem, Poorani Gurumallesh (2025)

A Systematic Review of Ocular Complications Following Different Types of Covid‐19 Vaccines, Journal of Immunology Research

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Aleksander Stawowski, Joanna Konopińska, Sylwester Stawowski, Justyna Adamczuk, Monika Groth, Anna Moniuszko-Malinowska, Piotr Czupryna (2024)

The Review of Ophthalmic Symptoms in COVID-19, Clinical Ophthalmology

Volume: Volume 18, First Page: 1417

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Yi Lin, Bingcai Jiang, Yuanqing Cai, Wangdu Luo, Changwei Zheng, Xiaomin Zhu, Qianyi Lin, Min Tang, Xiangji Li, Lin Xie (2023)

The causal relationship between COVID-19 and increased intraocular pressure: A bidirectional two-sample Mendelian randomization study, Frontiers in Public Health

Volume: 11

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Ali Forouhari, Vahid Mansouri, Sare Safi, Hamid Ahmadieh, Amir Ghaffari Jolfayi, Alessandro Meduri (2022)

A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research, Journal of Ophthalmology

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Giorgio Zauli, Sara AlHilali, Samar Al-Swailem, Paola Secchiero, Rebecca Voltan (2022)

Therapeutic potential of the MDM2 inhibitor Nutlin-3 in counteracting SARS-CoV-2 infection of the eye through p53 activation, Frontiers in Medicine

Volume: 9

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K. El Matri, S. Werda, A. Chebil, Y. Falfoul, A. Hassairi, R. Bouraoui, L. El Matri (2021)

Acute macular outer retinopathy as a presumed manifestation of COVID-19, Journal Français d'Ophtalmologie

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B. Anil Kumar, Raghu Veladanda, Tejaswini Padmanabhula (2023)

A STUDY ON THE OCULAR MANIFESTATIONS IN PATIENTS FOLLOWING COVID-19 INFECTION, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

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Swati Barne S, Joshi Devika S, Beke Nikhil N (2022)

A case report of bilateral, symmetrical intermediate uveitis in a post COVID 19 Indian patient, Indian Journal of Clinical and Experimental Ophthalmology

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Qing Bao, Yanru Shen, Zhiwei Zheng, Yan Zheng, Yuting Li, Yaoyao Ren, Nan Zhang, Xiaomin Chen, Min Ke (2025)

Changes in the spectrum of ocular disease during the COVID-19 pandemic in late 2022 in the Hubei Province, Scientific Reports

Volume: 15, Issue: 1

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Dimitrios Kazantzis, Genovefa Machairoudia, George Theodossiadis, Panagiotis Theodossiadis, Irini Chatziralli (2023)

Retinal microvascular changes in patients recovered from COVID-19 compared to healthy controls: A meta-analysis, Photodiagnosis and Photodynamic Therapy

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Shudan Wang, Jiaoyang Feng, Rui Zhu, Xin Jin, Yiheng Ding, Di Jin, Yu Guo, Hong Zhang (2025)

Characteristics of ocular findings of patients with coronavirus disease 2019 in China, Frontiers in Medicine

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Ana Santamaria, Julian Chang, Christian Savarain (2022)

SARS-CoV-2 among the Potential Viral Triggers for Vogt-Konayagi-Harada Disease: First Case Report and Literature Review, Ocular Immunology and Inflammation

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Emina Karahmet Sher, Adnan Ćosović, Amina Džidić-Krivić, Esma Karahmet Farhat, Emma Pinjić, Farooq Sher (2023)

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Eni Amaliah, Oki Dermawan, Trisna Kusuma Yusuf, ‎ Novianti (2024)

Implementation of Library Management in Increasing Interest in Reading at the University of Lampung, KnE Social Sciences

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Martina Ranzenigo, Elena Bruzzesi, Laura Galli, Antonella Castagna, Giulio Ferrari (2021)

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SeyedAhmad SeyedAlinaghi, Esmaeil Mehraeen, Arian Afzalian, Mohsen Dashti, Afsaneh Ghasemzadeh, Ava Pashaei, Amir Masoud Afsahi, Seyed Saeed Tamehri Zadeh, Iman Amiri Fard, AmirMohammad Vafaee, Ayoob Molla, Ramin Shahidi, Ali Dadjou, Mohammad Amin Habibi, Pegah Mirzapour, Omid Dadras (2024)

Ocular manifestations of COVID-19: A systematic review of current evidence, Preventive Medicine Reports

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Alhanouf Aljuhani, Omniah Albalawi, Rahaf Albalawi, Reem Alsalama, Safyah Alatawi, Reem Altemani, Mohamed S. Abdel‐Maksoud, Nehal Elsherbiny (2023)

Exosomes in COVID‐19 infection: Focus on role in diagnosis, pathogenesis, immunity, and clinical trials, Cell Biology International

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Sydney Roston, Caroline L. Minkus, Karen R. Armbrust (2024)

Incident Ocular Inflammation After COVID-19 Infection in a US Veteran Population, Ocular Immunology and Inflammation

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Fatemeh Eslami, Salman Khazaei, Anahita Eslamighayour, Tahere Mohammadi (2025)

Epidemiologic Investigation of Eye Symptoms Related to COVID-19 among Outpatient Population, Anti-Infective Agents

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Ali A. Almishaal, Ali A. Alrushaidan (2022)

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Elias Premi, Roberto Acampora, Greta Karen Wood, Ingrid Andreea Ilie, Benedict Daniel Michael, Francesco Lanfranchi (2022)

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Michael S Deiner, Gerami D Seitzman, Gurbani Kaur, Stephen D McLeod, James Chodosh, Thomas M Lietman, Travis C Porco (2022)

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Nayef F Alswaina, Abdulrahman Alsowinea, Yazeed K Alhabeeb, Abdulrahman Aljurbua, Asim Alghelfes, Bedr Aljabaan, Hussam S Alshetwi (2024)

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Pavol Vesely, Elena Novakova, Michal Stubna, Michal Trnka, Denisa Jurenova, Darina Lyskova, Robert Furda, Paulina Plesnikova, Vratko Himic, Alena Furdova (2022)

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Rania Medhat Fahmy (2024)

Influence of Face Mask on the Use of Soft Contact Lenses in Saudi Arabia, Journal of Ophthalmology and Advance Research

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Ali Sharifi, Arash Daneshtalab, Amin Zand (2022)

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Behin Barahimi, Cullen P. Moran, Alexander De Castro-Abeger, Sylvia Groth (2024)

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Infections and glaucoma, Survey of Ophthalmology

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Volodymyr M. Bilak, Andrij V. Ilko, Yaroslav Y. Ignatko, Lyudmila V. Ignatko (2022)

RARE COMPLICATION OF COVID -19 DISEASE TINU SYNDROME IN A 11-YEAR-OLD BOY, FEATURES AND MANAGMENT, Wiadomości Lekarskie

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Ahmed Roshdy Alagorie, Osama A Sorour, Hesham Eltoukhy, Elsayed Nassar (2022)

Evaluation of Urgent Retinal Practice and Safety Measures for Physicians and Patients During COVID-19 Pandemic, Clinical Ophthalmology

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Emily M. Cherenack, Deborah L. Jones, Chloe Kaminsky, JoNell Potter, Nicholas F. Nogueira, Jaime Dickerson, Mirjam-Colette Kempf, Caitlin A. Moran, Michelle Floris-Moore, Elizabeth F. Topper, Phyllis C. Tien, Seble Kassaye, Howard Minkoff, Anjali Sharma, Helen E. Cejtin, Maria L. Alcaide (2025)

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Naram Khalayli, Ghina Haider, Yara Hodifa, Maysoun Kudsi, Nada Naman (2023)

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Muge Toprak, Enes Kesim, Buğra Karasu, Ali Riza Cenk Celebi (2025)

Choroidal vascularity ındex findings ın patients recovered from mild course COVID-19 pneumonia, International Ophthalmology

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Nissar Shaikh, Huda Al Mahdi, Anant Pai, Ankush Pathare, Ahmad A. Abujaber, Ashwin Dsliva, Mahmood Al-Jabry, Kumran Subramanian, Saju Thomas, Ahmed S. Mohmed, Shahzad Anjum, Abdulqadir J. Nashwan, Mohammad Al Wraidat, Mohamad Y. Khatib (2022)

Ocular manifestations of COVID-19: facts and figures from a tertiary care center, Annals of Medicine

Volume: 54, Issue: 1, First Page: 310

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Nathan A. Fischer, Robert C. Wann, Jason N. Crosson (2023)

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Sanjeeta Sitaula, Arika Poudel, Bikram Prasad Gajurel (2022)

Non-arteritic anterior ischemic optic neuropathy in COVID-19 infection – A case report, American Journal of Ophthalmology Case Reports

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Qian Li, Wenbo Jiao, Xiaolin Li, Lingling Liang (2025)

An Overview of Ophthalmic Complications Associated With Emerging/Re‐Emerging Viruses: Focus on ZIKV, DENV, SARS‐CoV‐2, and MPXV, Reviews in Medical Virology

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Tatiana N. Safonova, Galina V. Zaitseva (2022)

Pathogenetic Mechanisms Of Dry Eye Syndrome In A Novel Coronavirus Infection Caused By SARS-CoV-2, Russian Open Medical Journal

Volume: 11, Issue: 3

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Zsuzsanna Valyi, Maria Khalil, Sigi Van den Wijngaert, François Willermain, Marie Bruyneel (2023)

Ocular surface manifestations and SARS-CoV-2 RNA detection in conjunctival swabs of patients hospitalized for COVID-19 pneumonia, European Journal of Internal Medicine

Volume: 114, First Page: 129

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Alexander E. Azar, Priya Shukla, Kevin C. Allan, Rishi P. Singh, Katherine E. Talcott (2025)

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Oksana G. Ionova, Andrey V. Karetsky, Valentina M. Hokkanen, Nataliya G. Zumbulidze, Oksana V. Bagriantseva (2023)

Manifestations of uveitis of toxoplasmosis etiology after vaccination: clinical cases, Ophthalmology Reports

Volume: 15, Issue: 4, First Page: 85

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Ehsan Sedaghat-Rostami, Brigid Veronica Carr, Liu Yang, Sarah Keep, Fabian Z X Lean, Isabella Atkinson, Albert Fones, Basudev Paudyal, James Kirk, Eleni Vatzia, Simon Gubbins, Erica Bickerton, Emily Briggs, Alejandro Núñez, Adam McNee, Katy Moffat, Graham Freimanis, Christine Rollier, Andrew Muir, Arianne C Richard, Nicos Angelopoulos, Wilhelm Gerner, Elma Tchilian (2025)

Porcine respiratory coronavirus as a model for acute respiratory disease: mechanisms of different infection outcomes, The Journal of Immunology

Volume: 214, Issue: 7, First Page: 1643

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Xufei Luo, Meng Lv, Xianzhuo Zhang, Janne Estill, Bo Yang, Ruobing Lei, Mengjuan Ren, Yunlan Liu, Ling Wang, Xiao Liu, Qi Wang, Min Meng, Yaolong Chen (2022)

Clinical manifestations of COVID‐19: An overview of 102 systematic reviews with evidence mapping, Journal of Evidence-Based Medicine

Volume: 15, Issue: 3, First Page: 201

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Kayo Sugiura, Ken Fukuda, Rika Shoji, Mayu Kadono, Kenji Yamashiro (2025)

Frosted Branch Angiitis After COVID-19, Seminars in Ophthalmology

Volume: 40, Issue: 2, First Page: 146

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Matthew Bickford, Karolinne Rocha (2021)

Impact of the COVID-19 Pandemic on Refractive Surgery, Current Ophthalmology Reports

Volume: 9, Issue: 4, First Page: 127

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JIN CHO, NANG KYEONG LEE, JIN YEONG KIM, CHRISTOPHER SEUNGKYU LEE, SUK HO BYEON, SUNG SOO KIM, SEUNG WON LEE, YONG JOON KIM (2025)

Trends in the Incidence of Retinal Artery and Vein Occlusion Before and After COVID-19: A National Study in South Korea (2017-2022), American Journal of Ophthalmology

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Yun Zhao, Ying Tang, Qi Yao Wang, Jia Li (2025)

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Volume: 16

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Luis Haro-Morlett, Guillermo Raul Vera-Duarte, Francisco Oliveros-Valdes, Thelma Noemi Cortes-Moreno, Arturo Ramirez-Miranda, Alejandro Navas, Enrique O. Graue-Hernandez (2025)

Effects of the COVID-19 Pandemic on Microbial Keratitis: A 5-Year Comparative Study, Cornea

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Y. Grace Chung, Christie M. Person, Jacquelyn O’Banion, Susan A. Primo (2022)

Coronavirus Disease 2019–Related Health Disparities in Ophthalmology with a Retrospective Analysis at a Large Academic Public Hospital, Advances in Ophthalmology and Optometry

Volume: 7, Issue: 1, First Page: 311

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Ryan Spiteri, Sousann Barakat, Meri Vukicevic (2023)

COVID-19 and sudden-onset ocular neurogenic palsy in prior healthy patients: a systematic review, Strabismus

Volume: 31, Issue: 2, First Page: 145

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Luke Michaels, Jay Richardson, Andrew Walkden, Fiona Carley (2022)

Impact of the COVID-19 Pandemic on the Incidence and Characteristics of Culture-Positive Microbial Keratitis at a Tertiary Eye Hospital in the UK, Clinical Ophthalmology

Volume: Volume 16, First Page: 2513

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Maria Letizia Salvetat, Marco Zeppieri (2024)

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Volume: 1457, First Page: 401

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Naser Nasiri, Hamid Sharifi, Tahereh Rahimi, Ghodsieh Sharif, Ali Sharifi (2022)

Ocular Manifestations in Children with COVID-19: Systematic Review and Meta-Analysis, Journal of Medical Microbiology and Infectious Diseases

Volume: 10, Issue: 2, First Page: 58

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Nada Ummamil Khoiroh, Khamdan Suriyok, Agus Andi Subroto, Sylvia Mufarrochah, Dina Nur Maulidah, Monica Putri Alda (2025)

The Effect of Beauty Influencers and Social Media Advertising on Purchase Decisions for Skincare Products Through Purchase Intention as a Mediating Variable: A Study on Somethinc Product Consumers in Beji, Bangil, and Pandaan, KnE Social Sciences

Volume: 10, Issue: 9, First Page: 291

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Suji Yeo, Hanju Kim, Jiwon Lee, Jeonghyun Yi, Yoo-Ri Chung (2023)

Retinal vascular occlusions in COVID-19 infection and vaccination: a literature review, Graefe's Archive for Clinical and Experimental Ophthalmology

Volume: 261, Issue: 7, First Page: 1793

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Christian Gronbeck, Andrzej Grzybowski, Jane M. Grant-Kels (2024)

COVID-19 and the eye, Clinics in Dermatology

Volume: 42, Issue: 1, First Page: 17

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S. Stoykova, M. Dragomirova (2023)

COVID-19 – OCULAR INVOLVMENT, FINDINGS AND THE RISK OF POTENTIAL TRANSMISSION, Trakia Journal of Sciences

Volume: 21, Issue: 4, First Page: 307

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Mamta Singh, Kunal Deokar, Bibhuti Prassan Sinha, Jinish Doshi, CDS Katoch (2024)

Infective pulmonary diseases and the eye: a narrative review, Monaldi Archives for Chest Disease

Volume: 95, Issue: 3

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