**8. Discussion**

SARS-CoV-2 is a highly infectious virus, transmitted by exposure to contaminated respiratory fluids causing mainly respiratory illness. Transmission by tear is not unlikely, and the eye can be a way for viral infection. This can be explained by the ACE2 coronaviruses receptor in the eye cells and that is why protecting the eyes is essential, especially for healthcare providers.

One out of 10 COVID-19 patients presents at least one ocular manifestation. The most prevalent ocular manifestation in patients with COVID-19 is follicular conjunctivitis, corresponding to 90% of ocular findings. The most frequent symptoms are dry eye or foreign body sensation, eye redness, tearing, itching, eye pain, and discharge.

It is important to know that the mechanism of dry eye or foreign body sensation is uncertain as during the pandemic screen time and face masks could also contribute to tear evaporation.

Attention to ocular manifestations, especially when combined with other COVID-19 manifestations like respiratory symptoms or fever, could help improve COVID-19 diagnosis, although ocular involvements are rare and nonspecific. There is evidence showing that conjunctivitis-related symptoms may occur prior to the onset of respiratory symptoms and could be the precursors for early diagnosis. Loffredo and colleagues reported that conjunctivitis in COVID-19 patients was significantly correlated with disease severity.

Posterior segment findings are less common than anterior segment manifestation. A few studies showed retinal layer attenuation in OCT. It should be noted that there is an important correlation between COVID-19 and Central Retinal Vein Occlusion, even in patients without comorbidities.

Ophthalmic manifestations are varied in terms of presentation, severity, and timing. Usually, ocular symptoms are mild and improve without further complications.
