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Retinal findings in hospitalised patients with severe COVID-19
  1. Leonardo Amarante Pereira1,
  2. Larissa Caroline Mansano Soares1,
  3. Priscila Alves Nascimento1,
  4. Luciano Rabello Netto Cirillo1,
  5. Hebert Toshiaki Sakuma1,
  6. Glaucia Luciano da Veiga1,2,
  7. Fernando Luiz Afonso Fonseca1,2,3,
  8. Vagner Loduca Lima1,
  9. Julio Zaki Abucham-Neto1
  1. 1 Discipline of Ophthalmology, Faculdade de Medicina do ABC, Santo Andre, Brazil
  2. 2 Clinical Analysis Laboratory, Faculdade de Medicina do ABC, Santo Andre, Brazil
  3. 3 Department of Pharmaceutical Sciences, Federal University of Sao Paulo, Diadema, Brazil
  1. Correspondence to Leonardo Amarante Pereira, Department of Ophthalmology, Faculdade de Medicina do ABC, 2000 Lauro Gomes Avenue, Santo André, Brazil; leonardoxamarante{at}


Aim To identify retinal findings using dilated eye examination, which are possibly related to SARS-CoV-2 infection in hospitalised patients with confirmed severe COVID-19.

Methods In this cross-sectional study, hospitalised patients with confirmed severe COVID-19 in a single referral centre for the treatment of COVID-19, in Santo André, São Paulo Metropolitan Area, Brazil, underwent dilated eye examination of both eyes performed by a retina specialist. Findings were recorded using a portable digital fundus camera. Retinographies were analysed by two retina specialists. Medical records were reviewed for assessment of patient demographics, baseline comorbidities and clinical data.

Results There were a total of 18 patients, nine (50%) male, median IQR age of 62.5 (12) years. Ten of the 18 patients (55.6%; 95% CI 33.7 to 75.4) had abnormalities on dilated eye examination. The main findings were flame-shaped haemorrhages (N=4; 22.2%; 95% CI 9.0 to 45.2) and ischaemic pattern lesions (cotton wool spots and retinal sectorial pallor) (N=4; 22.2%; 95% CI 9.0 to 45.2), with one patient having both cotton wool spots and flame-shaped haemorrhages.

Conclusion These findings suggest that patients with severe COVID-19 have acute vascular lesions of the inner retina including flame-shaped haemorrhages and cotton wool spots. Further studies controlling for confounding factors are necessary to properly assess these findings so as to increase the understanding of COVID-19 pathophysiology and to identify new therapies.

  • Retina
  • Infection
  • Imaging

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  • Contributors All authors have given final approval of this version to be published. LAP, LCMS, JZA-N designed the study; LAP, LCMS, PAN, LRNC, VLL conducted the study; LAP, LCMS, PAN, HTS, JZA-N, VLL, GLV managed the data; PAN, HTS, JZA-N, GLV, FLAF, VLL interpreted the data; LAP and JZA-N prepared the manuscript; and JZA-N, VLL, FLAF did overall coordination.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The institutional research ethics committee of Faculdade de Medicina do ABC under protocol 4.067.204.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from the corresponding author upon reasonable request.

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