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In the eye of the storm: SARS-CoV-2 infection and replication at the ocular surface?

Lookup NU author(s): Professor Lyle Armstrong, Dr Joseph Collin, Dr Islam Mostafa, Dr Rachel Queen, Professor Francisco FigueiredoORCiD, Professor Majlinda LakoORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in December 2019 and spread quickly causing the coronavirus disease 2019 (COVID-19) pandemic. Recent single cell RNA-Seq analyses have shown the presence of SARS-CoV-2 entry factors in the human corneal, limbal and conjunctival superficial epithelium, leading to suggestions that the human ocular surface may serve as an additional entry gateway and infection hub for SARS-CoV-2. In this article, we review the ocular clinical presentations of COVID-19 and the features of the ocular surface that may underline the overall low ocular SARS-CoV-2 infection. We critically evaluate the studies performed in non-human primates, ex vivo organ culture ocular models, stem cell derived eye organoids and the differences in infection efficiency observed in different parts of human ocular surface epithelium. Finally, we highlight the additional work that needs to be carried out to understand the immune response of the ocular surface to SARS-CoV-2 infection, which can be translated into prophylactic treatments that may be applied to other organ systems.

Publication metadata

Author(s): Armstrong L, Collin J, Mostafa I, Queen R, Figueiredo F, Lako M

Publication type: Article

Publication status: Published

Journal: Stem Cells Translational Medicine

Year: 2021

Volume: 10

Issue: 7

Pages: 976-986

Print publication date: 01/07/2021

Online publication date: 21/02/2021

Acceptance date: 30/01/2021

Date deposited: 07/11/2023

ISSN (print): 2157-6564

ISSN (electronic): 2157-6580

Publisher: Wiley


DOI: 10.1002/sctm.20-0543


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Funder referenceFunder name
MR/S035826/1Medical Research Council (MRC)