Key points What are the ocular manifestations and conjunctival viral prevalence in patients in Hubei Province, China, with coronavirus disease 2019 (COVID-19)? Findings In this case series including 38 patients with COVID-19, 12 patients had ocular manifestations, such as epiphora, conjunctival congestion, or chemosis, and these commonly occurred in patients with more severe systemic manifestations. Reverse transcriptase-polymerase chain reaction results were positive for severe acute respiratory syndrome coronavirus 2 in 28 nasopharyngeal swabs and 2 conjunctival swabs, and more significant changes in blood test values appeared in patients with abnormalities eyepieces. Significance These data may help ophthalmologists and others understand the ocular manifestations of COVID-19, thereby improving diagnosis and prevention of disease transmission. |
Summary
Importance
While the coronavirus disease 2019 (COVID-19) outbreak has resulted in more than 100,000 people infected in China and worldwide, there are few reports on the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) with ocular abnormalities. Understanding the ocular manifestations of COVID-19 patients by ophthalmologists and others may facilitate diagnosis and prevention of disease transmission.
Aim
To investigate ocular manifestations and viral prevalence in the conjunctiva of patients with COVID-19.
Design, environment and participants
In this case series, COVID-19 patients treated from February 9 to 15, 2020 at a hospital facility in Hubei Province, China, were retrospectively reviewed for ocular manifestations.
During the treatment period, ocular signs and symptoms, as well as blood test results and reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal and conjunctival swabs for SARS-CoV were observed and analyzed. -2.
Main results and measures
Ocular signs and symptoms, as well as blood test results and RT-PCR for SARS-CoV-2.
Results
Of the 38 included patients with clinically confirmed COVID-19, 25 (65.8%) were men, and the mean (SD) age was 65.8 (16.6) years. Among them, 28 patients (73.7%) had positive results for COVID-19 in RT-PCR of nasopharyngeal swabs, and of these, 2 patients (5.2%) had positive results for SARS-CoV-2 in their conjunctiva. and nasopharyngeal specimens
A total of 12 of 38 patients (31.6%; 95% CI, 17.5-48.7) had ocular manifestations consistent with conjunctivitis, including conjunctival hyperemia, chemosis, epiphora, or increased secretions.
Using univariate analysis, patients with ocular symptoms were more likely to have higher white blood cell and neutrophil counts and higher levels of procalcitonin, C-reactive protein, and lactate dehydrogenase than patients without ocular symptoms.
Additionally, 11 of 12 patients with ocular abnormalities (91.7%; 95% CI, 61.5-99.8) had positive results for SARS-CoV-2 in RT-PCR of nasopharyngeal swabs. Of these, 2 (16.7%) had positive results for SARS-CoV-2 in RT-PCR of conjunctival and nasopharyngeal swabs.
Conclusions and relevance
In this study, one-third of COVID-19 patients had ocular abnormalities, which frequently occurred in patients with more severe COVID-19.
Although there is a low prevalence of SARS-CoV-2 in tears, it is possible to transmit through the eyes.
Discussion
Few previous investigations have evaluated ocular signs and symptoms in patients infected with SARS-CoV-1 and SARS-CoV-2. Some reports have evaluated the presence of SARS-CoV-2 in tear fluid.
Our research suggests that among patients with COVID-19, 31.6% (95% CI, 17.5-48.7) have ocular abnormalities, and the majority among patients with more severe systemic manifestations or abnormal blood test findings.
These results suggest that ocular symptoms commonly appear in patients with severe pneumonia.
Our results show a low prevalence (5.2%; 95% CI, 0.6-17.8) of SARS-CoV-2 nucleotides in conjunctival samples from patients with COVID-19, consistent with previous studies on severe acute respiratory syndrome finding only 1 patient who presented conjunctivitis as the first symptom. Previous reports have shown that shedding of potentially infectious virus can occur in people who have no fever and mild or absent signs of infection.
Because unprotected eyes were associated with a higher risk of SARS-CoV-1 transmission in support of our current results, our results could suggest that SARS-CoV-2 could be transmitted through the eye.
Limitations of this study include a relatively small sample size and lack of detailed ocular examinations to exclude intraocular disease due to the logistical challenges of managing these patients at this time. Additionally, we only sampled each patient’s eye once, which may decrease prevalence due to false negatives.
In any case, these preliminary results are shared in an effort to inform ophthalmologists and others around the world about ocular symptoms with COVID-19.
