ESCRS - FPS06.08 - Primary Viral Replication Or Ocular Surface Secondary Colonization By Sars-Cov-2 In Covid-19 Pneumonia Patients?

Primary Viral Replication Or Ocular Surface Secondary Colonization By Sars-Cov-2 In Covid-19 Pneumonia Patients?

Published 2022 - 40th Congress of the ESCRS

Reference: FPS06.08 | Type: Free paper | DOI: 10.82333/p2rt-ps38

Authors: Mario Troisi* 1 , Gianluigi Franci 2 , Salvatore Troisi 3 , Carla Zannella 4 , Maddalena De Bernardo 3 , Nicola Rosa 3 , Ciro Costagliola 5

1Ophthalmology,Salerno Hospital University,Salerno,Italy;Ophthalmology,AOU Federico II ,Napoli,Italy, 2Microbiology,University of Salerno,Salerno,Italy, 3Ophthalmology,Salerno University Hospital,Salerno,Italy, 4Biology,Unicampania,Napoli,Italy, 5Ophthalmology,AOU Federico II ,Napoli ,Italy

Purpose

Coronavirus disease 19 (COVID-19) has been described to be potentially complicated by ocular surface involvement, particularly in the form of conjunctivitis or keratitis. The purpose of this study is to evaluate signs of conjunctival inflammation and corneal fluorescein staining in patients admitted to sub-intensive Unit for COVID-19-pneumonia with recent positive molecular nasopharyngeal swab, in order to understand if clinical kerato-conjunctival  changes are related to medical history, treatments, and tear positivity to reverse transcriptase-PCR SARS-CoV-2-RNA assay.

Setting

Multidisciplinary Emergency Covid Unit, Eye Unit, Microbiology Service, Salerno  University Hospital

Methods

Consecutive patients suffering from COVID-19 pneumonia admitted to sub-intensive Unit underwent clinical evaluation of conjunctival inflammation (follicular reaction and hyperemia by Efron Grading Scale) and corneal fluorescein staining by Oxford Scheme; furthermore, brushing of the lower and upper tarsal conjunctiva from the right eye, for examination of the material taken with reverse transcriptase-PCR SARS-CoV-2-RNA assay, was performed. Inclusion criteria: positive nasopharyngeal swab in the last 48 hours, no ocular therapies in progress, COVID pneumonia symptoms for at least seven days. Clinical history and treatments were also evaluated and related to changes in the ocular surface. 

Results

18 eyes from nine patients (7 males/2 females), with a mean age of  73.3 years (age range: 63 to 93 years), were examined. Sixteen of the 18 examined eyes had conjunctivitis and 9 of them keratitis too; viral infection of the ocular surface affected 7 of 9 COVID-19 patients. 3 eyes had grade 4, 9 grade 3, 3 grade 2, 1 grade 1, and 2 grade 0 inflammation (Efron Scale). The presence of SARS-CoV-2 RNA-virus in the conjunctival swab was found on 13 eyes of 7 patients; four of them suffered from diabetes mellitus, two from oncological diseases. The 7 subjects with ocular positivity for SARS-CoV-2 virus had undergone treatment with total face mask or oxygen helmet in the last week; the 2 negative have been treated with high-flow nasal cannulae.

Conclusions

The ocular involvement found in all patients undergoing treatment with oxygen total face mask or helmet, unlike those treated with nasal cannula, seems to suggest a possible secondary viral contamination of the ocular surface from the respiratory tract. Further studies are necessary to verify this causal association and the role of concomitant immunological disorders.