Episcleritis Revealing Coronavirus Disease (Covid-19): A Case Report.

COVID-19 is the disease caused by a novel coronavirus. The World health organization WHO became aware of this new virus on December 31, 2019 when an outbreak of "viral pneumonia" cases was reported in Wuhan and has since spread worldwide, causing a global pandemic.

This disease is caused by a new virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 can be transmitted by respiratory droplets that come into contact with the mucous surface of the mouth, nose, or eyes.

Although COVID-19 primarily affects the respiratory tract, involvement of the gastrointestinal tract and eye tissues has been reported.

The purpose of this work is to demonstrate that episcleritis can be one of the first signs of COVID-19.

We report the case of a 23-year-old man with no prior medical history who presented 3 days before his consultation with a painful red left eye without loss of visual acuity. Two days later, the patient reported headache, cough and fever (38◦C). Real-time fluorescence polymerase chain reaction testing of his nasopharyngeal swab tested positive for COVID-19.

Ophthalmological examination showed:

A visual acuity of 20/20 in both eyes.

In the left eye: a diffuse conjunctival and episcleral injection and a clear cornea. The diagnosis of episcleritis was made based on a phenylephrine test which was performed using 10% phenylephrine hydrochloride; results showed whitening of engorged superficial conjunctival and episcleral vessels.

Examination of the right eye is unremarkable. Intraocular pressure and fundus examination were normal.

The patient received treatment with a topical preservative-free lubricant with a nonsteroidal anti-inflammatory eye drops (Indomethacin) for 15 days, in addition to systemic treatment for Covid-19 disease. The evolution was satisfactory after 10 days.

Extra-pulmonary COVID-19 manifestations are clinically important as they can be a potential mode of transmission and are included in the mechanisms underlying the pathogenicity of SARS-CoV- 2.

Presently, our understanding of the clinical spectrum of the ocular manifestations of COVID-19 is limited. A recent case report illustrated that SARS-CoV-2 RNA can be detected in the conjunctival swab of a confirmed COVID-19 patient; this finding indicates that viral conjunctivitis can be one of the early signs of COVID-19. 

Bostanci Ceran et al. investigated the ocular findings of confirmed COVID-19 cases and found that 2 out of 93 patients had episcleritis.

This presentation of ocular features followed by pulmonary symptoms suggests a link between the ocular and systemic manifestations.

Understanding the association between ocular signs/diseases and COVID-19 can aid in its diagnosis and can help in limiting the transmission of the disease. Considering the limited number of studies on COVID-19 and its relationship with ocular tissues, further studies are needed to clarify this relationship and understand its pathogenesis.