Chinese researchers describe ocular symptoms of COVID-19 patients

The prevalence of COVID-19 in tears of infected patients is low, but ocular manifestations appear to be common in patients with COVID-19, and their presence was associated with more severe COVID-19, according to research reported by ophthalmologists in Hubei Province, China. The investigators concluded that their findings indicate the potential for the virus to be transmitted via the eyes. They stated that by assisting ophthalmologists and others to understand the ocular manifestations of COVID-19, their research has potential implications for enhancing diagnosis of the infection and preventing transmission. The study was published online in JAMA Ophthalmology. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2764083 The investigators aimed to gather data on ocular manifestations of COVID-19 infected patients and the prevalence of the virus in the conjunctiva because they noted a lack of published reports on these topics. The investigators explained that the causative pathogen of COVID-19 – severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – belongs to the same virus family as the pathogen that caused the disease known as SARS. Although there was no evidence associating the SARS virus with ocular manifestations, there had been reports that unprotected eyes were associated with an increased risk of transmission, the researchers said. Their study included 38 consecutive patients with clinically confirmed COVID-19 who were treated between February 9 and 15, 2020. Both nasopharyngeal and conjunctival swabs were obtained from all patients and analysed for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction. Twenty-eight (74%) of the 38 patients were positive for COVID-19 by nasopharyngeal swabs. Only two (5%) patients had a positive conjunctival specimen, both of whom also had a positive nasopharyngeal swab. Twelve (32%) patients in the series had conjunctivitis with signs that included conjunctival hyperemia, chemosis, epiphora, and increased secretions. Of those patients, 11 (92%) tested positive for COVID-19 by nasopharyngeal swab. In one patient, epiphora was the first symptom of COVID-19. Analyses of blood specimens for markers of infection severity showed that the patients with ocular manifestations were more likely than those without ocular findings to have higher levels of white blood cells, neutrophils, procalcitonin, C-reactive protein, and lactate dehydrogenase. According to disease severity grading from the National Guideline on Prevention and Control of the Novel Coronavirus Pneumonia, 6 (50%) of the 12 patients with ocular manifestations were categorized as critical, 2 (17%) were severe and 4 (33%) were moderate cases.

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