April 6, 2020
By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor
Review of Myopia Management
Preliminary data published in JAMA Ophthalmology suggests severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), might be transmitted through the eye.
Researchers analyzed data from 38 patients infected with COVID-19 from Hubei Province, China, and found 12 (31.6%; 95% CI, 17.5%-48.7%) individuals had ocular manifestations, including epiphora, conjunctival congestion, or chemosis.
These symptoms commonly occur in patients with severe systemic manifestations of COVID-19 and are consistent with conjunctivitis, or pink eye. None of the 12 patients experienced blurred vision. 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. The study also found COVID-19 was present on conjunctiva swabs from 2 of 11 (18%) patients tested for SARS-CoV-2 via nasopharyngeal swabs.
Previously, the American Academy of Ophthalmology (AAO) observed that some reports suggest “the virus can cause conjunctivitis and possibly be transmitted by aerosol contact with the conjunctiva.” The AAO also reported that there is a low risk of spreading COVID-19 through tears.
The primary importance of this finding is epidemiologic because it confirms other reports that the virus can invade the conjunctiva, which might, in turn, serve as a source of its spread.
Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China
Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K
Importance: While the outbreak of coronavirus disease 2019 (COVID-19) has resulted in more than 100 000 infected individuals 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 ocular manifestations of patients with COVID-19 by ophthalmologists and others may facilitate the diagnosis and prevention of transmission of the disease.
Objective: To investigate ocular manifestations and viral prevalence in the conjunctiva of patients with COVID-19.
Design, Setting, and Participants: In this case series, patients with COVID-19 treated from February 9 to 15, 2020, at a hospital center in Hubei province, China, were retrospectively reviewed for ocular manifestations. During the period of treatment, the ocular signs and symptoms as well as results of blood tests and reverse transcriptase–polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for SARS-CoV-2 were noted and analyzed.
Main Outcomes and Measures: Ocular signs and symptoms as well as results of blood tests and RT-PCR for SARS-CoV-2.
Results: Of the 38 included patients with clinically confirmed COVID-19, 25 (65.8%) were male, and the mean (SD) age was 65.8 (16.6) years. Among them, 28 patients (73.7%) had positive findings for COVID-19 on RT-PCR from nasopharyngeal swabs, and of these, 2 patients (5.2%) yielded positive findings for SARS-CoV-2 in their conjunctival as well as 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. By 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. In addition, 11 of 12 patients with ocular abnormalities (91.7%; 95% CI, 61.5-99.8) had positive results for SARS-CoV-2 on RT-PCR from nasopharyngeal swabs. Of these, 2 (16.7%) had positive results for SARS-CoV-2 on RT-PCR from both conjunctival and nasopharyngeal swabs.
Conclusions and Relevance: In this study, one-third of patients with COVID-19 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 via the eyes.
Wu, P., Duan, F., Luo, C., Liu, Q., Qu, X., Liang, L., & Wu, K. (2020). Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmology.