Case study links COVID-19 to follicular conjunctivitis

The authors report the ocular characteristics and presence of viral RNA in a patient with COVID-19.

Study design

This case report describes the clinical ocular manifestations of a 30-year-old male with COVID-19 in Shenzhen, China. The man presented with typical systemic symptoms and was diagnosed with bilateral acute conjunctivitis 13 days after illness onset.

Outcomes

After initially presenting with a sore throat and diarrhea, the patient tested positive for SARS-CoV-2 and developed pulmonary symptoms. His vital signs stabilized after beginning treatment with various medications including umifenovir, lopinavir and ritonavir on day 6 and beyond.

On day 13, the patient developed redness of both eyes along with foreign body sensation and tearing. Visual acuity was not significantly affected. Slit lamp examination revealed bilateral moderate conjunctival injection, watery discharge, inferior palpebral conjunctival follicles and tender palpable preauricular lymph nodes. Conjunctival swabs tested positive on RT-PCR for SARS-CoV-2. The patient was prescribed ribavirin eye drops and showed a decrease in conjunctival viral load on day 17. All ocular symptoms resolved by day 19, which coincided with negative conjunctival RT-PCR test results.

Limitations

Since this is a case report, it is unclear whether the ribavirin eye drops contributed to the resolution of this patient's ocular SARS-CoV-2 infection.

Clinical significance

This case suggests that SARS-CoV-2 RNA can be present during active infection of the conjunctiva, resulting in acute follicular conjunctivitis. The viral RNA levels in this patient's conjunctival specimens were much lower than in the respiratory samples and appeared to gradually decrease over the 5-day course of conjunctivitis.