JUN 17, 2020
This case study details 5 patients with nonremitting conjunctivitis that was the sole presenting sign and symptom of COVID-19.
Case study findings
Four males and 1 female (age 37 to 65) presented with acute conjunctivitis, with conjunctival hyperemia, epiphora, discharge and photophobia. They were referred to an eye clinic in Italy by their primary care physicians as their conditions did not seem to improve after several days. The patients continued with symptomatic therapy and moxifloxacin eye drops 4 times daily for 5 more days.
Each patient was questioned about recent travels or close contacts with positive COVID-19. They all said they had recently travelled to a region of the country, namely Lombardy, with very high numbers of COVID-19 cases. None displayed fever, general malaise or respiratory symptoms at presentation or during follow-up. Naso-pharyngeal swab was performed for all patients and infection with COVID-19 was confirmed by RT-PCR on naso-pharyngeal specimens for all 5 patients.
Patients were instructed to self-quarantine until complete resolution of the infection and were followed-up by phone. Of significance, conjunctivitis remained the only sign and symptom of COVID-19 throughout their illness.
There was no in-depth evaluation of the patients such as genetic analysis to determine why they did not subsequently develop more commonly associated symptoms of fever, general malaise or respiratory symptoms. In addition, it is unknown if the subjects previously had a mild case of undetected COVID-19 and had antibodies to COVID-19 upon presentation with the conjunctivitis.
What makes these cases especially relevant from an epidemiological standpoint is that conjunctivitis remained the only sign and symptom of active COVID-19. In fact, these patients never developed any other typical symptoms such as fever, general malaise or respiratory symptoms. Atypical clinical presentations of COVID-19 can occur and a high level of suspicion should be maintained.