COVID-19 patients might not harbor an ocular reservoir of SARS-CoV-2

The authors evaluated ocular donor tissues from a COVID-19 postmortem donor.

Study design

This case report details a 76-year-old patient that presented with a dry cough quickly progressing to acute respiratory distress syndrome (ARDS) and unfortunately succumbed to the disease on day 23 from onset. SARS-CoV-2 was detected in the pharyngeal swab and broncho-alveolar lavage during the acute phase of the illness. Thirteen hours postmortem, qRT-PCR-testing was performed on ocular tissues to assess for the presence of the virus.

Outcomes

SARS-CoV-2 RNA was absent in the ocular tissues tested, including conjunctival fluid swabs, bulbar conjunctiva, corneal epithelium, corneal stroma, corneal endothelium, anterior chamber fluid, lens, iris, vitreous, retina, uvea, sclera and optic nerve. All tested negative for SARS-CoV-2 viral RNA coding for S and E genes. This case poses the question as to whether the ocular tissues harbor SARS-CoV-2 in patients who have the disease. Although an interesting finding, it does not give us answers but only informs us that some patients with SARS-CoV-2 may not carry the virus in their ocular tissues. However, we do not know if this applies to all who carry the virus. Moreover, this raises the question of whether there is a higher chance of isolating the virus in patients with ocular manifestations.

Limitations

This is one case report of a patient with respiratory symptoms and a positive SARS-CoV-2 test with no documented ocular manifestations. One cannot draw a conclusion from this single case, but rather one can only pose further questions.

Clinical significance

This case demonstrates the absence of SARS-CoV-2 in postmortem ocular tissues from a patient who tested positive for SARS-CoV-2. This case, although interesting, is not enough to sway us from wearing the full personal protective equipment including eye protection. Further studies are required to address the presence of SARS-CoV-2 in ocular tissues.