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  • Nearly one-quarter of children with COVID-19 have ocular symptoms

    Comprehensive Ophthalmology, Cornea/External Disease, Pediatric Ophth/Strabismus

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    Review of: Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China

    Ma N, Li P, Wang X, et al. JAMA Ophthalmology, August 2020

    To help guide the prevention and management of ocular disorders in children with COVID-19, the authors investigated the largest reported sample size of children with confirmed COVID-19.

    Study design

    The investigators performed a cross-sectional retrospective analysis of children with COVID-19 treated at Wuhan Children’s Hospital in Wuhan, China, between January 26 and March 18, 2020. Infection was confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) of upper respiratory tract specimens.

    Outcomes

    A total of 216 pediatric patients was included, among whom 134 (62%) were boys, with a median age of 7.25 years. Forty-nine children (22.7%) showed various ocular manifestations, of which 9 had ocular complaints upon initial presentation. Common ocular manifestations were conjunctival discharge (27), eye rubbing (19), conjunctival congestion (5), ocular pain (4), eyelid swelling (4) and tearing (2). Children with systemic symptoms or cough were nearly twice as likely to develop ocular symptoms. The most common systemic symptoms among symptomatic children were fever (37.5%) and cough (36.6%). Ninety-three (43.1%) had no systemic or respiratory symptoms.

    Most ocular symptoms were mild; 23 patients recovered without treatment, while others received antibacterial, antiviral or antiallergic eye drops. Except for 8 children who had persistent eye rubbing, the other children recovered completely. The median duration of ocular symptoms was 7 days.

    Limitations

    The authors could not acquire the pathogenic evidence of ocular disorders in children. The descriptions of ocular symptoms can be subjective to a certain extent, especially in young children who are unable to express or describe the discomfort. The face-to-face examinations by ophthalmologists were performed in a COVID-19 isolation unit, which was not equipped with eye examination instruments. Children with COVID-19 in the present study came from one city in one country; therefore the findings may not be generalizable to children in other geographic locations.

    Clinical significance

    Nearly all of prior reported cases of ocular manifestations of COVID-19 were in adults and little was known or documented about ocular manifestations in children with COVID-19. It is important to be vigilant of potential COVID-19 in children who present with conjunctival discharge, eye rubbing, conjunctival congestion, ocular pain, eyelid swelling or tearing. COVID-19 in children was typically not severe, and all ocular symptoms were mild and could recover or improve eventually. Having a high index of suspicion for COVID-19 would allow for close monitoring of children and would lead to increased precautions taken to prevent further spread of COVID-19.