• Ocular Findings and Conjunctival SARS-CoV-2

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, July 2020

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    Shortly after conjunctivitis was iden­tified as a possible early symptom of COVID-19, reports of viral RNA in tears and conjunctival secretions of infected patients emerged. Working early in the pandemic, Zhou et al. studied the ocular traits and footprint of COVID-19, along with their rela­tionship to disease duration. Although they verified that severe acute respi­ratory syndrome coronavirus 2 (SARS-CoV-2) could be detected in conjunctival swabs, they noted that relatively few confirmed COVID-19 cases had ocular symp­toms suggestive of conjunctivitis or positive conjunctival swab results. Moreover, they found that neither fac­tor correlated with disease duration.

    This cross-sectional study was conducted in January and February of 2020 in Wuhan, China. The research­ers recruited 121 patients treated at a university hospital for SARS-CoV-2 infection, which had been confirmed by at least one positive respiratory or another clinical specimen finding or a positive serological antibody result. A record review and external eye exam with penlight provided clinical infor­mation on ocular symptoms at onset and later in the disease. Physicians col­lected conjunctival and nasopharyngeal swabs from the affected eye of patients with ocular symptoms, and conjuncti­val swabs from a random eye in those patients without such symptoms, all on the same day.

    The mean age of the 121 patients was 48 years (range, 22-89 years). SARS-CoV-2 RNA was found in three patients (2.5%); two of them had severe/critical disease and the other had mild/moderate disease. Eight patients (6.6%) had ocular symptoms, including itching (n = 5), redness (n = 3), tearing (n = 3), discharge (n = 2), and foreign body sensation (n = 2). Seven of these eight patients had severe/critical disease. Only one patient had ocular symptoms plus a conjunctival swab that was positive for SARS; two patients without ocular symptoms had a positive con­junctival swab result.

    There was no meaningful correla­tion between the presence of ocular symptoms and positive swab findings (odds ratio, 2.548; Fisher’s exact test, p = .39). Neither the proportion of patients with ocular symptoms nor the proportion with positive swab results had a significant relationship with dis­ease duration (Spearman rank correla­tion, 0.111 [p = .22] and 0.74 [p = .42], respectively). However, the difference in rates of positive SARS-CoV-2 test results with conjunctival swabs (2.5%) versus nasopharyngeal swabs (70.2%) was significant (p < .001). (Also see re­lated commentary by Irene C. Kuo, MD, in the same issue.)

    The original article can be found here.