Ocular Findings and Conjunctival SARS-CoV-2
Ophthalmology, July 2020
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.