PURPOSETo evaluate ocular manifestations and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) prevalence in the tears of children with coronavirus disease 2019 . METHODSA total of 27 pediatric patients with confirmed COVID-19 infection hospitalized from March 16 to April 15, 2020, at the Bambino Ges u Children's Hospital were enrolled in the study. At admission, all patients showed ocular manifestations. Reverse transcriptase-polymerase chain reaction from nasopharyngeal and conjunctival swabs were performed every 2-3 days before discharge. RESULTSOf the 27 patients, 4 (15%) were asymptomatic, 15 (56%) showed respiratory symptoms, and 8 (30%) had gastrointestinal symptoms. At admission, nasopharyngeal swabs were positive for COVID-19 in all patients; on the second swabs, 7 children (26%) tested negative, and 20 remained positive for COVID-19. Ocular manifestations consistent with mild viral conjunctivitis were observed in 4 patients (15%). At first conjunctival swab, 3 patients (11%), 1 symptomatic and 2 asymptomatic for ocular infection, had positive findings for COVID-19; 2 became negative on the second test and 1 on the third. CONCLUSIONSIn our study cohort, ocular manifestations of COVID-19 seem to have had a milder clinical course in pediatric patients than in adults. Despite the low prevalence and rapid regression of viral presence in the conjunctiva, SARS-CoV-2 transmission through tears may be possible, even in patients without apparent ocular involvement. ( J AAPOS 2020;24: 212-215) S ince its onset in December 2019 in Wuhan (Hubei Province, China) the coronavirus disease 2019 (COVID-19) has quickly spread across the globe, causing a global pandemic, according to the World Health Organization (WHO). 1 The pathogen of COVID-19 is a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can cause multiple system infections but mainly respiratory tract infections, such as severe acute respiratory syndrome. 2,3 The most common signs and symptoms include fever, cough, fatigue, myalgia, dyspnea, diarrhea. 4,5 Compared with adults, children with COVID-19 seem to have lower incidence, shorter course of disease, and a more favorable clinical presentation and prognosis. 6,7 The transmission route of this novel coronavirus (SARS-CoV-2) remains unclear, and most authors report that it occurs mainly through direct contact or respiratory droplets. 4 Previous studies have investigated the viral presence in tears of patients with SARS-CoV-1 and SARS-CoV-2, reporting controversial results. [8][9][10][11][12][13][14] All of these studies were performed in adult patients. In this study we evaluated ocular involvement and the SARS-CoV-2 virus shedding in tears of 27 pediatric patients admitted to the Bambino Ges u Children's Hospital (BGCH) COVID Center in order to better understand the pathogenicity of SARS-CoV-2 in children's eyes. Subjects and MethodsThis study was approved by the Bambino Ges u Children's Hospital Ethics Committee and adhered to the tenets of the Declaratio...

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Transepithelial collagen cross-linking by iontophoresis, unlike other transepithelial techniques, seems to halt pediatric keratoconus progression over 15 months. However, we did not record significant improvement in higher-order aberrations and topographic indices.