Evaluating Ocular Symptoms and Tear Film Cytokine Profiles in Symptomatic COVID-19 Patients

Abstract

Background: This study investigated the presence and duration of ophthalmic symptoms in the early phase of COVID-19 to assess the corresponding local immune response on the ocular surface. Methods: The study included data from 180 COVID-19 patients and 160 age-matched healthy controls. The main finding was the occurrence of ophthalmological manifestations at the time of admission to the hospital and during the preceding 7 days. Tear film concentrations of TNF-α, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p70, GM-CSF, and IFN-γ were determined by a magnetic bead assay. Results: Among the COVID-19 patients, 12.64% had at least one ocular symptom at the time of admission, and 24.14% had symptoms within the preceding 7 days (p < 0.001 vs. controls). We found that the COVID-19 patients complained more frequently about eye tearing (p = 0.04) and eye pain (p = 0.01) than controls. A multivariate analysis of the patients and controls adjusted for age and sex revealed that COVID-19 was an independent factor associated with higher VEGF and IL-10 tear film concentrations (β = +0.13, p = 0.047 and β = +0.34, p < 0.001, respectively) and lower IL-1β, IL-8, and GM-CSF levels (β = −0.25, p < 0.001; β = −0.18, p = 0.004; and β = −0.82, p = 0.0 respectively). Conclusions: SARS-CoV-2 does not attract a strong local response of the conjunctival immune system; therefore, ophthalmic symptoms may not constitute a substantial element in the clinical picture of novel COVID-19 infection.

IgA-Based Secretory Response in Tears of COVID-19 Patients: A Potential Biomarker of Pro-Inflammatory State in Course of SARS-CoV-2 Infection

“…The collected data were used to study the different aspects of ocular immunity for the course of the COVID-19 disease. Thus, the viral RNA and cytokine level data, at least for some of the patients, have been published elsewhere [ 11 , 12 ], using different methods of result comparison analysis.” An informed consent form in accordance with the Declaration of Helsinki was signed by all patients before the study enrolment.…”

“…A detailed ophthalmological health questionnaire collected information about the presence and severity of ocular symptoms and their duration at the time of examination in the emergency unit and in the preceding 7 days. Eye-COVID scores (ECSs) were calculated as in previous studies [ 11 , 12 ].…”

“…The tear samples and conjunctival swab collection and analysis were performed according to a previously developed protocol [ 11 , 12 ] and took place at the time of hospital admission. The concentration of SARS-CoV-2-specific IgA and several inflammatory cytokines (TNF-α, IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p70, GM-CSF, VEGF and IFN-γ) were measured in tear fluid, while the detection of SARS-CoV-2 was performed with conjunctival swabs collected from the lower conjunctival sac.…”

An eye to the future: Acute and long‐term neuro‐ophthalmological and neurological complications of COVID‐19

“…A retro‐orbital headache or the associated photophobia with a COVID‐19 associated migraineous headache may present as eye pain. Other causes of eye pain (aside from optic neuritis, which has been discussed previously) that have been reported in patients with COVID‐19 include conjunctivitis, scleritis and episcleritis 42,43 and are thought to be either a local inflammatory response or potentially direct viral infection.…”

Conjunctival Swabs Reveal Higher Detection Rate Compared to Schirmer Strips for SARS-CoV-2 RNA Detection in Tears of Hospitalized COVID-19 Patients

“…The most common symptoms are fever, cough, dyspnea, and sputum production [ 2 , 3 ]. Although eye symptoms are not often emphasized, light sensitivity, itchy eyes, tearing, eye redness, mucous discharge, foreign body sensation, and new onset floaters are symptoms that have been documented to occur in COVID-19 patients [ 4 ].…”