Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease

Abstract

PurposeTo report the ocular characteristics and the presence of viral RNA of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens in a patient with confirmed 2019 novel coronavirus disease (COVID-19).Participant and methodsA 30-year-old man with confirmed COVID-19 and bilateral acute conjunctivitis which occurred 13 days after illness onset. Based on detailed ophthalmic examination, reverse transcription PCR (RT-PCR) was performed to detect SARS-CoV-2 virus in conjunctival swabs. The ocular characteristics, presence of viral RNA and viral dynamics of SARS-CoV-2 in the conjunctival specimens were evaluated.ResultsSlit lamp examination showed bilateral acute follicular conjunctivitis. RT-PCR assay demonstrated the presence of viral RNA in conjunctival specimen 13 days after onset (cycle threshold value: 31). The conjunctival swab specimens remained positive for SARS-CoV-2 on 14 and 17 days after onset. On day 19, RT-PCR result was negative for SARS-CoV-2.ConclusionSARS-CoV-2 is capable of causing ocular complications such as viral conjunctivitis in the middle phase of illness. Precautionary measures are recommended when examining infected patients throughout the clinical course of the infection. However, conjunctival sampling might not be useful for early diagnosis because the virus may not appear initially in the conjunctiva.

Ocular manifestation as first sign of Coronavirus Disease 2019 (COVID-19): Interest of telemedicine during the pandemic context

“…Interestingly, our patient did not experience epiphora or secretions. Vision loss has not been reported among the ocular manifestations of COVID-19 (3,8) which is in accordance with the case presented here.…”

“…Interestingly, in the present case ocular symptoms were the first manifestation of the disease that progressed within a few hours to a severe respiratory distress. Here, the patient presented unilateral manifestations, but bilateral follicular conjunctivitis has been also reported in a COVID-19 patient (8).…”

“…We present here a case that illustrates the interest of telemedicine in an ophthalmological setting during the COVID-19 pandemic, where moderate conjunctival hyperemia was the presenting sign of the infection that rapidly progressed to respiratory distress. Ocular anomalies, including acute follicular conjunctivitis (8), conjunctival hyperemia, chemosis, epiphora, and increased secretions have been reported in patients with COVID-19 (3). These manifestations have been observed to occur more Page 5 of 7 J o u r n a l P r e -p r o o f frequently in patients with severe pneumonia and during the middle phase of illness (3) with only 1 patient in a series of 38 cases presenting with conjunctivitis as the initial manifestation of the disease (3).…”

The Ocular Surface and the Coronavirus Disease 2019: Does a Dual ‘Ocular Route’ Exist?

“…SARS-CoV-2 conjunctivitis has been described as a mild follicular conjunctivitis otherwise indistinguishable from other viral causes, and be potentially transmitted by aerosol contact with conjunctiva [4]. Other features of ocular surface involvement include unilateral or bilateral bulbar conjunctiva hyperemia alone or in association with chemosis, follicular reaction of the palpebral conjunctiva, watery discharge, epiphora, and mild eyelid edema.…”

“…The conjunctival swab specimens remained positive for SARS-CoV-2 on 14 and 17 days after onset. On day 19, RT-PCR result was negative for SARS-CoV-2 [4].…”