Ocular surface manifestation of COVID-19 and tear film analysis

Abstract

To evaluate the ocular manifestation in patients hospitalized with coronavirus disease 2019 (COVID-19) and to search for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears. This study was conducted in 29 hospitalized patients who were admitted to the COVID center at the Policlinic Hospital of the University of Messina, Italy. All patients underwent an ophthalmologic assessment comprising a Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire, anterior segment, and the ocular surface examination of both eyes using a portable slit lamp. The Schirmer I test was performed, and the filter paper strip was used to search for the presence of SARS-CoV-2 on the ocular surface by real-time quantitative polymerase chain reaction (RT-qPCR). A total of 10 patients reported ocular symptoms; in particular, four reported eye burning, three reported foreign body sensation, and three reported tearing. Moreover, seven patients presented conjunctival hyperemia and/or chemosis, eleven patients presented blepharitis signs such as lid margin hyperemia and/or telangiectasia, crusted eyelashes, and meibomian orifices alterations. Tear analysis did not reveal the presence of SARS-CoV-2. Ocular symptoms are common in patients with COVID-19; although, tear analysis did not reveal the presence of SARS-CoV-2.

The Transmission of SARS-CoV-2 Infection on the Ocular Surface and Prevention Strategies

“…In addition, RNA in the tear fluid of patients with moderate to severe COVID-19 was collected with a conjunctival swab or the Schirmer test, and the differences depending on the collection method were examined. However, the collection rate was similar in either method, and the detection rate of viral RNA in the tears reached 24% [ 47 ], while no viral RNA was detected in the tear fluid in COVID-19 patients [ 86 , 87 ]. Furthermore, the investigation of human post-mortem ocular tissues in COVID-19 patients found that there was no SARS-CoV-2 RNA in the different parts of ocular tissues and intraocular fluid including corneal epithelium, stroma and endothelium, conjunctival epithelium and fluid, and the anterior chamber [ 88 ].…”

Retinal Involvement in COVID-19: Results From a Prospective Retina Screening Program in the Acute and Convalescent Phase

“…Ocular involvement in coronavirus disease 2019 (COVID-19) is low and manifests mainly as conjunctivitis, in the form of conjunctival hyperemia, chemosis, increased secretions, and/or epiphora ( 1 – 3 ). Signs of blepharitis (crusted eyelashes, meibomian orifice alterations, lid margin hyperemia) and eye burning have also been reported ( 4 ). Dry eyes were reported in 72% of patients evaluated for neurotropism of the virus in the head–neck region ( 5 ).…”

SARS-CoV-2 RNA and antibodies in tear fluid

“…However, the presence of these ocular signs and symptoms being common in the general population was not checked prior to the onset of COVID-19 impeding the assessment of the correlation with COVID-19. 23 Among three patients with a positive tear sample result studied by Karimi et al , 7 only one patient had symptoms of conjunctivitis. No ocular abnormalities were observed in any patient with COVID-19 included in other studies concerning the ocular involvement, as was the case in our study.…”

“…Viral RNA was detected in conjunctival swabs of two patients, both having ocular abnormalities. 9 The presence of SARS-CoV-2 RNA on the ocular surface and ocular manifestations was studied in 29 hospitalised patients with COVID-19 by Meduri et al 23 RNA was not detected in any of the tear samples by RT-qPCR on Schirmer strips, in spite of a high prevalence of mild ocular symptoms (eye burning: n=4; foreign body sensation: n=3; tearing: n=3). Furthermore, mild conjunctival hyperaemia and/or chemosis (n=7) and blepharitis signs (n=11) were often observed.…”