Precaution and prevention of coronavirus disease 2019 infection in the eye

Chen, Meng Jou; Chang, Kao-Jung; Hsu, Chih Chien; Lin, Pei Yu; Liu, Catherine Jui Ling

doi:10.1097/jcma.0000000000000334

Cited by 19 publications

(22 citation statements)

References 16 publications

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“…43 The implications of these findings for everyday life and the workplace are that individuals may in which case eye protection is advised as well. 44 In addition, every individual, even those who are asymptomatic, should wear a well-fitting surgical face mask to reduce emissions, which would increase the overall protection for the medical staff. 42…”

Section: Discussionmentioning

confidence: 99%

Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019

2020

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IMPORTANCE Individuals with asymptomatic or mild coronavirus disease 2019 (COVID-19) have been reported to frequently transmit the disease even without direct contact. The severe acute respiratory syndrome coronavirus 2 has been found at very high concentrations in swab and sputum samples from such individuals. OBJECTIVE To estimate the virus levels released from individuals with asymptomatic to moderate COVID-19 into different aerosol sizes by normal breathing and coughing, and to determine what exposure could result from this in a room shared with such individuals. DESIGN, SETTING, AND PARTICIPANTS This mathematical modeling study combined the sizedistribution of exhaled breath microdroplets for coughing and normal breathing with viral swab and sputum concentrations as approximation for lung lining liquid to obtain an estimate of emitted virus levels. Viral data were obtained from studies published as of May 20, 2020. The resulting emission data fed a single-compartment model of airborne concentrations in a room of 50 m 3 , the size of a small office or medical examination room. MAIN OUTCOMES AND MEASURES Modeling was used to estimate the viral load emitted by individuals breathing normally or coughing, and the concentrations expected in the simulated room at different ventilation rates. RESULTS The mean estimated viral load in microdroplets emitted by simulated individuals while breathing regularly was 0.0000049 copies/cm 3 , with a range of 0.0000000049 to 0.637 copies/ cm 3. The corresponding estimates for simulated coughing individuals were a mean of 0.277 copies/cm 3 per cough, with a range of 0.000277 to 36 030 copies/cm 3 per cough. The estimated concentrations in a room with an individual who was coughing frequently were very high, with a maximum of 7.44 million copies/m 3 from an individual who was a high emitter. However, regular breathing from an individual who was a high emitter was modeled to result in lower room concentrations of up to 1248 copies/m 3. CONCLUSIONS AND RELEVANCE In this modeling study, breathing and coughing were estimated to release large numbers of viruses, ranging from thousands to millions of virus copies per cubic meter in a room with an individual with COVID-19 with a high viral load, depending on ventilation and microdroplet formation process. The estimated infectious risk posed by a person with typical viral load who breathes normally was low. The results suggest that only few people with very high viral load pose an infection risk in poorly ventilated closed environments. These findings suggest that strict respiratory protection may be needed when there is a chance to be in the same small room with an individual, whether symptomatic or not, especially for a prolonged period.

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Section: Discussionmentioning

confidence: 99%

Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019

2020

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“…There is now an additional confounder for injecting in the perioral and periorbital zone, the risk of contamination in a patient carrying or presymptomatic of COVID‐19. Although not common, COVID‐19 has been found in ocular secretions with reports of ophthalmologists and otolaryngologists dying of coronavirus 27 . The nose and surrounding zones and the mouth and perioral area are more concerning 28 especially as fillers in these areas are so common.…”

Section: Discussionmentioning

confidence: 99%

Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers

Goodman

Al‐Niaimi

McDonald

et al. 2020

J of Cosmetic Dermatology

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Background Tissue fillers are generally safe and well tolerated by patients. However, complications do occur and may be very severe, such as intravascular injection (with occasional residual tissue loss, visual and neurological sequelae) and late nodularity and swelling. Methods to lessen the likelihood of complications have been the subject of much recent literature. Depth of injection has been identified as a key safety consideration. Patients/Methods The role of injection of facial filler into the muscular layer of the face is explored in this article. Literature was explored using available search facilities to study the role of injections in or around this layer in the production of significant adverse reactions. Results A body of literature seems to suggest that injection into mimetic musculature of the face especially the musculature in the periorbital and perioral regions is prone to adverse reactions. Conclusions Injection of agents into the perioral and periorbital mimetic muscular layer may produce, product clumping, displacement, and tendency to late nodularity and swelling. It also risks intravascular injection as compared to injection of other layers of the face. Injection into the mimetic muscles especially the sphincteric muscles should be avoided to minimize the risk of complications.

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“…This raised questions about potential alternative modes of transmission. During the current pandemic, there have been various reports of ocular involvement including features of follicular conjunctivitis in patients infected with SARS-CoV 2 with some of them even demonstrating the presence of viral RNA in conjunctival or tear specimens collected from these patients [13][14][15][16]. However, the implications of ocular involvement in the course and prognosis of the systemic disease are not known.…”

Section: Introductionmentioning

confidence: 99%

Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

et al. 2020

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Purpose This study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods A systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible. Results A total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens in 3.5% patients. Conclusion The most common reported ocular presentations of COVID-19 included ocular pain, redness, discharge, and follicular conjunctivitis. A small proportion of patients had viral RNA in their conjunctival/tear samples. The available studies show significant publication bias and heterogeneity. Prospective studies with methodical collection and data reporting are needed for evaluation of ocular involvement in COVID-19.

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Precaution and prevention of coronavirus disease 2019 infection in the eye

Cited by 19 publications

References 16 publications

Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019

Estimation of Viral Aerosol Emissions From Simulated Individuals With Asymptomatic to Moderate Coronavirus Disease 2019

Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers

Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

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