Recurrent keratoconjunctivitis as the sole manifestation of COVID-19 infection: A case report

Abstract

Introduction: Ocular symptoms are uncommon manifestations of coronavirus disease 2019 (COVID-19) infection. Earlier study reported that dry eye, blurred vision, foreign body sensation, tearing, itching, conjunctival secretion, conjunctival congestion, ocular pain, and photophobia are among the ocular symptoms that could be found in COVID-19 patients. However, there are only a few reports available regarding corneal involvement in this disease. Here we report a case of keratoconjunctivitis as the only symptom of COVID-19 infection. Case description: A 27-year-old man who worked as an obstetrics and gynecology resident came to the outpatient clinic with the chief complaints of eye discomfort, foreign body sensation, conjunctival hyperemia, lacrimation, and photophobia in his right eye for the past 3 weeks. Fluorescence test showed a small corneal lesion. The patient was then diagnosed with keratoconjunctivitis. A week after the treatment, all symptoms were resolved. A month later, the patient came to the emergency room with the same eye complaints but with a more severe pain. The fluorescence test showed wider corneal lesion compared to last month. The result from the corneal swab is negative for bacterial or fungal infection, indicating a viral infection. Afterwards, reverse transcriptase polymerase chain reaction test from nasopharyngeal swab was performed and revealed that the patient was positive for COVID-19. Conclusions: This case report showed that keratoconjunctivitis may occur as the only manifestation of COVID-19 infection. Thus, patient presented with unexplainable eye symptoms should be evaluated for COVID-19 infection.

Ocular manifestations of COVID-19

“…Conjunctivitis 2 , 10 , 11 and keratoconjunctivitis 12 are the most prevalent ocular symptoms in adults. 13 Conjunctival irritation was the most prevalent ophthalmological finding (50.8%), followed by diplopia (27.8%) and cotton wool patches (27.8%).…”

Ocular manifestations in SARS-CoV-2 infection and pre-exposure prophylaxis of ophthalmic medical staff

“…Corneal manifestations in SARS-CoV-2 infections are rare. They are mainly cases of superficial punctate keratitis [28,29]. Subepithelial inflammatory tree-like keratitis similar to that seen in herpetic keratitis has also been described [22].…”

“…In addition to conjunctivitis, ocular surface manifestations of COVID-19 described in the literature also include keratitis [22,28,29] and scleritis [30,31].…”

Treatment of moderate to severe and active thyroid orbitopathy during SARS-CoV-2 pandemic.

“…Serous conjunctivitis is the most common ocular manifestation in patients with COVID-19, and its prevalence has been reported to range from 0.8% [33] to as high as 64% [34]. Most authors reported the incidence of ocular symptoms between 3% and 8%, and interestingly, investigators have reported a much lower incidence of keratitis than conjunctivitis [35][36][37]. In a study conducted on a group of 74 patients, Polish authors demonstrated the presence of ocular symptoms in almost half of the subjects (n = 35), but only 7 patients showed advanced conjunctivitis [36].…”