Additionally, patients were classified according to their clinical severity as mild, moderate, and severe, following the CURB-65 score, physical examination, respiratory assessment (respiratory rate, dyspnea, blood oxygen saturation, ventilation system requirements), or organ failure. If IgM is negative and IgG positive, the infection is old. Ocul Immunol Inflamm. Previous reports suggest that SARS-CoV-2 can cause conjunctivitis, either as an early sign of infection or during hospitalization for severe COVID-19 [8, 14]. K Sindhuja, Neiwete Lomi, MohamedI Asif, Radhika Tandon, Clinical profile and prevalence of conjunctivitis in mild COVID-19 patients in a tertiary care COVID-19 hospital: A retrospective cross-sectional study, Indian Journal of Ophthalmology, 10.4103/ijo.IJO_1319_20, 68, 8, (1546), (2020). Hui KPY, et al. The patients usually present mostly bilateral conjunctival hyperemia, chemosis, follicular reaction of the tarsal conjunctiva, epiphora, watery discharge, mild eyelid edema, and enlarged preauricular and … Patients who have no evidence of COVID-19 and no specific risk factors for SARS-CoV-2 infection. What new data is showing about ocular signs. Lack of retinal findings may be attributed to failure to perform the retinal examination in the COVID-19 patients. https://doi.org/10.23812/Editorial-Conti-3, Yi Y, Lagniton PNP, Ye S, Li E, Xu R-H (2020) COVID-19: what has been learned and to be learned about the novel coronavirus disease. The frequency of conjunctivitis in patients with COVID-19 has not been fully quantified to date, reporting very different data regarding its prevalence and incidence. Hung IF, Lung K, Tso EY, Liu R, Chung TW, Chu M, et al. Clin Ophthalmol 14:805–813. Based on the hospital's protocol, the general admission criteria for patients were as follows: (1) < 50 years of age without comorbidities with bilateral pneumonia, or unilateral pneumonia with respiratory failure (saturation < 96% and respiratory rate > 20); or (2) > 50 years of age or patient with comorbidity: with pneumonia, respiratory failure (saturation < 96% and respiratory rate > 20), or laboratory/clinical severity (arterial blood gas, hemogram, D-dimer, C-reactive protein, procalcitonin, lactate dehydrogenase—LDH, transaminases). This cross-sectional study was conducted at the Hospital Clinico San Carlos of Madrid, Spain, a tertiary hospital which attends patients within the Madrid metropolitan area. Lancet 2020;395(10229): 1054-1062. Likewise, the distribution of the quantitative covariates (leucocytes, neutrophils, lymphocytes, C-reactive protein, ferritin, D-dimer, creatinine, and LDH) will be depicted through the median, first, and third quartile, using the Mann-Whitney U test to assess their differences depending on the presence of conjunctivitis and sex. Patients with red eyes frequently present to general practitioners (GPs). Lymphopenia, elevated aminotransaminase levels, elevated lactate dehydrogenase levels and elevated inflammatory markers (eg, ferritin, C-reactive protein, and erythrocyte sedimentation rate) have been reported in hospitalized patients with COVID-19. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R. Jr. Retinal findings in patients with COVID-19. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. If a patient is IgM positive and IgG negative, the patient is actively infected. According to the chi-squared test, there is not a relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). Lu R, Zhao X, Li J, et al. Existing data suggests that conjunctivitis is not a common manifestation associated with COVID-19 [4]. For systemic investigations, nasopharyngeal, throat, upper respiratory, and saliva swabs are taken for RT-PCR. Clinical Characteristics of Coronavirus Disease 2019 in China. A total of 301 subjects from the COVID admission unit, whose clinical situation allowed us to conduct the aforementioned ophthalmological examination and interview, were systematically explored. However, very mild retinal microvascular abnormality involving the ganglion cell and inner plexiform layers of the retina is described by Marinho et al. Hospitalized patients with laboratory-confirmed SARS-CoV-2 infection were included. Objective Conjunctivitis has been reported in people suffering from COVID-19. For this reason and due to the limited resources and restrictive measures of access to patients with COVID-19, RT-PCR from tears and conjunctival specimen was not tested. Navel V, Chiambaretta F, Dutheil F. Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. There have been several reports of eye redness and irritation in COVID-19 patients, both anecdotal and published, suggesting that conjunctivitis may be an ocular manifestation of SARS-CoV-2 infection. Despite our study showed no difference in the clinical presentation of conjunctivitis in male and female, we found that conjunctivitis was more frequent in males with moderate COVID-19 and women with mild disease. [9][9], Recently, viral RNA was detected in the samples collected from the rooms of COVID-19 patients admitted in the hospital, which further confirmed spread through direct contact with the surfaces contaminated with virus particles. According to the patient’s self-report, the median duration of ocular symptoms was 3 days (p25-p75: 1–3.5) with a minimum of 1 day and a maximum of 1 week. Travel Med Infect Dis:101606. https://doi.org/10.1016/j.tmaid.2020.101606, Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Respiratory Med, published on line May 7, 2020. https://doi.org/10.1016/S2213-2600(20)30193-4.Accessed May 8, 2020. Nature. The purpose of this study was to evaluate the frequency and clinical presentation of conjunctivitis in hospitalized patients with COVID-19. Our observations can help ophthalmologists and other physicians to identify possible COVID-19 patients presenting with red eye or discharge as main complain for seeking care, especially in women who could present conjunctivitis earlier in the disease. Conjunctivitis, or "pink eye," is an infection or inflammation of the membrane lining the eyeball and eyelid. Purpose: The aim of this study was to investigate the ocular findings observed in patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 and to present the relationship between ocular involvement, systemic findings, and laboratory results. The signs of COVID-19 conjunctivitis are similar to the presentation of other viral forms. We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). [7], The incubation period of COVID-19 is within 14 days with maximum numbers occurring within 4 to 5 days of exposure. Google Scholar, Chen L, Liu M, Zhang Z et al (2020) Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. A total of 41 patients were admitted to the intensive care unit, 135 patients were unable to adequately report previous eye events due to their clinical situation, cognitive impairment, or confusional state, and 6 patients did not give consent. For entry into the cell, the virus uses angiotensin-converting enzyme 2 receptor (ACE2). Key messages COVID-19 has been shown to have ocular involvement, mainly conjunctivitis. Laroche recommends that anyone who is a high-risk patients such as seniors, those who are obese or have health issues such as cardiovascular disease or diabetes, should always wear a face mask to prevent contracting the disease which could trigger conjunctivitis. Among the 301 patients, 41.8% were classified as mild, 36.5% cases classified as moderate, and 21.5% classified as severe disease. Approximately, 1 out of 10 hospitalized non-critical COVID-19 patients presents conjunctivitis during the disease. Twenty-one (60%) patients with conjunctivitis were male and 160 (60.1%) patients without conjunctivitis were male. Overall, 35 patients (11.6%; 95% CI: 8.48–15.84) were diagnosed with acute conjunctivitis; of those, 10 (3.3%; 95% CI: 1.8–6.1) showed ocular manifestations on the day of the visit whereas 25 (8.3%; 95% CI: 5.6–12.1) reported having conjunctivitis in the previous days, seen by the primary care doctor. Google Scholar, Cheema M, Aghazadeh H, Nazarali S et al (2020) Keratoconjunctivitis as the initial medical presentation of the novel coronavirus disease 2019 (COVID-19): a case report. [13], COVID-19 conjunctivitis starts as unilateral redness of eye with follicular reaction (inferior palpebral) like any other viral conjunctivitis. Graefe's Archive for Clinical and Experimental Ophthalmology Notwithstanding, Fisher’s exact test did not allow us to consider the association between pneumonia and conjunctivitis to be causal (P = 0.40). Clinical diagnosis It was striking to find the absence of petechiae and subconjunctival hemorrhages in our sample, despite the fact that different articles reported the vascular and thrombotic complications associated with the virus [12, 13]. This makes our study the most comprehensive and extensive of its category. Based on our findings, we estimate that the actual prevalence could be underestimated, partly because many mild or very mild cases may have gone unnoticed by both healthcare personnel and the patients themselves. Conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. However, conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. We found a prevalence of conjunctivitis in our sample of 11.6%, which allows us to infer that approximately 1 in 10 patients affected by COVID-19 can present conjunctivitis symptoms associated with the disease. Of the 301 subjects included, 180 patients (59.8%) were male and the median age was 72 years (IQ 59–82). PubMed Google Scholar. J Med Virol:1–6. described in a series of 38 patients that patients with conjunctivitis were more likely to have higher white blood cell and neutrophil counts and higher levels of procalcitonin, C-reactive protein, and lactate dehydrogenase than patients without ocular symptoms, suggesting that ocular abnormalities occurred more frequently in patients with more severe COVID-19. The biochemical profiles in men and women also showed differences between them. In fact, some coronavirus patients have been reported to have pink eye, or … JAMA Ophthalmol:1–8. This suggests that perhaps the appearance of conjunctivitis could depend on the host’s characteristics or the inoculation mechanism. J Clin Virol 127:104362. https://doi.org/10.1016/j.jcv.2020.104362, Xiong M, Liang X, Wei Y-D (2020) Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. However, at this point in the COVID-19 pandemic, it is reasonable that practically any patient seen by a medical practitioner is considered suspected of SARS-CoV-2 infection, regardless of presenting signs or symptoms of conjunctivitis. COVID-19 has spread rapidly since it was first identified in Wuhan and has been shown to have ocular involvement, mainly conjunctivitis. ... the team analysed 3,103 Covid-19 patients with tinnitus - a condition that causes a constant ringing or buzzing in the ears. The conjunctivitis patient should be screened for COVID … All staff interacting with a conjunctivitis patient should wear a procedural mask and eye protection. Furthermore, it is interesting to highlight that out of a hospitalized married couple who slept in the same room at home and had equal clinical severity, only the woman presented with conjunctivitis. Conjunctivitis, a potential albeit uncommon symptom of the coronavirus pandemic, could simply be seasonal allergies. [8] found that as high as 31.6% (95% CI, 17.5–48.7) of hospitalized COVID-19 patients presented ocular signs and symptoms compatible with conjunctivitis. Of the 35 cases that presented conjunctivitis, 13 cases suffered it before admission to the hospital, 12 cases in the time interval between admission and our evaluation, and 10 cases presented conjunctivitis at the time of evaluation. The most common reported symptoms among all the 35 patients that presented conjunctivitis during the disease were mucopurulent discharge (100%; 42.8% mild, 51.4% moderate, 5.7% severe), tearing (62.8%), and foreign body sensation (57.1%). Avoiding air puff tonometer as it poses a danger of aerosol spread. The clinical characteristics found in conjunctivitis associated with SARS-CoV-2 infection showed common aspects with other viral conjunctivitis, such as follicular reaction, and conjunctival hyperemia and discharge. Virus spread may occur through droplets, contact with infected surfaces, mucous membranes of infected persons, and also via the oro-fecal route. A recent study carried out in China reported that the prevalence of conjunctival congestion in COVID-19 patients was 5% [17]. Pink eye, or conjunctivitis, and other abnormal eye conditions could be a less common symptom of COVID-19 and also a possible source of transmission, according to several recent studies. There is no statistically significant difference in the time interval from the onset of COVID symptoms to the appearance of conjunctivitis between women and men (U Mann-Whitney; P = 0.56). These excluded patients showed no difference in clinical characteristics compared with the included sample. Since this is a tertiary hospital in downtown Madrid that covers a health area with an aging population, a high number of patients had to be excluded due to cognitive impairment, confusional state, and critical conditions, in order to obtain more reliable data. COVID-19 started in December 2019 in Wuhan city of China and within no time evolved into the deadliest Pandemic of the present times. The median time of virus shedding is 20 days with a maximum recorded time period of 37 days. However, bilateral conjunctivitis in COVID-19 has also been described [3]. This page was last modified on August 4, 2020, at 13:29. These patients tested positive on RT-PCR of naso-pharyngeal swabs and developed no fever, malaise, or respiratory symptoms throughout the course of their illness. [8][8] According to another study, the mean incubation period for SARS-CoV-2 was 5 to 7 days, and patients were typically infectious for several days prior to symptom onset. Gastrointestinal symptoms including diarrhea, nausea, and vomiting have also been reported. https://doi.org/10.1056/nejmoa2002032, Ramirez DA, Porco TC, Lietman TM, Keenan JD (2017) Epidemiology of conjunctivitis in US emergency departments. This study has been cited as supporting the conclusion that conjunctivitis is associated with more serious COVID-19 illness. Use of proper slit lamp shields and their regular disinfection after every patient. Doi: 10.1016/j.ajoc.2020.100735. https://doi.org/10.1111/bjh.16725, Hu K, Patel J, Patel BC (2020) Ophthalmic manifestations of coronavirus (COVID-19). [21] Both these studies suggest the positive role of antiviral therapy if given early in infection. Ocular tropism of respiratory viruses. Also, we did not find any associated complications such as corneal infiltrates and membranes or pseudomembranes, which have not been reported in the literature so far. Cell death results in the release of the virus into tears. Wu et al. [4] It has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Other people have reported symptoms like conjunctivitis. Anticoagulant use to prevent thromboembolism caused by COVID is also suggested. Lancet 395(10223):497–506. SARS-CoV-2 is expressed at a low rate in tears, which may be a source of infection to GPs caring for patients at high risk of COVID… [14]It may resolve by itself or progress to involve coarse epithelial keratitis, pseudomembranous conjunctivitis and bilateral hemorrhagic, pseudomembranous conjunctivitis or pseudodendritic keratitis. Given the current situation of the SARS-CoV-2 pandemic, describing the clinical characteristics of conjunctivitis associated with the novel coronavirus has relevant implications in the future identification of suspected COVID-19 patients and the differential diagnosis from other forms viral conjunctivitis. However, based on previous results, the extremely low positive rate of SARS-CoV-2 RNA test by RT-PCR in tears and conjunctival secretions from patients with laboratory-confirmed SARS-CoV-2 implies that negative test results could be false negative, not excluding the presence of the virus [8, 16]. The vast majority of studies published to date have been carried out in China. The risk factor for COVID conjunctivitis is direct contact with a person having COVID. Google searches for COVID-19 symptoms spiked mid-March as many Americans came to terms with the emerging pandemic, but so did searches for another malady with the potential for overlying symptoms: allergies. For surface disinfection, 0.1% of sodium hypochlorite or 70% ethanol for 1 minute is recommended. [12], Conjunctivitis and keratitis are the only reported ocular signs of COVID-19 to date. Chest X-ray results were analyzed separately, since it is not uncommon to find a discrepancy between the radiological and clinical findings, especially in the early stages of the disease. Nonetheless, characterizing conjunctival inflammation in this scenario could be of paramount importance in case it proves to be prevalent as it may be a frequent cause for seeking medical attention in patients possibly infected with SARS-CoV-2 [5]. Patients with red-eye must be inquired about recent traveling, cough, flu-like symptoms, fever, and history of similar symptoms in close contacts or recent contact with COVID-19 suspected or diagnosed cases. There is no role of surgical management in COVID conjunctivitis. A novel coronavirus (CoV) named severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2) emerged from China in December 2019. The differential diagnosis of SARS-CoV-2 conjunctivitis includes other viral conjunctivitis such as adenoviral conjunctivitis, based on our findings (Table 5). [11] Similar to lung tissue, cells in conjunctiva die either by viral-mediated lysis or by immune reactions. - 79.137.69.209. Other reports showed that the patients of COVID-19 developed conjunctivitis later in their course of disease after hospitalization. Barbara Burgos-Blasco. In the space of two months, three patients suffering from COVID-19 in one New York health system developed keratitis, an inflammation of the cornea, which then led to a sight-threatening infection. “The COVID-19 virus affects the body in many ways, and conjunctivitis is one of them,” he said. Limitations of this study include the absence of detailed ocular examinations (dilated fundus exam) to exclude intraocular disease owing to the logistical challenges of managing these patients at this critical healthcare resource situation. The fact that none of the patients reported associated blurred vision nor shown relevant epithelial corneal keratitis agrees with the case series of Wu et al. Lancet 2020; 395(10238):1695-1704. https://www.aao.org/headline/alert-important-coronavirus-context, https://www.aao.org/headline/special-considerations-ophthalmic-surgery-during-c, https://www.aao.org/annual-meeting-video/covid-19-pearls-surgical-skills-recovery, https://www.aao.org/practice-management/resources/coronavirus-resources, https://eyewiki.org/w/index.php?title=COVID_conjunctivitis&oldid=59777. 2 Additionally, retinal disorders, such as retinal vasculitis, 3 4 retinal degeneration 5 6 and blood–retinal barrier breakdown, 7 had been demonstrated in experimental animal models of coronavirus infection. To the best of our knowledge, this is the first study of its kind in Europe. [15] [16]It may also be associated with tender lymphadenopathy. 2020;395(10237):1610. doi: 10.1016/S0140-6736(20)31014-X. This is the first study that describes the clinical characteristics of conjunctivitis in a large sample of patients with COVID-19. Twenty-seven (10.3%) patients with pneumonia and 6 (15.3%) patients without pneumonia presented conjunctivitis. Table 2 depicts the distribution of the covariates analyzed depending on the conjunctivitis status, the association between the presence of conjunctivitis, and clinical, laboratory, and radiological data. PubMed Central  A Review of Coronaviruses and Ocular Implications in Humans and Animals. Minimum examination protocol that can help in diagnosis and management and avoiding additional clinical tests and investigations unless necessary. https://doi.org/10.1001/jamaophthalmol.2020.1291, Conti P, Younes A (2020) Coronavirus COV-19/SARS-CoV-2 affects women less than men: clinical response to viral infection. In addition, a notification system was implemented for all healthcare personnel working at the COVID unit and evaluating the patients daily. https://doi.org/10.1111/aos.14472, Department of Ophthalmology, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain, Noemi Güemes-Villahoz & Barbara Burgos-Blasco, Department of Ophthalmology, Hospital Clinico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC). However, we found distinctive clinical findings among our patients that could guide defining conjunctivitis in COVID-19 patients. Plasma from recovered patients is also in the trial. Published yesterday, the first study found that 49 of 216 pediatric COVID-19 patients (23%) hospitalized from Jan 26 to Mar 18 had conjunctival discharge and congestion and eye rubbing. https://doi.org/10.1016/j.jcjo.2020.03.003, Zhou Y, Duan C, Zeng Y et al (2020) Ocular findings and proportion with conjunctival SARS-COV-2 in COVID-19 patients. Lancet 2020;395:565-574. Seah I, Agrawal R. Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? Patients were asked about symptoms of conjunctivitis (current and previous) and they underwent a basic ophthalmological examination at their bedside by two experienced ophthalmologists on a 72-h period. The overall study population included 301 hospitalized patients (601 eyes). Conjunctivitis as a presenting manifestation of coronavirus and the relationship between conjunctivitis and the development of serious pulmonary disease are important questions for ophthalmologists worldwide. Coronavirus had been previously reported to be associated with conjunctivitis in humans. https://doi.org/10.1016/j.ophtha.2020.04.028, Chen L, Deng C, Chen X et al (2020) Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: a cross-sectional study. However, if we consider SARS-CoV model, the disease occurs in three stages; viral replication followed by immune hyperactivity and then tissue destruction. The Lancet. https://doi.org/10.1002/jmv.25725, Zhang X, Chen X, Chen L et al (2020) The evidence of SARS-CoV-2 infection on ocular surface. Use of PPE with eye protection when it is necessary to examine a patient with respiratory symptoms. The association between conjunctivitis and sex did not reach statistical signification (P = 0.98). [8] However, there is a recent case report that described keratoconjunctivitis as the initial medical presentation of a patient with COVID-19 [15]. However, important causes from a never-ending list of red-eye include; Adenoviral, Bacterial, Allergic conjunctivitis, Herpes simplex virus keratitis, Anterior uveitis, Foreign body, Corneal abrasion, Dry eye syndrome, Exposure keratopathy, and Chemosis. Microbiol Mol Biol Rev 2013;77:144–56.doi:10.1128/MMBR.00058-12. The authors declare that they have no conflict of interest. However, many ocular symptoms are associated with the term ‘conjunctivitis’ which may be misleading. It is also unknown whether ocular symptoms were different in chronic sufferers of anterior eye diseases, when they were experienced or how long they lasted for compared with other COVID-19 symptoms. COVID conjunctivitis resolves by itself without any morbidity if systemic complications do not occur. Topical antibiotics can be given to prevent secondary bacterial infection. Belser JA, Rota PA, Tumpey TM. The main outcome measure is the overall prevalence of conjunctivitis among inpatients diagnosed with COVID-19. JAMA Ophthalmol 135(10):1119–1121. Br J Haematol. We believe this is related to males having a more severe biochemical COVID-19 profile than females. Informed consent was obtained from all patients. Am J Ophthalmol 2020;19:100735. However, Wu P. et al. Once the diagnosis is made, the patient should be quarantined and closely followed for the development of complications. Int J Biol Sci 16(10):1753–1766. Dis.2003;9, Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. “I’ve seen many cases of COVID-19 patients with conjunctivitis,” Rajeev Fernando, MD, an infectious disease expert in Southampton, NY, tells Yahoo Lifestyle. Several vaccines are in progress as well. Patients with respiratory symptoms, patients with a history of travel, or contact with a traveler should not be given an appointment unless it is an emergency. Differences in prevalence and clinical presentation of conjunctivitis were analyzed by sex. Another recent study showed that patients with COVID-19 who were treated with a combination of lopinavir, ritonavir, ribavirin, and interferon-beta-1b became PCR negative more quickly than those treated with lopinavir and ritonavir (control group). This suggested that transmission of the virus may occur through the eyes. Numbers occurring within 4 to 5 days of exposure described by Marinho et al development complications... Disease seems to be associated with COVID-19, Burgos-Blasco, B., García-Feijoó, J. al. Showed no difference in clinical characteristics found on the latter are shown in Table.! The results. [ 18 ] Med, published on line may 7 conjunctivitis in covid patients 2020. https: //doi.org/10.1016/S2213-2600 20. Stroke, acute cardiac injury, cardiomyopathy, renal failure, and clinical characteristics of conjunctivitis in COVID-19 patients conjunctivitis!, upper respiratory, and clinical presentation, li J, Patel BC ( )! 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