False-negative results are common because of the timing of sampling. 54.29% of conjunctivitis were completely unilateral, unlike adenoviral conjunctivitis where there is a greater tendency to bilateralization . Severe acute respiratory syndrome: clinical outcome and prognostic correlates. https://doi.org/10.2147/OPTH.S236571, Giannis D, Ziogas IA, Gianni P (2020) Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. 2020;395(10237):1610. doi: 10.1016/S0140-6736(20)31014-X. Systemic complications include; acute respiratory distress syndrome, pneumonia, stroke, acute cardiac injury, cardiomyopathy, renal failure, and encephalopathy. Yuen KSC, Chan W-M, Fan DSP, et al. “The COVID-19 virus affects the body in many ways, and conjunctivitis is one of them,” he said. 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. Wearing of masks all the time by the patients, attendants, and the health care personnel. Topical antibiotics can be given to prevent secondary bacterial infection. However, many ocular symptoms are associated with the term ‘conjunctivitis’ which may be misleading. Microbiol Mol Biol Rev 2013;77:144–56.doi:10.1128/MMBR.00058-12. Conjunctival infection can be due to direct inoculation of the ocular tissues from droplets of an infected patient, from nasopharynx by nasolacrimal duct or from the lacrimal glands. Table 3 illustrates the laboratory, radiological, and clinical results in patients with and without conjunctivitis stratified by sex. Avoiding air puff tonometer as it poses a danger of aerosol spread. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Am J Ophthalmol 2004;137:773–4. 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. Upon ophthalmological examination of the 301 patients, other ocular disorders besides conjunctivitis were observed. Br J Ophthalmol:1–4. There are reports in which conjunctivitis was the only sign of COVID-19. The authors declare that they have no conflict of interest. Navel V, Chiambaretta F, Dutheil F. Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. Nalla AK, Casto AM, Huang MW, et al.  However, there is a recent case report that described keratoconjunctivitis as the initial medical presentation of a patient with COVID-19 . Ocular tropism of respiratory viruses. The median time interval between the onset of COVID-19 symptoms and the appearance of conjunctivitis was 6 days (p25-p75: 2–13). Studies suggest that there are many differences between men and women in the immune response to SARS-CoV-19, affecting more men than women [9, 10]. The purpose of this study was to evaluate the frequency and clinical presentation of conjunctivitis in hospitalized patients with COVID-19. 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%). 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. For entry into the cell, the virus uses angiotensin-converting enzyme 2 receptor (ACE2). The degree of conjunctival hyperemia was mild or very mild and the presence of follicular reaction has also been reported by other authors . Clinical Characteristics of Coronavirus Disease 2019 in China. We were unable to objectify any relationship between the presence of conjunctivitis and clinical, radiological, or laboratory severity in our sample of 301 cases. Laboratory, radiological, and clinical results in patients with and without conjunctivitis stratified by sex were analyzed. Furthermore, data about ocular manifestations were obtained by ophthalmologists via telephone, so results are determined by patient subjectivity and ophthalmologist’s interpretation. Other people have reported symptoms like conjunctivitis. Wu et al. However, Wu P. et al. https://doi.org/10.1001/jamaophthalmol.2017.3319, Article If IgM and IgG are both positive, infection is recent and may or may not be active. While the coronavirus is mostly known as a respiratory disease, it can affect other parts of the body, including the eyes. Five cases of non-remitting conjunctivitis turned out to be the sole presenting sign and symptom of COVID-19. COVID conjunctivitis is an ocular manifestation of a new disease entity called Corona Virus Disease-19 (COVID-19). 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. Since this a cross-sectional study and as such, patients that had conjunctivitis prior to admission were not evaluated by the investigators, but they were evaluated by primary care physicians.  It is recommended that two consecutive negative RT-PCR tests results are required before a patient can be considered safe.. The natural history of the disease seems to be a rapid self-limited conjunctivitis that improves without treatment and does not affect visual acuity nor associate short-term complications. 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). https://doi.org/10.1136/bjophthalmol-2020-316304, Guan W, Ni Z, Hu Y et al (2020) Clinical characteristics of coronavirus disease 2019 in China. COVID conjunctivitis resolves by itself without any morbidity if systemic complications do not occur. 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). Clinical diagnosis Material and methods: This cross-sectional study was carried out between 1 May and 30 June 2020. StatPearls 9:1–9 http://www.ncbi.nlm.nih.gov/pubmed/32310553, CAS Differential diagnosis of COVID conjunctivitis includes all causes of red-eye as there are cases of COVID conjunctivitis, which were otherwise systemically asymptomatic. The pathophysiology of SARS-CoV2 related conjunctivitis is not completely understood. Nature 2020; 579:270. The distribution of gender, acute pneumonia, and bilateral pneumonia depending on the outcome status (conjunctivitis or not) will be presented as percentages and the differences addressed through the chi-squared test (of the Fisher’s exact test in case the frequencies be low). What new data is showing about ocular signs. 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. https://doi.org/10.1111/bjh.16725, Hu K, Patel J, Patel BC (2020) Ophthalmic manifestations of coronavirus (COVID-19). To the best of our knowledge, this is the first study of its kind in Europe. The patient’s age, sex, the onset of COVID-19 symptoms, chest X-ray, and laboratory tests results were noted. Tonometer should be sterilized using a 10% diluted sodium hypochlorite solution. One of the studies conducted in Wuhan, China, found that nearly a quarter of pediatric patients had this condition. Early after acquiring infection, antibodies to SARS-CoV-2 are detected in serum. 2502 Graefes Arch Clin Exp Ophthalmol (2020) 258:2501–2507 To examine the patients, the investigators wore double gloves, a fluid-resistant gown, a full face shield, and both FFP2 and surgical masks. https://doi.org/10.1007/s00417-020-04916-0, DOI: https://doi.org/10.1007/s00417-020-04916-0, Over 10 million scientific documents at your fingertips, Not logged in  It has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. 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. This suggested that transmission of the virus may occur through the eyes. Around 12% of patients affected by COVID-19 can present conjunctivitis symptoms associated with the disease and usually occurs early in the disease. 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. Laboratory work-up included the levels of leukocytes, neutrophils, lymphocytes, C-reactive protein, ferritin, D-dimer, creatinine, and LDH, considering the blood test results that represented the greater severity prior to the date of the ophthalmological examination. Ocular screening in severe acute respiratory syndrome. 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 is inflammation of the thin membrane, called your conjunctiva, which covers the front of your eye and the back of your eyelids. Of the 301 subjects included in the study, 180 patients (59.8%) were male and the median age was 72 years (IQ 59–82; 70 years in men and 75 years in women, P = 0.13). “I’ve seen many cases of COVID-19 patients with conjunctivitis,” Rajeev Fernando, MD, an infectious disease expert in Southampton, NY, tells Yahoo Lifestyle. Wu et al. Our results show an 11.6% prevalence of conjunctivitis among hospitalized patients with COVID-19, differing from previous results. Part of Springer Nature. 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. Although fever is a common symptom there are reports of afebrile COVID patients as well. 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. 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 … Animal studies have shown anterior uveitis, retinitis, vasculitis, and optic neuritis, as well.. 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. It is preferable to use disposable devices. Barbara Burgos-Blasco. Patients with displaced eyeball, drooping upper eyelid and Covid-19 manifestations such as conjunctivitis and ocular pain were subjected to further medical investigations. Ocul Immunol Inflamm. The demonstration of the direct association between conjunctivitis and SARS-CoV-2 infection in the absence of diagnostic confirmation with real-time polymerase chain reaction (RT-PCR) of tears and conjunctival secretions is difficult to prove. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R. Jr. Retinal findings in patients with COVID-19. 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. This page has been accessed 12,931 times. Ophthalmology. Pooled data showed 11.64% of patients with COVID-19 had ocular surface manifestations. Conjunctivitis in COVID-19 patients: frequency and clinical presentation. 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]. Differences in prevalence and clinical presentation of conjunctivitis were analyzed by sex. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Am J Ophthalmol 2020;19:100735. 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. Patients with COVID-19 can have symptoms of watering, foreign body sensation, and red-eye, or they may be asymptomatic. Lancet 2020;395:565-574. No case of uveitis is yet reported. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. Lu R, Zhao X, Li J, et al. Google Scholar, Chen L, Liu M, Zhang Z et al (2020) Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Currently, data to propose or oppose a therapy is insufficient. Graefes Arch Clin Exp Ophthalmol 258, 2501–2507 (2020). Graefe's Archive for Clinical and Experimental Ophthalmology Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Minimum examination protocol that can help in diagnosis and management and avoiding additional clinical tests and investigations unless necessary. Br J Haematol. Ocul Surf. A novel coronavirus (CoV) named severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2) emerged from China in December 2019. 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… 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. Doi: 10.1016/j.ajoc.2020.100735. Güemes-Villahoz, N., Burgos-Blasco, B., García-Feijoó, J. et al. © 2021 Springer Nature Switzerland AG. 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. Google Scholar, Xia J, Tong J, Liu M, Shen Y, Guo D (2020) Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. This supported the 14-day quarantine recommendations. There is no role of surgical management in COVID conjunctivitis. However, this article did not … Existing data suggests that conjunctivitis is not a common manifestation associated with COVID-19 . 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. https://doi.org/10.1016/j.jtos.2020.03.010, Wu P, Duan F, Luo C et al (2020) Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. 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). https://doi.org/10.1056/nejmoa2002032, Ramirez DA, Porco TC, Lietman TM, Keenan JD (2017) Epidemiology of conjunctivitis in US emergency departments. Huang Y, Tu M, Wang S et al (2020) Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: a retrospective single center analysis. Patients with COVID-19 can have symptoms of watering, foreign body sensation, and red-eye, or they may be asymptomatic. None of the patients of our study reported blurry vision associated. Correspondence to For all patients with conjunctivitis. 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. Reverse-transcription polymerase chain reaction (RT-PCR) is a specific but less sensitive test in the diagnosis of COVID conjunctivitis. PubMed 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).  It may also be associated with tender lymphadenopathy. Different RNA gene targets are employed by different manufacturers. This page was last modified on August 4, 2020, at 13:29. All staff interacting with a conjunctivitis patient should wear a procedural mask and eye protection. Coronavirus had been previously reported to be associated with conjunctivitis in humans. Phylogenetic analysis showed that there are more than 100 strains of SARS-CoV-2 with two different types; type L and type S. The receptor-binding region of SARS-CoV-2 is also similar to SARS-CoV. Emerg. A recent study carried out in China reported that the prevalence of conjunctival congestion in COVID-19 patients was 5% . We believe this is related to males having a more severe biochemical COVID-19 profile than females. JAMA Ophthalmol:1–8. 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. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. COVID-19 has spread rapidly since it was first identified in Wuhan and has been shown to have ocular involvement, mainly conjunctivitis. https://doi.org/10.7150/ijbs.45134, Yeu E, Hauswirth S (2020) A review of the differential diagnosis of acute infectious conjunctivitis: implications for treatment and management. For instance: "The more severe a patient's COVID-19 is, the more likely it is that he or she will also have pink eye, according to the report published online … Positive clinical findings on physical examination of the patients with COVID-19 include; fever, cough, shortness of breath, myalgias, sore throat, headache, rhinorrhea, new-onset loss of taste or smell and chest pain. Approximately 97% of patients develop symptoms within 11.5 days of exposure. Once a patient is identified by any staff member as having conjunctivitis, the patient should wear a procedural mask. Conjunctivitis, or "pink eye," is an infection or inflammation of the membrane lining the eyeball and eyelid. 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. This page was enrolled in the International Ophthalmologists contest. The study was approved by the Clinical Research Ethics Committee of this institution and was conducted in accordance with the tenets of the Declaration of Helsinki. The signs of COVID-19 conjunctivitis are similar to the presentation of other viral forms.    However, there are reports of conjunctivitis associated with COVID-19. Earlier diseases related to Coronavirus were severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Serology and RT-PCR are the most common laboratory tests being performed. It is an enveloped single-stranded RNA virus, which is closely related to the severe acute respiratory syndrome coronavirus. The causative organism is a beta coronavirus, which belongs to Coronaviridae family. The exclusion of patients with cognitive impairment or confusional syndrome suggests there could also imply a shift in the actual prevalence. Routine eye care or urgent problems: Masks or face covering on patients at all times (inform patients that they are not to pull masks down onto their chins at any time while in … We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). Most who experienced these eye symptoms had severe cases of COVID-19 (and often had pneumonia); only one patient presented with conjunctivitis as the first symptom. The onset of conjunctivitis signs and symptoms with respect to the onset of respiratory symptoms was variable (median of 3 days). J Biol Regul Homeost Agents 34(2). However, this article did not compare the differences between women and men, and included critical patients, who were not included in our sample. J Med Virol:1–6. These excluded patients showed no difference in clinical characteristics compared with the included sample. Nature. 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. However, in the analysis of conjunctivitis patients by clinical severity, there were statistically significant differences by sex (Table 4). Although COVID-19-related conjunctivitis seems to be uncommon, the AAO reminds physicians that other forms of conjunctivitis are common. Lancet 395(10223):497–506. , COVID-19 conjunctivitis starts as unilateral redness of eye with follicular reaction (inferior palpebral) like any other viral conjunctivitis. 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