ArticlePDF AvailableLiterature Review

A comprehensive Chinese experience against SARS-CoV-2 in ophthalmology

Authors:
  • The Eye Hospital of Wenzhou Medical University, Wenzhou, China
  • The Eye Hospital of Wenzhou Medical University,Wenzhou, China

Abstract and Figures

Abstract The 2019 novel coronavirus disease (COVID-19) has now swept through the continents and poses a global threat to public health. Several investigations have been conducted to identify whether COVID-19 can be transmitted through the ocular route, and the conclusion is that it is a potential route but remains uncertain. Due to the face-to-face communication with patients, frequent exposure to tears and ocular discharge, and the unavoidable use of equipment which requires close proximity, ophthalmologists carry a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on 33 articles published by Chinese scholars, guidelines and clinical practice experience in domestic hospitals, we have summarized the Chinese experience through the lens of ophthalmology, hoping to make a contribution to protecting ophthalmologists and patients around the world.
Content may be subject to copyright.
R E V I E W Open Access
A comprehensive Chinese experience
against SARS-CoV-2 in ophthalmology
A-Yong Yu
*
, Ruixue Tu, Xu Shao, Anpeng Pan, Kaijing Zhou and Jinhai Huang
Abstract
The 2019 novel coronavirus disease (COVID-19) has now swept through the continents and poses a global threat to
public health. Several investigations have been conducted to identify whether COVID-19 can be transmitted
through the ocular route, and the conclusion is that it is a potential route but remains uncertain. Due to the face-
to-face communication with patients, frequent exposure to tears and ocular discharge, and the unavoidable use of
equipment which requires close proximity, ophthalmologists carry a high risk of contracting severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2). Based on 33 articles published by Chinese scholars, guidelines and clinical
practice experience in domestic hospitals, we have summarized the Chinese experience through the lens of
ophthalmology, hoping to make a contribution to protecting ophthalmologists and patients around the world.
Keywords: Coronavirus, SARS-CoV-2, COVID-19, Ophthalmology, Ocular transmission
Background
Since the first pneumonia patient was identified around
December 2019, in Wuhan, China, multiple human cases
of severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection have been reported. The 2019
novel coronavirus disease (COVID-19) has now swept
through the continents and poses a global threat to
public health. Up till 12th March 2020, at least 80,980
cases in China and 43,538 cases beyond China were
confirmed, covering 118 countries, areas or territories.
Many infections amongst medical staff have been re-
ported, of whom three ophthalmologists from Wuhan
Central Hospital died of COVID-19 due to occupational
exposure, and Dr. Guangfa Wang, a pneumonia expert,
was infected by SARS-CoV-2 through unprotected eye
exposure. These events raise an alarm on the route of
SARS-CoV-2 transmission. Faced with the possibility of
ocular transmission, ophthalmologists are very likely to
contract the infection. Drawing on the rich experience
during the previous SARS outbreak, the Chinese
government has promptly released various protection
measures for ophthalmology, and recommended protec-
tion for the eyes, as well as mouth and nose, when car-
ing for patients potentially infected with SARS-CoV-2.
The American Academy of Ophthalmology recently
published a similar recommendation for ophthalmolo-
gists from the Centers for Disease Control and Preven-
tion (CDC). Based on the latest published literatures,
guidelines and clinical practice experience in domestic
hospitals, we have summarized the Chinese experience
through the lens of ophthalmology, hoping to make a
contribution to protecting ophthalmologists and patients
around the world, and praying that the pandemic will be
contained as soon as possible.
Main text
Articles on SARS-CoV-2 for ophthalmology from Chinese
scholars
We searched MEDLINE, ScienceDirect, Embase, the
Cochrane Library, WanFang Database, VIP Database,
SinoMed, China National Knowledge Infrastructure
(CNKI), the CDC for COVID-19 website (https://www.
cdc.gov/coronavirus/2019-ncov/publications.htm),
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: yaybetter@hotmail.com
Eye Hospital of Wenzhou Medical University, 270 Xueyuan West Road,
Wenzhou 325000, Zhejiang, P. R. China
Yu et al. Eye and Vision (2020) 7:19
https://doi.org/10.1186/s40662-020-00187-2
Chinese Scientific Research Academic Exchange Plat-
form for COVID-19 (http://medjournals.cn/2019NCP/
index.do), and relevant references for papers related to
"ophthalmology and SARS-CoV-2/COVID-19"; pub-
lished till 12
th
March 2020. The search strategy was as
follows: (SARS-CoV-2 or 2019-nCov or COVID-19 or
NCP or coronavirus or "severe acute respiratory syn-
drome coronavirus 2" [Supplementary Concept] or
"COVID-19" [Supplementary Concept]) and (ocular or
eye or ophthalm* or ophthalmologist or tear or
conjunctiv* or "Conjunctivitis"[Mesh] or "Conjunctivitis,
Viral"[Mesh]).
We identified 33 articles in total published by Chinese
scholars directly relevant to ophthalmology and SARS-
CoV-2/COVID-19. Twenty-seven articles are published
in Chinese journals, most articles are reviews, almost all
regarding ophthalmic precautions and ocular surface
transmission of SARS-CoV-2 infection (Table 1).
Transmission of SARS-CoV-2
For ophthalmologists, comprehensive information is
needed to understand SARS-CoV-2 feature and epidemi-
ology of the outbreak. Coronaviruses are big, enveloped,
single, plus-stranded RNA viruses [34]. Seven corona-
virus species are known to cause diseases in humans,
among which severe acute respiratory syndrome cor-
onavirus(SARS-CoV), Middle East respiratory syn-
drome coronavirus(MERS-CoV), and SARS-CoV-2
drew great attention. SARS-CoV, MERS-CoV and SARS-
CoV-2 all belong to the β-CoV family and can cause
fatal pneumonia. MERS-CoV carries the highest fatality
rate of 34.5% [35], followed by SARS-CoV (9.6%) [36],
then SARS-CoV-2 (3.70%, following data till 12th March
2020), which has a lower disease severity but higher
transmission efficiency.
SARS-CoV-2 has been sequenced and was shown to
be 7580% identical to SARS-CoV and 40% identical to
MERS-CoV [36]. SARS-CoV-2 shares the same host re-
ceptor with SARS-CoV, the human angiotensin-
converting enzyme 2 (ACE2) receptor, suggesting a simi-
lar transmission route. The person-to-person transmis-
sion of SARS-CoV-2 can occur through respiratory
droplet transmission and contact transmission. Airborne
aerosol and the fecal-oral transmission route [37] remain
to be further confirmed.
Theoretically, transmission through the ocular route is
likely for SARS-CoV-2. First, its host receptor ACE2 has
been identified on the ocular surface [38,39]. Second,
the ocular surface is an open microenvironment.
Through the nasolacrimal duct, the virus may transport
to the inferior meatus of the nose. Third, the ocular mu-
cosal immune system is associated with lymphoid tissue
in the nasolacrimal duct and nasal cavity [40].
There have been some studies reporting the presence
of SARS-CoV or MERS-CoV in tears or conjunctival sac
[41,42], while negative results in all of included patients
were also reported [43]. Several investigations have been
conducted to identify whether COVID-19 can be trans-
mitted through the ocular route. Shen and colleagues [3]
performed a prospective case series study in 30 COVID-
19 patients, finding SARS-CoV-2 in two conjunctival
swabs of one patient. Another study by Chen et al. [1]
demonstrated that out of 67 patients enrolled, SARS-
CoV-2 can be detected in the conjunctival sac of three
COVID-19 patients without ocular symptoms. Sun et al.
found [2] that among 72 patients confirmed by labora-
tory diagnosis with SARS-CoV-2 RT-PCR assay, SARS-
CoV-2 RNA fragments were found in ocular discharges
belonging to one patient. The above studies confirmed
that SARS-CoV-2 can exist in tears or the conjunctival
sac, but the infection of SARS-CoV-2 through the eyes
remains uncertain.
The negative results in the ocular surface may be in-
fluenced by viral concentration, sampling time lag, and
diagnostic method. The time of exposure to SARS-CoV-
2 infected patients is critical because of the higher viral
load at the early stage of infection. Improvements in the
sensitivity of molecular diagnostic methods are needed
in the future. More well-designed trials with large
sample sizes are required to ascertain whether the ocular
route is indeed a mode of transmission.
Precautions for SARS-CoV-2
Due to face-to-face communication with patients, fre-
quent exposure to tears and ocular discharge, and the
unavoidable use of equipment such as slit lamp, tonom-
eter, laser etc., ophthalmologists could carry higher risks
of contracting a SARS-CoV-2 infection. Ophthalmolo-
gists are recommended to take measures for mouth,
nose and eyes protection when caring for patients poten-
tially infected with SARS-CoV-2. The following recom-
mendations on ophthalmic practice are based on the
Guidelines for the Prevention and Control of Novel Cor-
onavirus Pneumonia in Medicine, the Guideline for the
Use of Medical Protective Equipment in the Prevention
and Control of Novel Coronavirus Pneumonia, the list
of published journal articles listed in Table 1and clinical
experience in domestic hospitals, as well as previous do-
mestic SARS experiences and other departments such as
the department of dentistry [44,45].
Outpatient management
Before coming to hospital
a) Control number of visiting patients
Yu et al. Eye and Vision (2020) 7:19 Page 2 of 9
Table 1 A summary of published articles by Chinese scholars directly relevant to ophthalmology and SARS-CoV-2/COVID-19
Study type Language N Date
(yyyy.mm.dd)
City Key Point
[1] Retrospective
cohort study
English 67 2020.02.11 Wuhan SARS-CoV-2 can be detected in the conjunctival sac of patients with COVID-19.
Through clinical analysis, viral transmission via the conjunctival route was not
supported by the data. Good clinical protection can effectively cut off the trans-
mission path.
[2] Cross-
sectional study
English 102 2020.02.26 Wuhan The nosocomial infection of SARS-CoV-2 through the eyes after occupational
exposure is a potential route. Protective goggles should be worn by all health-
care workers.
[3] Prospective
case series study
English 30 2020.02.26 Hangzhou SARS-CoV-2 may be detected in the tears and conjunctival secretions of COVID-
19 patients with conjunctivitis.
[4] Editorial English 2020.03.03 Hong Kong As the novel corona-virus infection is still on the upward trend, it is of para-
mount importance to remain vigilant and start taking necessary measures to
prevent its transmission.
[5] Editorial English 2020.02.13 Beijing, Hong
Kong,
Guangzhou
Ophthalmologists should take particular care when examining patients,
research studying whether COVID-19 can be found in tears and conjunctival
scrapings would be valuable and inform ongoing disease-prevention strategies.
[6] Letter English 2020.02.22 Changchun SARS-CoV-2 transmission through the ocular surface must not be ignored.
[7] Review Chinese 2020.02.22 Beijing A COVID-19 patient with ocular syndrome was reported and treated combined
with traditional Chinese medicine (TCM). The article discussed COVID-19 from
the perspective of TCM.
[8] Review Chinese 2020.02.23 Beijing Research of beta coronavirus receptors on ocular surfaces found two host
receptors, ACE2 and DPP4. Their expression in the cells of ocular surface may
be an access route of corona virus in eye, which provides clues to elucidating
the pathogenesis of corona virus in the eyeballs.
[9] Review Chinese 2020.02.13 Wenzhou This article preliminarily reviews several different aspects, including the
characteristics of SARS-CoV-2, the anatomical connection between ocular sur-
face and respiratory tract, previous work on the link between respiratory virus
and ocular complication, and the data of ACE2 receptor expression and mo-
lecular detection of SARS virus in tear. Based on these reviews, intervention
measures are advised for ophthalmic practitioner, whilst suggestions are indi-
cated for further clinical and basic investigations in the future.
[10] Review Chinese 2020.02.04 Wuhan It is extremely important to disinfect ophthalmic examination instruments and
protect ophthalmic medical care during the epidemic period to reduce cross-
infection in clinical practice. Some suggestions against SARS-CoV-2 infection
were offered in this article.
[11] Review Chinese 2020.02.12 Multi-center Ophthalmic experts, from Society of Public Health Ophthalmology, Chinese
Preventive Medicine Association and Beijing Ophthalmological Society and
Youth Committee of Beijing Ophthalmological Society, provided suggestions
on eye protection during the novel coronavirus pneumonia epidemic.
[12] Review Chinese 2020.02.14 Guangzhou The delay of back-to-school time is an important measure to reduce cross in-
fection on campus, and to protect the health of children and teenagers during
the 2019 novel coronavirus outbreak. Meanwhile, remote teaching models has
led to a dramatic shift in eye-use habits of children and adolescents. The poten-
tial effects on adolescent visual health cannot be ignored.
[13] Review Chinese 2020.02.24 Beijing This paper provided general guidance about precautions in ophthalmic
practice in the prevention and control of the novel coronavirus pneumonia
epidemic.
[14] Review Chinese 2020.02.17 Beijing/
Shenzhen
Some suggestions of integrated Traditional Chinese and Western Medicine are
described to avoid the infection of ophthalmic medical practitioners and to
effectively deal with novel coronavirus conjunctivitis during the diagnosis and
treatment.
[15] Review Chinese 2020.02.06 Beijing This article briefly introduced the characteristics and identifications of SARS-
CoV-2 infection, and put forward suggestions and opinions from the aspects of
personal protection of ophthalmologists, control managements of ophthalmic
outpatient department and ward, cleaning and disinfection of ophthalmic equipment.
[16] Review Chinese 2020.02.24 Chongqing During the prevention and control period of the epidemic of COVID-19, strict
adherence to the prevention and control measures can effectively ensure the
smooth implementation of the operation and the perioperative safety of med-
ical staff and patients
Yu et al. Eye and Vision (2020) 7:19 Page 3 of 9
Table 1 A summary of published articles by Chinese scholars directly relevant to ophthalmology and SARS-CoV-2/COVID-19
(Continued)
Study type Language N Date
(yyyy.mm.dd)
City Key Point
[17] Case report Chinese 30 2020.02.21 Wuhan Three cases in 30 NCP patients with binocular conjunctivitis were found. Of
them, one case visited for conjunctivitis as a first symptom and then diagnosed
as NCP, and two cases visited for binocular conjunctivitis during the NCP onset.
Although positive viral nucleic acid were detected in the conjunctiva sacs of 2
of other 27 NCP patients by using swabs and RT-PCR technology, no conjunc-
tivitis occurred in these two patients.
[18] Review Chinese 2020.02.21 Wenzhou Systematic and standardized detection of viral nucleic acid and related blood
factors is a necessary, fast and feasible prevention and control method in
specialist ophthalmic institute during the COVID-19 epidemic.
[19] Review Chinese 2020.02.17 Beijing This paper indicated some suggestions about the management of clinical trials
during novel coronavirus pneumonia outbreak including the follow-up of sub-
jects, the treatment of epidemic serious adverse event (SAE) and the manage-
ment requirements of co-sponsors, as well as the requirements and
management principles for environment, subjects, examiners and inspection
equipment in the process of ophthalmic clinical trials.
[20] Case report Chinese 2 2020.03.03 Wuhan Several COVID-19 cases with conjunctivitis or conjunctivitis as the first symptom
have been observed in clinical work. This paper reports the diagnosis and treat-
ment of one COVID-19 patient with conjunctivitis as the first symptom and one
COVID-19 patient with conjunctivitis.
[21] Review Chinese 2020.02.27 Xian Understanding the mechanism and cell receptors of coronavirus transmission
through ocular surface and the transmission characteristics of homologous
coronavirus can provide some suggestions for appropriately ocular protection
and identify COVID-19 coexisting with ocular signs for ophthalmologists during
this epidemic disease.
[22] Review Chinese 2020.02.17 Qingdao Strengthening basic and clinical research on ocular infection caused by
coronavirus should be one of the important tasks for ophthalmologists in China.
[23] Review Chinese 2020.02.23 Shantou In the absence of clinical and experimental evidence of SARS-CoV-2 in ocular
infection, a retrospective literature analysis of viral pathogens that simultan-
eously trigger ocular lesions during the onset of epidemic diseases helps under-
stand the methods of ocular protection in the prevention and control of the
COVID-19.
[24] Cross-
sectional study
Chinese 2020.02.27 Wenzhou Aerosol can be produced by non-contact air-pufftonometer spraying, and it
fluctuates with the increase of spraying times, showing a cumulative effect. The
aerosol accumulation is higher in the hall with insufficient air circulation. And
more aerosol can be produced without gauze mask.
[25] Review Chinese 2020.03.04 Lanzhou A review of the literature on coronavirus, especially SARS-CoV, can provide ref-
erences for the prevention and control of SARS-CoV-2.
[26] Review Chinese 2020.02.20 Jinan During the SARS-CoV-2 outbreak, ophthalmologists should be alert to the po-
tential transmission of ophthalmology-related viruses.
[27] Review Chinese 2020.02.10 Shantou This article reviews the eye performance of various types of epidemic virus
infections and provides a reference for COVID-19 prevention and control.
[28] Case report Chinese 4 2020.02.13 Wuhan Four COVID-19 patients with conjunctivitis were mentioned in this article, and
all the patients were medical staff of the hospital. One patient was positive for
conjunctival sac virus nucleic acid test.
[29] Review Chinese 2020.02.14 Hangzhou According to the characteristics of previous ocular-respiratory infection viruses,
ocular surface transmission may possible through the following ways: (1) infec-
tion through the nasolacrimal duct system. (2) infection through contact with
eyes and nose. (3) the above two conditions exist simultaneously and cause infection.
[30] Review Chinese 2020.02.18 Wuhan This paper suggests the necessary medical protective measures for
ophthalmology outpatient and ward. For the patients who were asymptomatic
with the virus, there is currently a lack of effective screening methods,
ophthalmologists need to be vigilant at all times.
[31] Review Chinese 2020.02.18 Multi-center Experts from multiple hospitals discussed the prevention and control system of
medical staff in ophthalmic medical institutions during the epidemic of COVID-19.
[32] Review Chinese 2020.03.01 Wenzhou The authors proposed how to choose protective goggles correctly, and seven
methods of anti-fog in this article.
Yu et al. Eye and Vision (2020) 7:19 Page 4 of 9
Reducing outpatient visitors will be critical to decrease
cross-infection. Patients are asked to make an appoint-
ment before going to the hospital.
b) Make good use of online platforms
Onlineplatformssuchasthehospitals official web-
site or WeChat should be well utilized. Online plat-
forms can provide notice for decreasing outpatient
visits and updates on COVID-19, help patients distin-
guish between urgent and non-urgent ocular diseases,
recommend safe and self-executing treatments for
common nonurgent ocular diseases, remind patients
to prepare correct personal protection before coming
to the hospital, advise patients with suspicious symp-
toms such as fever to first visit the screening center
before coming to the ophthalmic clinic, and give
targeted guidance for common chronic eye diseases
during this period.
c) Online ordering and delivery of prescribed
medication
Both hospital and patients can benefit from submitting
prescriptions online and having patient medication sent
to their doorsteps via non-contact delivery.
Entering the hospital
a) Reduce the number of accessible gateways into and
out of the hospital by closing unnecessary ones
Visitors will be funneled through these gateways to
allow for efficient manpower management.
b) Set up two checkpoints in hospital entrance and
treatment area entrance (Fig. 1)
Visitors should be screened through temperature
measurement and symptoms before entering the hospital
and treatment area.
The questionnaire includes questions about typical
clinical symptoms of COVID-19, travel history to Wu-
han city and other badly affected areas or countries,
contact history with confirmed or suspected COVID-19
patients within the past 14 days, etc. (Fig. 1).
c) Remind patients to properly put on the mask
Every patient should wear the mask at all times in the
hospital, if the self-prepared mask cannot sufficiently
protect the patient, the hospital shall provide a suitable
one.
d) Prepare a separate clinic for patients with
symptoms of infection
Setting up a special clinic for conjunctivitis is recom-
mended, and patients with conjunctivitis and suspicious
contact/travel history should be treated for COVID-19.
Patients with suspected conjunctivitis are advised to be
tested more than two times for SARS-CoV-2 RNA in
the conjunctival sac and tears.
Entering the clinic room
a) Practice social distancing in the registration and
waiting areas
Patients should stay at least 1.5 m apart from one
another when in registration and waiting area.
b) Limit the number of people in the room
Keeping 1 doctor and 1 patient in 1 room is required
except for visually impaired patients, patients with com-
munication/mobility difficulties or parents of small chil-
dren. The room should be well-ventilated. After each
patients consultation or treatment, the used instruments
such as slit lamp must be disinfected immediately.
c) Reduce outpatient examinations
Operation of many ophthalmic equipment requires
close proximity, reducing outpatient examinations helps
protect both doctors and patients.
Micro-aerosols can be generated when non-contact to-
nometry is used [46]. Air-puff ophthalmic equipment
like non-contact tonometry should be avoided if un-
necessary. It is advised to place the tonometer in a
Table 1 A summary of published articles by Chinese scholars directly relevant to ophthalmology and SARS-CoV-2/COVID-19
(Continued)
Study type Language N Date
(yyyy.mm.dd)
City Key Point
[33] Cross-
sectional study
Chinese 2020.03.08 Wenzhou The Remote Dedicated Doctor Platform of Ophthalmology (RDDPO) establishes
a channel for doctor-patient communication during the epidemic, which can
be considered as an important way to effectively address the needs of patients
for medical treatment.
Yu et al. Eye and Vision (2020) 7:19 Page 5 of 9
ventilated place, and that the measurement interval be-
tween patients should be extended. During the measure-
ment, patients should wear a face mask.
Direct ophthalmoscope examination is not recom-
mended, which can be replaced by slit light lens or fun-
dus photography. Protective shields (better transparent)
should be installed on slit lamps and any other equip-
ment used which needs close doctor-patient contact.
Both doctor and patient should refrain from bare face-
to-face speaking during any examination.
Inpatient management
Before coming to the ward
a) Control the number of scheduled surgeries
Non-emergency surgeries, such as elective cataract
operations and ophthalmic plastic surgery, should be
postponed. Emergency surgeries, such as endophthal-
mitis, eyeball rupture, macula-on rhegmatogenous
retinal detachment and intraocular foreign body, can
continue. Elective surgeries should still be appro-
priately reduced in areas where the infection is under
good control.
b) Improve preoperative infection screening of
inpatients
Preoperative CT examination, SARS-CoV-2 (RNA)
detection, and blood routine examination are recom-
mended. Testing of nasopharyngeal swab two or more
times is recommended in suspected cases with an ini-
tially negative result [36]. If CT examination is not avail-
able for specialized hospitals or primary hospitals (lack
of medical imaging department), or due to some limita-
tions with regards to special groups (such as pregnant
women), inspection of hematological indices including
C-reactive protein (CRP) and serum amyloid A (SAA)
are suggested as routine tests of preoperative screening
for ocular surgery patients.
The infection screening results need to be checked
and confirmed before surgery appointment. In general, a
patient with COVID-19 is not recommended to undergo
ocular surgeries unless urgent. The emergency surgeries
for a COVID-19 infected patient should be arranged in a
negative pressure operating room, with advance notice
given to the ward and operating room. If there is no
negative pressure operating room in the hospital,
COVID-19 patients should go to other qualified
hospitals.
Fig. 1 Patient screening chart
Yu et al. Eye and Vision (2020) 7:19 Page 6 of 9
Entering the ward a) Repeat temperature taking and
query with questionnaire
Repeated temperature taking and query with question-
naire ought to be done at the ward entrance. In addition,
daily temperature measurement must be a routine for all
patients. The patients temperature and necessary exami-
nations should not be ignored.
b) Check infection screening results of inpatients again
Infection screening results of inpatients should be
checked immediately after the patient enters the ward.
Repeated preoperative CT examination, SARS-CoV-2
(RNA) detection, and blood routine examination after
hospital admission are also recommended by some
experts.
c) Arrange a single room for every patient if possible
The necessary doctor-patient conversation can be con-
ducted in the patients room. One patient is not allowed
to have more than one attendant, and the attendant
should be the same. Both patient and the attendant
should wear the mask.
d) Reduce unnecessary inpatient examinations
e) Avoid operations under general anesthesia if
possible
Operations should preferably be done under local
anesthesia. The operating room should be left standing
for a sufficient time between each operation after ad-
equate disinfection measures. Operations for healthy
patients will be done in a positive pressure laminar flow
operating theater while for suspected or infected
patients, in a negative pressure laminar flow operating
theater.
Staff management
1) Offer relevant infection control training to the staff
The training content should include current knowledge
of COVID-19, precaution measures, hand disinfection
training, etc. Ophthalmologists should be able to identify
a suspected case of COVID-19. Typical clinical symptoms
of SARS-CoV-2 infection were onset of fever, generalized
weakness, myalgia and dry cough [36,47]. The clinical
manifestations of conjunctivitis in COVID-19 patients are
consistent with other viral conjunctivitis [6].
2) Report temperature and abnormal symptoms every
day
Temperature taking and query with questionnaire be-
fore entering the hospital also applies to staff. Staff are
advised to measure their own body temperatures twice
every day and promptly report any abnormal symptoms.
3) Increase personal protection
Caps, respiratory protection, gloves, gowns, eye protec-
tion, and face shields are used for personal protection.
Based on the possibility of the spread of SARS-CoV-2
infection, three-level protective measures for ophthalmic
professionals are as follows (Table 2).
Strict hand hygiene is required for every staff. It is ad-
visable to not use a pair of latex gloves for long periods
of time. Moreover, strict hand hygiene must be practiced
after taking off gloves.
4) Set up inspectors and inspection group
Inspectors and inspection group will check the imple-
mentation of protective measures for members in their
respective departments every day. Furthermore, they will
also examine the patientsself-protection.
Environmental management
1) Turn off the central air conditioning, enhance the
air ventilation
2) Disinfect rooms and instruments thoroughly
Rooms and instruments should be thoroughly dis-
infected according to local disinfection guidelines. The
elevator should be disinfected regularly. People should
avoid unnecessary contact with elevator buttons and
other objects when using the elevators.
Patient education
Patient education is crucial. It is vital to prevent nosoco-
mial cross-infections, and thus every patient needs to
pay attention to personal precautions.
Online platforms, the hospitals official website or
WeChat public platform, for example, should be well
utilized before patients come to the hospital as men-
tioned above.
When patients are in the hospital, videos in the wait-
ing rooms and brochures are effective approaches to
teach patients updated knowledge regarding COVID-19
and personal hand hygiene, as well as remind them of
proper mask wearing, and practicing social distancing.
Follow-up after discharge is easy to overlook. Despite
rigorous preoperative screening, it is possible that pa-
tients in the incubation period or asymptomatic patients
may be admitted for surgery. Telephone follow-up,
Yu et al. Eye and Vision (2020) 7:19 Page 7 of 9
asking about their postoperative symptoms, is very im-
portant for us to prevent unexpected virus transmission.
Conclusions
The SARS-CoV-2 infection in China has been well con-
trolled thanks to the large collective effort. The National
Health Commission has reported that the peak of the
current infection in China has passed. However, a com-
ing nationwide resumption of work in China and devel-
oping epidemic in foreign countries are worrying; we
still need to take every precaution against COVID-19.
Since 2002, coronaviruses seem to impose a continu-
ous and enormous threat to human beings. Even as this
infection dies down, we should be vigilant of future out-
breaks. Ocular transmission of coronavirus remains un-
certain, and more well-designed trials with large sample
sizes are urgently needed.
Disclosure and sharing of knowledge are keys to con-
trolling the outbreak. Again, we sincerely hope the Chin-
ese experience against SARS-CoV-2 in ophthalmology
can, to some extent, contribute to protecting the lives of
ophthalmologists and patients worldwide.
Acknowledgements
Not applicable.
Authorscontributions
Design of the study (A.Y., R.T.); literature/data collection and analysis (R.T.,
A.P., A.Y.); writing the manuscript (R.T., A.Y., X.S.); critical revision of the
manuscript (A.Y., K.Z., J.H.); supervision (A.Y.). All authors read and approved
the final manuscript.
Funding
Supported by the Natural and Science Foundation of China (Grant No.
81570869), and Wenzhou Key Team of Scientific and Technological
Innovation (Grant No. C20170002).
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no conflict of interest.
Received: 15 March 2020 Accepted: 25 March 2020
References
1. Zhou Y, Zeng Y, Tong Y, Chen C. Ophthalmologic evidence against the
interpersonal transmission of 2019 novel coronavirus through conjunctiva.
medRxiv. 2020. https://doi.org/10.1101/2020.02.11.20021956.
2. Sun X, Zhang X, Chen X, Chen L, Deng C, Zou X, et al. The infection
evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional
study. medRxiv. 2020. https://doi.org/10.1101/2020.02.26.20027938.
3. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and
conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol.
2020. https://doi.org/10.1002/jmv.25725.
4. Lai THT, Tang EWH, Chau SKY, Fung KSC, Li KKW. Stepping up infection
control measures in ophthalmology during the novel coronavirus outbreak:
an experience from Hong Kong. Graefes Arch Clin Exp Ophthalmol. 2020.
https://doi.org/10.1007/s00417-020-04641-8.
5. Li JO, Lam DSC, Chen Y, Ting DSW. Novel coronavirus disease 2019 (COVID-
19): the importance of recognising possible early ocular manifestation and
using protective eyewear. Br J Ophthalmol. 2020;104(3):2978. https://doi.
org/10.1136/bjophthalmol-2020-315994.
6. Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface
must not be ignored. Lancet. 2020;395(10224):e39. https://doi.org/10.1016/
S0140-6736(20)30313-5.
7. Li X, Xie L, Hao X, Ma K, Luo J. Understanding of novel coronavirus
pneumonia and its ocular manifestations, prevention and treatment from
the perspective of TCM epidemic diseases. World Chin Med. 2020. https://
doi.org/10.3969/j.issn.1673-7202.2020.02.007.
8. Yin X, Zhang J. Advance in research of beta coronavirus receptors on ocular
surface. Chin J Exp Ophthalmol. 2020;38(0):E009. https://doi.org/10.3760/
cma.j.cn115989-20200223-00098.
9. Zhou X, Qu J. 2019-nCoV and eye, what we know and what we should do.
Chin J Optom Ophthalmol Vis Sci. 2020;22(2):816. https://doi.org/10.3760/
cma.j.issn.1674-845X.2020.02.001.
10. Zhang M, Xie H, Xu K, Cao Y. Suggestions for disinfection of ophthalmic
examination equipment and protection of ophthalmologist against 2019
novel coronavirus infection. Zhonghua Yan Ke Za Zhi. 2020;56(0):E001.
https://doi.org/10.3760/cma.j.issn.0412-4081.2020.0001.
11. Society of Public Health Ophthalmology, Chinese Preventive Medicine
Association, Beijing Ophthalmological Society and Youth Committee of
Beijing Ophthalmological Society. Suggestions from ophthalmic experts on
eye protection during the novel coronavirus pneumonia epidemic.
Zhonghua Yan Ke Za Zhi. 2020;56(0):E002. https://doi.org/10.3760/cma.j.issn.
0412-4081.2020.0002.
12. Lin H, Xiang Y, Cui T, Chen Q. Online learning-related visual impairment and
preventive measures during the 2019 novel coronavirus outbreak.
Zhonghua Yan Ke Za Zhi. 2020;56(0):E004. https://doi.org/10.3760/cma.j.
cn112142-20200219-00089.
13. Wang N, Jie Y, Tao F. Precautions in ophthalmic practice in the prevention
and control of the novel coronavirus pneumonia epidemic. Zhonghua Yan
Table 2 Three-level protective measures of the ophthalmic professionals
Level of
protection
Protective measures Applicable object
Primary
protection
Cap, surgical mask, and working clothes (with/without gown) Indirect contact with patients, usher, non-operative inquiry and
ward rounds.
Secondary
protection
Cap, surgical mask/N95 mask, working clothes with gown,
protective goggles/face shield, and disposable gloves
Direct contact with patients such as slit lamp, gonioscopy,
ultrasound and other specialized examinations; puncture,
injection, outpatient laser and other professional operations.
Tertiary
protection
Cap, N95 mask, protective clothing with gown, protective goggles,
face shield, and two pairs of disposable gloves
Contact with blood, body fluids, secretions and other spillages;
specimen collection that may produce eye aerosols; internal eye
surgery etc.
The anesthesiologist should also adhere to this level of
protection during general anesthesia operations.
Yu et al. Eye and Vision (2020) 7:19 Page 8 of 9
Ke Za Zhi. 2020;56(0):E007. https://doi.org/10.3760/cma.j.cn112142-
20200224-00102.
14. Kang Z, Zhou Y, Zhang L, QIn S, Li Y, Zhang S, et al. Ophthalmic protection
of novel coronavirus infection and clinical prevention and control
suggestions of integrated Traditional Chinese and Western Medicine. China
J Chin Ophthalmol. 2020;30(2):759. https://doi.org/10.13444/j.cnki.zgzyykzz.
2020.02.http://kns.cnki.net/kcms/detail/detail.aspx?FileName=ZGKZ202002
001&DbName=CJFQTEMP.
15. Shao L, Wei W. Suggestions on the protection for ophthalmologists against
the infection of the novel coronavirus. Int Rev Ophthalmol. 2020;44(1):4.
https://doi.org/10.3760/cma.j.issn.1673-5803.2020.01 http://www.j-bio.net/
CN/Y2020/V44/I1/1.
16. Wang X, Wang Z, Yao C, Li S. Management of ophthalmic perioperative
period during 2019 novel coronavirus disease outbreak. Chin J Exp
Ophthalmol. 2020;38(0):E011. https://doi.org/10.3760/cma.j.issn115989-
20200224-00100.
17. Ye Y, Song Y, Yan M, Hu C, Chen X, Yu J, et al. Novel coronavirus
pneumonia combined with viral conjunctivitis:three cases report. Zhonghua
Yan Ke Za Zhi. 2020;38(03):242-4. https://doi.org/10.3760/cma.j.cn112142-
20200214-00063.
18. Zheng M, Wu W, Chen W, Yu X, Shi Y, Qu J. Necessity and feasibility of viral
RNA detection in specialist ophthalmic institute during the COVID-19
epidemic. Chin J Exp Ophthalmol. 2020;38(0):E008. https://doi.org/10.3760/
cma.j.cn115989-20200224-00105.
19. Zhang P, Lu Y, Song S, Yu X, Dai H. Key points of serious adverse event and
protection of patients in ophthalmic clinical trials during novel coronavirus
pneumonia outbreak. Chin J Exp Ophthalmol. 2020;38(0):E007. https://doi.
org/10.3760/cma.j.cn115989-20200217-00072.
20. Li X, Wang M, Dai J, Wang W, Yang Y, Jin W. Novel coronavirus disease with
conjunctivitis and conjunctivitis as first symptom: two cases report. Chin J
Exp Ophthalmol. 2020;38:E002. https://doi.org/10.3760/cma.j.issn.115989-
20200303-00133.
21. Song J, Xing Y, Wu J, Zhang H. Caution of coronavirus transmission through
ocular surface. Int Eye Sci. 2020; Epub 20200301. http://kns.cnki.net/kcms/
detail/61.1419.R.20200226.1935.002.html.
22. Xie L, Zhou Q, Gao H, Shi W. Strengthening basic and clinical research on
ocular infection caused by coronavirus. Zhonghua Yan Ke Za Zhi. 2020;
56(00):E003. https://doi.org/10.3760/cma.j.cn112142-20200219-00087.
23. Zhang M. New coronavirus pneumonia and ocular surface transmission. Int
Eye Sci. 2020; Epub 20200226. http://kns.cnki.net/kcms/detail/61.1419.R.202
00223.1432.002.html.
24. Li C, Tang Y, Chen Z, Wang A, Huang X, Chen Y, et al. Aerosol formation
during non-contact air-pufftonometry and its significance for prevention
of COVID-19. Chin J Exp Ophthalmol. 2020;38(0):E010. https://doi.org/10.
3760/cma.j.issn.115989-20200226-00112.
25. Niu F, Ku N, Sun Y. Investigation of possible mechanism of eye transmission
of SARS-CoV-2 based on SARS-CoV. Int Eye Sci. 2020. Epub 20200304. http://
kns.cnki.net/kcms/detail/61.1419.R.20200304.1437.002.html.
26. Gao H, Shi W. Ophthalmology research and prevention of 2019 novel
coronavirus based on ocular manifestations of viral diseases. Chin J
Ophthalmol. 2020;56(0):E006. https://doi.org/10.3760/cma.j.cn112142-
20200216-00068.
27. Yin S. New coronavirus pneumonia and outbreak epidemic virus and eye
disease. Chin J Exp Ophthalmol. 2020;38(2):156-60. https://doi.org/10.3760/
cma.j.issn.2095-0160.2020.02.014.
28. Li X, Wang M, Chen C, Yang A, Jin W. Prevention and control strategies for
ophthalmologists dealing with SARS-CoV-2 infectious patients concomitant
or first-onset of conjunctivitis. Chin J Exp Ophthalmol. 2020;38(0):E002.
https://doi.org/10.3760/cma.j.issn.2095-0160.2020.0002.
29. Jin X, Lin L, Huang X. Possible mechanism of eye transmission of SARS-CoV-
2 and precaution for it. Chin J Ophthalmol. 2020; Epub 20200303. https://
doi.org/10.3760/cma.j.cn112142-20200214-00063.
30. Chen B, Zhang X, Sun X. Precaution of 2019 novel coronavirus infection in
ophthalmology medical staff. Int Eye Sci. 2020;20(3):5802. https://doi.org/
10.3980/j.issn.1672-5123.2020.3.41.
31. Zhao M, Li X, Li M, Sun D, Lin B, Yan M, et al. Precaution for clinical
diagnosis and treatment and post operating procedures in ophthalmology
during the epidemic of COVID-19. Chin J Exp Ophthalmol. 2020;38(03):261
6. https://doi.org/10.3760/cma.j.issn.2095-0160.2020.0004.
32. Huang X, Qu J, Chen Y, Zhang P, Zhang C, Zheng X. Correct choice of
goggles and anti-fog guidance during the epidemic period of COVID-19.
Chin J Optom Ophthalmol Vis Sci. 2020;22(0):E002. https://doi.org/10.3760/
cma.j.cn115909-20200301-00054.http://rs.yiigle.com/yufabiao/1184382.htm.
33. Gao Z, Wang X, Huang X, Zhang J, Qu J. Developmentof remote dedicated
doctor platform of ophthalmology and its application efficancy during
COVID-19 epidemic. Chin J Exp Ophthalmol. 2020;38(00):E013. https://doi.
org/10.3760/cma.j.issn.115989-20200306-00149.
34. Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and
immune responses. J Med Virol. 2020;92(4):42432. https://doi.org/10.1002/
jmv.25685.
35. Momattin H, Al-Ali AY, Al-Tawfiq JA. A systematic review of therapeutic
agents for the treatment of the Middle East Respiratory Syndrome
Coronavirus (MERS-CoV). Travel Med Infect Dis. 2019;30:918. https://doi.org/
10.1016/j.tmaid.2019.06.012.
36. She J, Jiang J, Ye L, Hu L, Bai C, Song Y. 2019 novel coronavirus of
pneumonia in Wuhan, China: emerging attack and management strategies.
Clin Translat Med. 2019, 2020;9(1):19. https://doi.org/10.1186/s40169-020-
00271-z.
37. Holshue M, DeBolt C, Lindquist S, Lofy K, Wiesman J, Bruce H, et al. First
case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;
382(10):92936. https://doi.org/10.1056/NEJMoa2001191.
38. Wang P, Chen J, Zheng A, Nie Y, Shi X, Wang W, et al. Expression cloning of
functional receptor used by SARS coronavirus. Biochem Biophys Res
Commun. 2004;315(2):43944. https://doi.org/10.1016/j.bbrc.2004.01.076.
39. Sun Y, Liu L, Pan X. Binding action between SARS-CoV S666 protein and
ACE2 receptor in eyes. Rec Adv Ophthalmol. 2007;27(4):2503. https://doi.
org/10.3969/j.issn.1003-5141.2007.04.004.
40. Chentoufi AA, Dasgupta G, Nesburn AB, Bettahi I, Binder NR, Choudhury ZS,
et al. Nasolacrimal duct closure modulates ocular mucosal and systemic
CD4+ T-cell responses induced following topical ocular or intranasal
immunization. Clin Vaccine Immunol. 2010;17(3):34253. https://doi.org/10.
1128/cvi.00347-09.
41. Loon SC, Teoh SC, Oon LL, Se-Thoe SY, Ling AE, Leo YS, et al. The severe
acute respiratory syndrome coronavirus in tears. Br J Ophthalmol. 2004;
88(7):8613. https://doi.org/10.1136/bjo.2003.035931.
42. de Wit E, Rasmussen AL, Falzarano D, Bushmaker T, Feldmann F, Brining DL,
et al. Middle East respiratory syndrome coronavirus (MERS-CoV) causes
transient lower respiratory tract infection in rhesus macaques. Proc Natl
Acad Sci U S A. 2013;110(41):16598603. https://doi.org/10.1073/pnas.
1310744110.
43. Chan WM, Yuen KS, Fan DS, Lam DS, Chan PK, Sung JJ. Tears and
conjunctival scrapings for coronavirus in patients with SARS. Br J
Ophthalmol. 2004;88(7):9689. https://doi.org/10.1136/bjo.2003.039461.
44. Chan WM, Liu DT, Chan PK, Chong KK, Yuen KS, Chiu TY, et al. Precautions
in ophthalmic practice in a hospital with a major acute SARS outbreak: an
experience from Hong Kong. Eye (Lond). 2006;20(3):2839. https://doi.org/
10.1038/sj.eye.6701885.
45. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-
nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):9. https://doi.
org/10.1038/s41368-020-0075-9.
46. Britt JM, Clifton BC, Barnebey HS, Mills RP. Microaerosol formation in
noncontact air-pufftonometry. Arch Ophthalmol. 1991;109(2):2258.
https://doi.org/10.1001/archopht.1991.01080020071046.
47. Huang Y, Tu M, Wang S, Chen S, Zhou W, Chen D, et al. Clinical
characteristics of laboratory confirmed positive cases of SARS-CoV-2
infection in Wuhan, China: a retrospective single center analysis. Travel Med
Infect Dis. 2020. https://doi.org/10.1016/j.tmaid.2020.101606.
Yu et al. Eye and Vision (2020) 7:19 Page 9 of 9
... Triediaci systém je tiež dôležitý na identifikáciu pacientov s horúčkou, respiračnými príznakmi a/alebo akútnou konjunktivitídou alebo tých, ktorí nedávno cestovali do oblastí ohniska nákazy. Odporúča sa tiež objednávanie a dodávanie predpísaných liekov online, najmä pri liekoch na dlhodobé používanie pri chronických ochoreniach [36]. ...
... Pre personál je potrebné prekrytie horných dýchacích ciest vrátane nosa a úst ochrannými prostriedkami, hygiena rúk a dodržiavanie odstupov viac ako 2 metre. Priame vyšetrenie oftalmoskopom sa neodporúča a je možné ho nahradiť Volkovými šošovkami s vyšetrením na štrbinovej lampe, optickou koherentnou tomografiou alebo fotografiou očného pozadia [36]. ...
... Vyžaduje sa prísna hygiena rúk a rukavice by sa mali pravidelne meniť. Jeden pár latexových rukavíc by sa nemal používať dlhší čas [36]. ...
Article
In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from China. Coronaviruses belong to enveloped ssRNA viruses and are classified into four genera: Alpha coronavirus, Beta coronavirus, Gamma coronavirus and Delta coronavirus. It is assumed that SARS-CoV-2 is spread primarily during a personal contact via bigger respiratory droplets. These droplets with viruses can be directly inhaled by other people or can lend on the surfaces with the possibility of further spreading. The ocular surface has been suggested as one of possible infection entries. Human eye has its own renin-angiotensin system with present ACE2 receptors, which bind the virus through spike protein. The most common symptoms of the SARS-CoV-2 infection are fever, cough and dyspnoea. Several clinical entities, such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been associated with this infection. The most common ophthalmologic symptom associated with COVID-19 disease is conjunctivitis. Some studies indicate that eye symptoms are commonly present in patients with severe COVID-19 pneumonia and that it is possible to detect viral RNA from the conjunctival sac of these patients. In ophthalmologic praxis, we manage not only the therapy of the eye structures` inflammation in relation with this infection, but also the overall management of the visits and the supervision of the patients who are at risk and positive for coronavirus. Ophthalmologists could potentially have a higher risk of SARS-CoV-2 infection due to personal communication with the patients, frequent exposure to tears and eye secrets and the use of devices. We would like to provide an ophthalmologist`s perspective on this topic.
... Conjunctival sac irrigation is a routine preoperative operation of ophthalmic surgery, but the irrigation process is prone to aerosols, which causes a safety hazard. Similarly, during surgical procedures, the splash of intraocular irrigation fluids and frequent exposure to tears and ocular discharge may increase risk of infection [60] . So it is necessary for medical staff in ophthalmology working on the front lines to carry out strict precautions and nursing care to avoid cross-infection. ...
Article
A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCOV), causing coronavirus disease 2019 (COVID-19), has rapidly spread to most countries and regions worldwide since it broke out at the end of 2019. Epidemic of the virus produces a tremendous pressure on the global health systems. With progressive insight into SARS-CoV-2, the role of eye tissue has attracted wide attention in the spread of COVID-19. Whether SARS-CoV-2 can enter the human body through eyes and cause infection? The fact that unprotected exposure of the eyes to 2019-nCoV might have allowed the virus to infect the body implies that 2019-nCOV can invade eye tissue and set foot in organism. Facing the severe challenge of preventing spread of the COVID-19, combined with the high-risk environment of ophthalmology, it is crucial to investigate ocular tropism of coronavirus. This paper explores the possibility of coronavirus transmission through the eye from aspects of probable mechanisms, clinical cases, detection of coronavirus; and puts forward precautions for ophthalmologists and nurses. Consequently, this review reveals our understanding of ocular tropism of coronavirus and contributes to determining risk of ocular transmission, raising awareness of necessary eye protection among medical workers and reducing further prevalence of SARS-CoV-2.
... Conforme apresentado nesta revisão, diferentes autores demonstram em suas pesquisas a presença do vírus na lágrima ou na bolsa conjuntival, embora, é de se destacar que a prevalência desses achados é aparentemente ínfima 25,26,27 . Mesmo com diferentes resultados, a infecção COVID-19 através da via ocular ainda é uma incerteza, mas, isso não quer dizer, que as medidas de proteção, a qual inclui evitar a elevação das mãos aos olhos, devem ser esquecidas ou menosprezadas 28 . ...
Article
Full-text available
O objetivo deste trabalho é descrever casos clínicos e séries de casos relacionados a alterações oftalmológicas em pacientes com diagnóstico de COVID-19. Foi realizada uma revisão narrativa/descritiva de casos clínicos e série de casos. A partir das buscas de dados com descritores pré-definidos, foram integrados na revisão, 17 estudos. Dentre os principais temas identificados, destacam-se: alterações conjuntivais, alterações retinianas e oftalmoparesias. O quadro de alterações da conjuntiva foi prevalente em relação aos demais. Essa revisão incluiu não apenas afecções oculares em adultos, mas também, em crianças e adolescentes. O estudo chama atenção para o fato de que as alterações oculares foram descritas como alteração isolada, alteração precipitante e alteração simultânea ao quadro respiratório. Conclui-se que as afecções oculares vão além de alterações conjuntivais, embora sejam essas preponderantes, havendo ainda alterações retinianas, quadro de oftalmoparesia e ainda a incomum síndrome de Miller Fisher. Novos ensaios irão poder avaliar, qual é de fato, a representatividade dos problemas oculares na cadeia epidemiológica da COVID-19.
... [11] Many patients sought ophthalmologist's advice thinking it to be a sign of COVID 19 disease, as suggested by multiple reports. [12,13] Babu et al. also reported a similarly high number of cases of red eyes. [4] Most of the patients who presented with redness of eyes were diagnosed with conjunctivitis, and most of these patients were lost to follow-up. ...
Article
Full-text available
Purpose: To analyze the profile of patients visiting the ophthalmic emergency department during coronavirus disease-2019 lockdown and analyze its impact on a tertiary eye care center in South India. Materials and Methods: Retrospective analysis of Electronic Medical records of all patients presenting in the period from March 24, 2020 to May 3, 2020 (lockdown group) and the same was compared with the data of patients from the same period in the previous year (prelockdown group). Data regarding their demographic details, presenting complaints, final diagnosis, medical treatment, and surgical interventions undertaken if any were scrutinized. Results: The total number of patients seen in the emergency services during the lockdown phase was 591. The number of patients coming to the emergency showed a decline of 35% compared to the previous year. The most common presenting complaint was defective vision (n = 112, 18.95). Review checkup was done in 128 patients (21.65%). The most common ocular diagnosis was conjunctivitis (n = 78, 13.19%). Emergency surgical interventions were advised in 30 patients (5.07%). Conclusion: A significant decline in the number of visits to the emergency in the lockdown period was observed probably due to the various constraints and hardships faced by patients.
... General measures and heightened infection control practices were put in place in SNEC from January 2020, in line with other ophthalmic institutes in Singapore, and globally. These measures have been previously described in detail [5][6][7][8][9][10][11][12][13][14][15]. ...
Article
Much has been written on infection control and clinical measures for ophthalmic institutions and departments to cope with the COVID-19 pandemic. However, few articles have detailed implementation plans to manage lockdowns and subsequent re-openings. In this article, specific operational responses and their outcomes in a large tertiary ophthalmology centre are described. Through a concerted effort led by a dedicated task force, the Singapore National Eye Centre (SNEC) planned and executed an operational transformation to respond to the restrictions imposed on healthcare delivery during a national lock down. A carefully calibrated re-starting of services was carried out with the subsequent phased reopening of the country, taking into consideration unique constraints faced at that time. Strategies for operating in the new normal environment were also developed. Outpatient attendances were safely and expediently reduced by 70% (8749 vs. 29,311) and 82% (5164 vs. 29,342) in April and May 2020, respectively, compared to the corresponding months in 2019. A correspondingly large reduction in surgical load was also achieved through a similar triaging and prioritization system. Through optimizing the center’s use of space and time, as well as expanding on new models of care, a return to pre-pandemic patient load was achieved 3 months into the phased reopening of the country, and subsequently exceeded in the following months. The lessons gleaned from SNEC’s experience may be useful for institutions currently facing the same challenges, and for future responses to COVID-19 resurgences or other pandemics.
Chapter
The current epidemic of Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-2) has led to a major health crisis in 2020. SARS-CoV-2 has spike protein, polyproteins, nucleoproteins, and membrane proteins with RNA polymerase, 3-chymotrypsin-like protease, papain-like protease, helicase, glycoprotein, and accessory proteins. These are probable targets to be explored for the discovery of antiviral agents, still, to date, no definite treatment or vaccine has been discovered. Virtual screening with molecular docking has its advantage to speed up the drug development procedure in an accurate manner. In this chapter, novel computational strategies for drug discovery have been elaborated. Docking tools and drug filtering rules which may efficiently assist the drug development procedure and channelize the whole process in the right direction have also been discussed. A case study with 322 natural, semi-synthetic, and synthetic derivatives of citric acid (2-hydroxy-1,2-3-propane tricarboxylic acid), in search of a potential lead molecule to combat the novel coronavirus SARS-CoV-2, has been elaborated. The derivatives were explored from the PubChem database. The obtained library of compounds was filtered through Lipinski's rules, out of which, 74 obeyed the rule and were further subjected to molecular docking investigation against the SARS-CoV-2 replicase polyprotein 1a or pp1a (ID: 6LU7), with AutoDock Vina and iGEMDOCK. Deptropine possessed the highest binding affinity, in terms of released binding energy (-7.4 kcal/mol), against the SARS-CoV-2 replicase polyprotein 1a.
Article
Эпидемия SARS-CoV-2 представляет глобальную угрозу для общественного здоровья. Известно, что SARS-CoV-2 способен вызывать у зараженных угрожающую жизни дыхательную недостаточность. Существуют данные о способности коронавирусов поражать орган зрения и проникать в организм через конъюнктиву.Мы провели систематический обзор всех доступных публикаций, найденных по запросу (SARS-CoV-2 OR COVID19) AND Ophthalmology в базе данных PubMed. Были проанализированы 42 публикации, включавшие клинические исследования, описания клинических случаев, обзоры и статьи, описывающие организацию офтальмологической помощи в условиях эпидемии.Опубликованные данные говорят о возможности развития конъюнктивита, ассоциированного с SARS-CoV-2. Несмотря на то, что данное проявление COVID-19 наблюдается относительно редко, конъюнктивит сам по себе – явление частое. Поэтому офтальмологи могут быть первыми врачами, контактирующими с пациентами с COVID-19. При этом необходимо помнить, что вирус может содержаться в слезе и конъюнктивальном отделяемом, заставляя принимать меры предосторожности.Риск трансконъюнктивальной передачи SARS-CoV-2 увеличивается при длительном контакте с зараженными. В соответствии с рекомендациями американского общества офтальмологов, медицинским работникам в период эпидемии SARS-CoV-2 необходимо, кроме всего прочего, носить защитные очки. Офтальмологам рекомендуется применять защитные экраны для щелевой лампы.Здоровая глазная поверхность – защита от SARS-CoV-2, поэтому профилактические меры должны включать инстилляции слезозамещающих растворов и при необходимости проведение инъекционных курсов низкомолекулярного натрия гиалуроната. The SARS-CoV-2 epidemic poses a global threat to public health. SARS-CoV-2 is known to cause life- threatening respiratory failure in infected individuals. There is evidence of the ability of coronaviruses to infect the organ of vision and enter the body through the conjunctiva. However, researchers have not yet agreed on whether SARS-CoV-2 uses this strategy.We conducted a systematic review of all available publications found by query (SARS-CoV-2 OR COVID19) AND Ophthalmology in the PubMed database. 42 publications were an alyzed, including clinical trials, clinical case descriptions, reviews, and articles describing the organization of ophthalmic care in an epidemic time.Published data suggest the possibility of conjunctivitis associated with SARS-CoV-2. Although this manifestation of COVID-19 is relatively rare, conjunctivitis itself is a common occurrence. Therefore, ophthalmologists may be the first physicians in contact with patients with COVID-19. It should be remembered that the virus can be contained in the tear and conjunctival discharge and take precautions.The risk of transconjunctival transmission of SARS-CoV-2 increases with prolonged exposure to virus. In accordance with the recommendations of the American Society of Ophthalmologists, medical personnel during the SARS-CoV-2 epidemic need to, among other things, wear safety glasses. Ophthalmologists are advised to use protective screens for a slit lamp.
Article
The disease, which originated from the SARS-CoV-2 virus, is primarily transmitted by direct contact with infected individuals. Visual healthcare professionals perform clinical practices that pose a significant risk of infection due to their proximity with patients during the examination. This systematic review aims to identify preventive measures that will aid in reducing the risk of infection during standard appointments between patients and visual health professionals. A systematic review was done for articles published in indexed journals from December 2019 to December 2020. The search for these articles was done in 3 electronic databases. As part of the search criteria, articles were selected if they had the keywords (SARS-CoV-2), (COVID-19), and coronavirus combined with ophthalmology, optometry, eye care, and the eye. Once duplicated and unrelated items were eliminated, 36 articles of interest were selected. Seven sections were described in detail: telephone screening, (COVID-19) triage, decreasing transmission within shared spaces, hand washing, use of personal protective equipment Personal Protective Equipment (PPE), cleaning of diagnostic instruments, and use of telemedicine. This paper helps healthcare professionals to better understand the context of the "new normal" clinical practice. Visual health professionals and their patients must adhere to norms and use the indicated PPE during the consultation to safeguard each other.
Article
Purpose To describe a case of macular intraretinal microvascular abnormality (IRMA) detected with Optical Coherence Tomography Angiography (OCTA) and to show its remodeling and vascular density changes after panretinal photocoagulation (PRP) during an 18-month follow-up. Methods Case report. Results A 22-year-old female patient with proliferative diabetic retinopathy was found to have a small hyperreflective formation with posterior shadow cone and signal flow, located at the temporal margin of the fovea avascular zone (FAZ), identified as macular IRMA with OCTA. Her best-corrected-visual acuity was 20/20. Four months later the macular IRMA was larger and, in its context, there was also an increase in the flow area in B-scan. The patient underwent PRP and after 18 months we observed a regression of macular IRMA and an increase in the superficial capillary plexus vessel density in all sectors in comparison to baseline. Conclusion OCTA is a non-invasive tool that recognize macular IRMA in diabetic retinopathy patient and it could be helpful to follow their qualitative and quantitative vascular evolution over time.
Article
Full-text available
PurposeCoronavirus disease (COVID-19) has rapidly emerged as a global health threat. The purpose of this article is to share our local experience of stepping up infection control measures in ophthalmology to minimise COVID-19 infection of both healthcare workers and patients.Methods Infection control measures implemented in our ophthalmology clinic are discussed. The measures are based on detailed risk assessment by both local ophthalmologists and infection control experts.ResultsA three-level hierarchy of control measures was adopted. First, for administrative control, in order to lower patient attendance, text messages with an enquiry phone number were sent to patients to reschedule appointments or arrange drug refill. In order to minimise cross-infection of COVID-19, a triage system was set up to identify patients with fever, respiratory symptoms, acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 14 days. Micro-aerosol generating procedures, such as non-contact tonometry and operations under general anaesthesia were avoided. Nasal endoscopy was avoided as it may provoke sneezing and cause generation of droplets. All elective clinical services were suspended. Infection control training was provided to all clinical staff. Second, for environmental control, to reduce droplet transmission of COVID-19, installation of protective shields on slit lamps, frequent disinfection of equipment, and provision of eye protection to staff were implemented. All staff were advised to measure their own body temperatures before work and promptly report any symptoms of upper respiratory tract infection, vomiting or diarrhoea. Third, universal masking, hand hygiene, and appropriate use of personal protective equipment (PPE) were promoted.Conclusion We hope our initial experience in stepping up infection control measures for COVID-19 infection in ophthalmology can help ophthalmologists globally to prepare for the potential community outbreak or pandemic. In order to minimise transmission of COVID-19, ophthalmologists should work closely with local infection control teams to implement infection control measures that are appropriate for their own clinical settings.
Article
Full-text available
A novel β-coronavirus (2019-nCoV) caused severe and even fetal pneumonia explored in a seafood market of Wuhan city, Hubei province, China, and rapidly spread to other provinces of China and other countries. The 2019-nCoV was different from SARS-CoV, but shared the same host receptor the human angiotensin-converting enzyme 2 (ACE2). The natural host of 2019-nCoV may be the bat Rhinolophus affinis as 2019-nCoV showed 96.2% of whole-genome identity to BatCoV RaTG13. The person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fetal–oral routes may also be a potential person-to-person transmission route. The participants in dental practice expose to tremendous risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.
Preprint
Full-text available
Purpose: The aim of this study was to identify whether SARS-COV-2 infected in ocular surface. Methods: Cross-sectional study of patients presenting for who received a COVID-19 diagnosis, from December 30, 2019 to February 7, 2020, at Tongji hospital, Tongji medical college, Huazhong University of Science and Technology. Demographics, temperature was recorded, blood routine test (Rt), chest Computed Tomography (CT) were took intermittently, and SARS-COV-2 real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay were arranged for the nasopharyngeal and conjunctival swab samples. Results: A total of 102 patients (48 Male [50%] and 54 Female [50%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) confirmed by laboratory diagnosis with SARS-COV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis was identified from 72 patients with a laboratory confirmed COVID-19. However, SARS-COV-2 RNA fragments was found in ocular discharges by SARS-COV-2 RT-PCR only in one patient with conjunctivitis. Conclusions: Although we suspect the incidence of SARS-COV-2 infection through the ocular surface is extremely low, the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-COV-2. Therefore, to lower the SARS-COV-2 nosocomial infection, the protective goggles should be wore in all the health care workers.
Article
The prevention and control of novel coronavirus pneumonia is the most priority recently, and various measures during the prevention and control period will have varying degrees of impact on the implement of clinical trials.However, various examinations in ophthalmological clinical trials need close contact between operators and patients, which put us at risk of cross-infection.This paper indicated some suggestions based on the criteria of clinical trials under major public health emergencies, the management of clinical trials during epidemic period, including the follow-up of subjects, the treatment of epidemic serious adverse event (SAE) and the management requirements of co-sponsors, as well as the requirements and management principles for environment, subjects, examiners and inspection equipment in the process of ophthalmic clinical trials.It may be helpful to the ophthalmic clinical trial researchers and subjects during the period of novel coronavirus infection.
Article
Since the outbreak of the new coronavirus pneumonia (NCP) in Wuhan City, China, the main transmission mode as well as the diagnosis and treatment of NCP have become a focus of research in China and World Health Organization.Understanding the mode of infection, transmission and biological behavior of the novel coronavirus (2019-nCoV) is undoubtedly a key of cutting off the spread and prevention of the disease which doctors are fearing to be a worldwide epidemic.In February 2020, Lancet published a correspondence paper, which reviewed a case of NCP patient who first started with conjunctivitis, and raised the issue that the transmission of 2019-nCoV through the ocular surface must not be ignored, causing widespread concern.However, due to a lack of clinical observation data and laboratory research at present, the relationship between NCP pathogen infection and ocular surface infection is not completely clear.So far, there have been many studies and reports on the observation of large-scale epidemic virus infections and eye diseases.This article reviews the eye performance of various types of epidemic virus infections and provides a reference for NCP prevention and control.
Article
This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on February 24, 2020. In China, the fight against the 2019 novel coronavirus (2019-nCoV) has been at a critical stage. It has been confirmed that the transmission of 2019-nCoV is mainly through respiratory droplets and contact. Some scholars also pointed out that the possibility of transmission through the digestive system and eyes should not be ignored. Whether infection with 2019-nCoV will develop eye symptoms and whether the virus will spread through eyes are confusing to the medical workers and the general public, and it is ophthalmologists' responsibility to carry out in-depth discussions. Based on the ocular manifestations of viral diseases, this article analyzes whether the eye secretions and tears carry the virus, and whether ophthalmologists and patients are at a high risk for 2019-nCoV infection, and then presents the current research methods and the necessary prevention and control measures in the field of ophthalmology, with an aim to contribute to the fight against 2019-nCoV. ( Chin J Ophthalmol, 2020, 56: 414-417).
Article
This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on March 2, 2020. Prevention and control of novel coronavirus pneumonia is now the top priority, and the protection of the eyes in the fight against the epidemic has also been an issue of great concern. Based on the latest progress made in basic and clinical research and practical experience in epidemic prevention and control, this article delivers objective guidance on whether the eye is a route of transmission of novel coronavirus infection, the precautions that should be taken by ophthalmologists in clinical practice during the epidemic, the novel coronavirus infection in the eyes and its clinical manifestation, and the public health education on eye protection, so as to provide valuable evidence for the scientific prevention and control of the epidemic and developing targeted countermeasures. (Chin J Ophthalmol, 2020, 56: 330-332).
Article
Objective: This study aimed to assess the presence of novel coronavirus in tears and conjunctival secretions of SARS-CoV-2 infected patients. Methods: A prospective interventional case series study was performed, and 30 confirmed novel coronavirus pneumonia (NCP) patients were selected at the First Affiliated Hospital of Zhejiang University from January 26, 2020 to February 9, 2020. At an interval of 2-3 days, tear and conjunctival secretions were collected twice with disposable sampling swabs for reverse transcription polymerase chain reaction (RT-PCR) assay. Results: 21 common type and 9 severe type NCP patients were enrolled. Two samples of tear and conjunctival secretions were obtained from the only one patient with conjunctivitis yielded positive RT-PCR results. 58 samples from other patents were all negative. Conclusion: We speculate that SARS-CoV-2 may be detected in the tears and conjunctival secretions in NCP patients with conjunctivitis. This article is protected by copyright. All rights reserved.
Article
目前我国对2019新型冠状病毒疫情的防治工作正处于关键时期,延迟开学是减少校园内交叉感染、保护儿童和青少年身体健康、共同抗击疫情的重要举措。与此同时,远程教学模式的大规模开展导致儿童和青少年的学习模式和用眼习惯发生巨大转变,其对儿童和青少年视觉健康的潜在影响不容忽视。本文对线上学习相关眼健康问题和眼科疾病进行总结,并提出针对性的预防措施,为儿童和青少年在线上学习期间的视功能保护提供有效指导。(中华眼科杂志,2020,56: ).