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Clinical profile and prevalence of conjunctivitis in mild COVID-19 patients in a tertiary care COVID-19 hospital: A retrospective cross-sectional study


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Purpose: To find the clinical profile and prevalence of conjunctivitis and other ocular manifestations in mild COVID-19 positive patients in a nodal COVID-19 hospital. Methods: A retrospective cross-sectional, single-center study conducted in 127 mild cases of COVID-19 positive patients admitted between 27th March and 19th April 2020 in a tertiary care COVID-19 hospital in north India. From the hospital records, demographic data is collected. Ocular history and ocular examinations were done by face-to-face survey during ward rounds. Results: A total of 127 patients were included in the study with a median age of 38.8 years. Forty-eight (37.80%) patients had upper respiratory tract symptoms, 20 (15.75%) patients had systemic illness, 18 (14.17%) patients were using spectacles, and 50 (39.37%) patients had history of hand-eye contact. Out of 12 (9.45%) patients who had ocular complaints, 11 (8.66%) had ocular manifestation after admission. Among 11 patients, eight (6.29%) had conjunctival congestion. Three (3/8) patients had developed conjunctival congestion even before the manifestation of definite COVID-19 symptoms. Five patients (5/8) patients had no other associated ocular symptoms other than congestion. Six patients (6/8) had symptoms of upper respiratory tract infection. Conclusion: Mild conjunctivitis manifesting as conjunctival congestion is common and is one of the major ocular manifestations in COVID-19 positive patients even with milder disease.
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© 2020 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Original Article
Clinical prole and prevalence of conjunctivitis in mild COVID-19 patients in
a tertiary care COVID-19 hospital: A retrospective cross-sectional study
Sindhuja K, Neiwete Lomi, Mohamed I Asif, Radhika Tandon
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Purpose:          
             th
   
 Results:           
            
    
        
           
   
Key words:
    th 
05‑May‑2020 Revision: 26‑May‑2020
06‑Jun‑2020 24‑Jul‑2020
   
    
 The main symptoms of
 
  
      
appropriate measures while examining a patient with
 
 
     
     
      
 
Cite this article as: Sindhuja K, Lomi N, Asif MI, Tandon R. Clinical prole
and prevalence of conjunctivitis in mild COVID-19 patients in a tertiary care
COVID-19 hospital: A retrospective cross-sectional study. Indian J Ophthalmol
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  
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Demographic data of patients
     
 
      
the 3rd week of admission and few patients (13 patients in 1st
week and 15 patients in 2nd
    
Data regarding systemic history
 
   
Data regarding ocular history
      
 1
    
    
 2]
 3
 
during 1st
nd 
patients in 3rd
one patient during 3rd
 
 
Data regarding patients with conjunctival congestion sug-
gestive of conjunctivitis
   
     
  
     
  
 
during 1st
nd 
patients in 3rd
   
 
 
      
time of admission and one patient developed sore throat on
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1548  Volume 68 Issue 8
  
 
   
  
   
  
    
  
     
   
 4     
 
Table2: Characteristics of patients with conjunctival congestion
Patient 1 2 3 4 5 678
Age(years) 24 51 61 61 27 29 24 52
Sex Male Male Male Male Male Male Male Male
Exposure history Religious
Contact from
positive nonfamily
Cough Fever and
Sore throat Sore throat Sore throat
manifested on 7th
No No Cough and
Duration of
systemic symptom
at the time of
5days 4days 2days 2days Asymptomatic on
Asymptomatic Asymptomatic 2days
Systemic illness Nil Nil Nil Diabetes Nil Nil No Diabetes and
Ocular complaints H/O
and watering
for 2days
for 2days
watering, and
Itching, photophobia
and periorbital rash
on and off
Redness on
and off and
watering for
Day of
of conjunctival
congestion after
7th day(1st
2nd day(1st
19th day(3rd
18th day(3rd
5th day(1st week) 18th day(3rd
2nd day(1st
2nd day(1st
of conjunctival
congestion after
onset of systemic
12th day(2nd
6th day(1st
21st day(3rd
20th day(3rd
4th day
(1st week)
Hand eye contact Yes No No Yes Yes No No No
h/o use of goggles/
No No Yes No No No No Yes
No No Diffuse Diffuse Diffuse Diffuse No No
Associated findings Lid edema
Periorbital rash
Table1: Ocular symptoms of patients(12/127)
Symptom No of patients Percentage
Conjunctival congestion 9 7.08
Burning sensation 10.79
Watering 1 0.79
Painful eyelid swelling 10.79
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 et al 
  
     
  
     
 
  
    
    
   
     
studies 5
    
  
      
   
    
    
   
  
Financial support and sponsorship
Conicts of interest
Table4: Percentage of patients who developed
conjunctival congestion with various associations
Conjunctivitis P
Yes No
H/O Hand‑eye contact
Yes 3 47 >0.999
No 5 72
Systemic illness
Yes 2 18 0.611
No 6101
No use of eye goggles or glasses
Yes 6103 0.316
No 2 16
Upper respiratory tract infection
Yes 642 0.052*
No 2 77
P<0.05 is considered as significant
Table3: Characteristics of patients with other ocular manifestations
Patient 9 10 11
Age(years) 48 59 26
Sex Female Male Male
Contact history Contact from positive
nonfamily member
Contact from positive
Nonfamily member
Contact from positive nonfamily member
COVID‑19‑related systemic symptoms No No No
Systemic illness Hypertension, hypothyroidism HTN Nil
Ocular complaints Burning sensation for 1week Watering for 10days Painful swelling in left lower eyelid for 2days
Day of manifestation of ocular
symptom after admission
2nd day 2nd day 7th day
Hand‑eye contact No Yes No
H/O use of goggles Yes Yes No
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1550  Volume 68 Issue 8
Table5: Comparison of prevalence of conjunctival congestion between various studies
Study name Month and
year of
Patients with
Patients with
swab positive
% patients with
Guan etal.[3] conducted a study to find the clinical
characteristics of coronavirus 2019 disease in china.
Feb 2020 1099 9 Not done 0.81%
Xia etal.[4] conducted a study to evaluate
coronavirus in tears and conjunctival secretions of
patients with SARS‑CoV‑2 infection
Feb 2020 30 1 1 3.33%
Chen etal.[5] studied ocular manifestation and
clinical characteristics of 534cases of COVID‑19 in
China: ACross‑sectional study
March 2020 534 25 not done 4.68%
Wu etal.[6] studied characteristics of ocular findings
of patients with COVID‑19 in Hubei Province, China
March 2020 38 12* 231.57%
Loffredo etal.[7] did a meta‑analysis: Conjunctivitis
and COVID‑19
April 2020 1167 1.1% (3% in severe,
0.7% in nonsevere)
Hong etal.[9] conducted a study to evaluate the
ocular symptoms and tropism of SARS‑CoV‑2 in
patients confirmed with COVID‑19.
April 2020 56 2 1 3.57%
*In study conducted by Wu etal., among 12patients with ocular symptoms suggestive of conjunctivitis, 10patients(26.31%) had conjunctival congestion. The
study included more severe cases of COVID‑19 positives
 
 
et al 
     et al
   
 et al
   
     
 et al
  
  
     
     et al
  
 
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... [2,3] Among the ocular manifestations of COVID-19, conjunctivitis is the most prevalent manifestation with or without presence of viral RNA in conjunctival specimens unrelated to viral RNA from nasopharyngeal swab (NPS) orthroat swabs. [4,5,6] The present study from western India aims to evaluate ocular ...
... [2,15,18,19] Sindhuja K et al., reported ocular complaints with conjunctival congestion in 6.29% (8/11) patients even with mild COVID-19 stage, although no conjunctival specimen was subjected for RT-PCR analysis in their study. [5] . Chawhan A et al., also did not find any positive CS results in ocular symptomatic patients . ...
Full-text available
Background: Ocular manifestations of SARS-CoV-2 and the associated risk factors require a comprehensive analysisincludingConjunctival swab (CS) RT-PCR results irrespective of ocular involvement. Aims: To study the correlation of ocular manifestations & systemic COVID-19 status with clinical risk factors, during first & second outbreaks (FO & SO) of COVID19 pandemic in western India. CS RT-PCR results of diagnosed COVID-19 patients with positive nasopharyngeal swab (NPS) RT-PCR with or without ocular manifestations to be evaluated. Material and Methods: Prospective study conducted with confirmed COVID-19 cases with positive NPS RT-PCR during FO & SO of COVID-19 pandemic in year 2020 & 2021 in western India. Ocular manifestations & CS RT-PCR results were evaluated with systemic COVID-19 status. CS was collected within 48 hours of admission for RT-PCR analysis with repeat test within 72 hours upon increasing severity of COVID-19 stage. Result: Thirty-two (20.51%,13 FO,19 SO) patients had uniocular complaints, redness being the commonest during both the outbreaks. Out of 32 patients with ocular symptoms (OS), 87.5% had refractive error, 75% had diabetes & 53.1% had moderate COVID-19, (P
... As a result of our study, seizures were found to be a rare occurrence, but another study conducted by Keshavarzi et al. [69] found that seizures were among the presenting manifestations of COVID-19 in 0.8% of patients admitted to the hospital for severe illness. Despite our results, conjunctivitis was a common symptom in earlier studies conducted around the world [70][71][72]. Additionally, 20% of patients had CVD, and 14% had diabetes. ...
Full-text available
The COVID-19 pandemic has a devastating impact globally, claiming millions of lives and causing significant social and economic disruptions. In order to optimize decision-making and allocate limited resources, it is essential to identify COVID-19 symptoms and determine the severity of each case. Machine learning algorithms offer a potent tool in the medical field, particularly in mining clinical datasets for useful information and guiding scientific decisions. Association rule mining is a machine learning technique for extracting hidden patterns from data. This paper presents an application of association rule mining based Apriori algorithm to discover symptom patterns from COVID-19 patients. The study, using 2875 records of patient, identified the most common symptoms as apnea (72%), cough (64%), fever (59%), weakness (18%), myalgia (14.5%), and sore throat (12%). The proposed method provides clinicians with valuable insight into disease that can assist them in managing and treating it effectively.
... This wide range may result from differences in age, gender, and severity of the disease. 67 More ocular manifestations such as keratoconjunctivitis, episcleritis, 68 and dacryoadenitis 69 are also crucial. Additionally, hyperemia was observed in this pandemic. ...
The coronavirus disease 2019 (COVID-19) caused the outbreak of viral pneumonia in Wuhan, China, in December 2019. It is principally identified with respiratory disease and pulmonary manifestations. However, based on various reports, COVID-19 infection not only affects the respiratory system but also infects other organs. Cardiac manifestations, gastrointestinal complications, liver dysfunction, musculoskeletal disorders, ocular findings, and hematological manifestations are among the published extrapulmonary clinical manifestations. Lack of awareness and attention to these extrapulmonary features might result in misdiagnosis, delayed diagnosis, incorrect treatment, and eventually an increase in the spread of the virus by unidentified individuals to others in the community. Therefore, the current study comprehensively reviews and discusses the extrapulmonary manifestations of COVID-19 in mild or severe patients.
... Согласно современным данным, частота поражения глаз при коронавирусной инфекции достигает 32%. Самое частое проявление -это односторонние или двусторонние конъюнктивиты с такими симптомами, как хемоз, гиперемия конъюнктивы, слезотечение, слизистое отделяемое, отек век, субконъюнктивальные кровоизлияния [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Описаны единичные случаи кератоконъюнктивита [16,17], эписклерита [18,19]. ...
Preliminary data show that the incidence of eye damage in COVID-19 reaches 32%, with a diverse range of clinical manifestations. Both the anterior segment of the eye (conjunctivitis, keratoconjunctivitis) and the posterior segment (retinal vascular thrombosis, neuritis, neuroretinitis) can be affected. The infection in children is diagnosed much less frequently than in adults, so ophthalmic manifestations have hardly ever been studied. Purpose : to present cases of congenital eye lesions in children born to mothers who had COVID-19 during pregnancy. Material . We present 4 clinical cases of ocular manifestations in newborns born to such mothers. Results . 4 variants of congenital ocular manifestations are reported. Clinical manifestations are listed, and treatment tactics for such patients is proposed. Conclusion . In order to timely diagnose, and choose the optimal treatment tactics of such conditions, thorough collection of case history and the ophthalmologists’ awareness of ocular symptoms of COVID-19 manifestations is essential.
... 1 Numerous studies conducted across the globe revealed that this highly contagious virus also causes eye symptoms in its early stages of infection with conjunctivitis being the most prevalent one in humans. 2 Some of the common ocular manifestations of the coronavirus include dry eyes, redness, itching, pain, photophobia, and congested conjunctiva. 3 At times, these ocular manifestations are so subtle that the healthcare professionals might miss them. ...
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We present frequency of ocular symptoms in COVID-19 patients in Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of 333 admitted patients with laboratory-confirmed SARS-CoV-2 infection were included. Patients were enquired and examined for any ocular symptoms that developed along with COVID-19. The results were stratified by sex, age, comorbidities, High Resolution CT (HRCT) and condition of conjunctiva. Data was analyzed using SPSS Chi square test was performed to measure the p value of the reported eye symptoms. Out of the 333, 81 subjects fulfilled the inclusion criteria. Forty-six patients (56%) were females and 52 patients out of 81 (64.2%) reported redness of conjunctiva. A positive relationship between the COVID-19 and the frequency of eye symptoms was observed with p value of 0.001. A weak positive correlation between HRCT and conjunctiva was found through bivariate analysis (0.132).
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The trigeminal nerve is the fifth cranial nerve, which transmits facial sensations, and is divided into the ophthalmic, maxillary, and mandibular branches. Damage to this nerve can cause trigeminal neuralgia, a clinical condition that can also present in patients with coronavirus disease 2019 (COVID-19). This meta-analysis reviews the clinical cases of trigeminal neuralgia reported in patients with COVID-19 from 2019 to 2022, describes the anatomical mechanism of pain and its radiation and identifies other associated symptoms. We performed a literature search to identify reports of patients with COVID-19 who developed trigeminal neuralgia and examined these cases for prevalence and any identified source of associated ocular pain. Of the relevant studies identified, 638 patients with COVID-19 developed trigeminal neuralgia out of 7561 total COVID-19 cases (8.4 %). Of the 638 cases, 590 (7.8 %) had known causes of ocular pain, while the cause of ocular pain was unknown in 48 cases (0.6 %). Trigeminal neuralgia developed infrequently in patients with COVID-19, and cases with known causes of ocular pain were more common than cases with unknown causes. Understanding the link between COVID-19 and trigeminal neuralgia may lead to preventing further complications and mortality in these patients, as well as improving care for patients with these conditions in the future. Additionally, understanding these new clinical issues can prepare many types of physicians to protect themselves better in the event of a COVID-19 outbreak among medical staff in different departments of hospitals, such as clinics, wards, emergency rooms, and operating theatres.
Background And Objective: The objective of this study was to evaluate ocular manifestations in Post COVID-19 patients. Materials And Methods: This study was conducted at the Department of Ophthalmology, Chalmeda Ananda Rao Institute of Medical Sciences from October 2020 to April 2021. 200 patients with the history of COVID-19 infection were included in the study. Detailed history was taken, slit lamp examination and fundoscopy was done for all patients, relevant investigations like Optical coherence Tomography, Fundus Fluorescein Angiography were done. Results: 23 out of 200 (122 male and 78 female) patients had ocular manifestations, 15 patients had viral conjunctivitis, 3 patients had episcleritis, 2 patients had central serous chorioretinopathy (CSCR), 1 patient had Central retinal artery occlusion (CRAO), 2 patients were Rhino-Orbito-Cerebral Mucormycosis (ROCM) suspects. Conclusion: Study emphasises on ocular manifestations associated with COVID 19 infection and its sequelae. As these patients presented with an association with COVID 19 infection (either during or recovery) ophthalmologists should be watchful and screen for such entities
Purpose: The aim of our study was to evaluate the subclinical changes in the macula, retinal nerve fiber layer (RNFL) and choroidal thickness after COVID-19 infection using spectral domain optical coherence tomography (OCT). Methods: Our study was prospectively designed and involved 170 eyes of 85 patients. Patients with PCR positive COVID-19 infection were examined in the ophthalmology clinic before and after infection were included. All included patients had mild COVID-19 with no hospitalization and no need for intubation. Control ophthalmic examination was repeated at least six months after PCR positivity. Macular and choroidal thickness and RNFL parameters were compared before and at least 6 months after PCR positive COVID-19 infection using OCT. Results: When the mean macular thickness data were evaluated, a significant decrease was detected in the inner (mean difference -3.37 µm; CI95% -6.09 to -0.65, P=0.021) and outer (mean difference -6.56 µm; CI95% -9.26 to -3.86, P<0.001) temporal segments and the inner (mean difference -3.39 µm; CI95% -5.46 to -1.32, P=0.002) and outer (mean difference -2.01 µm; CI95% -3.70 to -0.31, P=0.018) superior segments in the post-COVID-19 measurements compared to pre-COVID-19 measurements. Similarly, on RNFL evaluation, some thinning was evident in the temporal superior (mean=1.14 µm, P=0.004) and temporal inferior (mean=1.30 µm, P=0.032) regions. All choroidal regions, including central, nasal 500 µm and 1500 µm and temporal 500 µm and 1500 µm, exhibited significant thinning (P<0.001). Conclusion: At least six months after mild COVID-19 infection, significant thinning was seen in the temporal and superior quadrants of the macula, the temporal superior and temporal inferior regions of the RNFL and all measured areas of choroidal regions.
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Introduction: Coronavirus Disease-2019 (COVID-19) can affect multiple system of body including eye. In eye, it can cause mild conjunctivitis, posterior segment involvement, neuro-sensory involvement and lethal opportunistic infection like mucormycosis. Associated co-morbidities, severity of COVID-19 infection and corticosteroids used in its management can affect ophthalmic involvement. Aim: To determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. Materials and Methods: This prospective observational study was conducted on indoor patients of Shree Krishna Hospital, a rural, tertiary care hospital affiliated with Pramukh Swami Medical College, Karansad, Gujarat, India, from 1st May 2021 to 1st January 2022. Second wave of COVID-19 was from 13th March 2021 to 19th June 2021. Patients’ demographic data, details of COVID-19 infection severity score, oxygen requirement, use of corticosteroids, history of various co-morbidities and stages of Rhino-Orbital-Cerebral Mucormycosis (ROCM) (if present) were noted. Bedside ophthalmic examination was done with torch light, fluorescent strip, cobalt blue light of direct ophthalmoscope and fundus examination with indirect ophthalmoscopy under institutional COVID-19 guidelines. Descriptive Statistics {Mean, (SD), Frequency, (%)} were used for analysis of the collected data. Results: Out of 649 COVID-19 patients, 368 were male and 281 were female with mean age of 52.58 (±15.38) years. All over prevalence of ophthalmic manifestations was 9.86% (n=64 out of 649 patients). A total of 63 patients (9.71%) did not require any oxygen supplement, 352 patients (54.24%) required nasal prongs, 201 patients (30.97%) required non invasive ventilator support and 33 patients (5.08%) required mechanical ventilation. The 378 patients (58.24%) received cortico-steroids in oral or intravenous form. A total of 325 patients (50.1%) had diabetes,267 patients (41.1%) had hypertension, 29 patients (4.5%) had chronic kidney disease and 15 patients (2.3%) had thyroid disease. A total of 52 patients (8.01%) had conjunctivitis. Mean age of patients with conjunctivitis was 50.04 (±15.28) with male preponderance (n=30, 57.7%). Most common systemic presentation was fever (n=29,55.8%). Patients with conjunctivitis had high D-dimer (>500 ng/mL) (n=42;80.8%) and C-Reactive Protein (CRP) values (>3 mg/L) (n=39;75%). A total of 144 patients (22.2%) were vaccinated with COVID-19 vaccine first dose while ten patients (19.23%) out of 52 patients having conjunctivitis were vaccinated. Out of 649 patients, prevalence of ROCM was 1.85% (n=12) with mean age 58.58 years (±9.71 years) and male preponderance (n=8, 66.66%). Nine out of twelve patients had high blood sugar levels (mean level 340 mg/dL) at the time of admission. Out of twelve, eight patients had received corticosteroids for management of COVID-19 infection. Six patients of ROCM (50%) did not require any oxygen support while two patient (16.7%) required nasal prongs for mean 7.50 days and four patient (33.3%) required non invasive ventilator support for mean 7.33 days (±2.5 days). One patient had stage 2C disease, one had stage 3B, five patients had stage 3C while five patients had stage 4C disease. Conclusion: Ocular manifestations of COVID-19 range from conjunctivitis to ROCM. Conjunctivitis has mild and self-limited course while ROCM is sight threatening and life-threatening condition, if not treated appropriately.
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Purpose To investigate the ocular manifestations and clinical characteristics of COVID‐19 patients caused by SARS‐CoV‐2 in Wuhan, China. Methods A total of 535 COVID‐19 patients were recruited at Mobile Cabin Hospital and Tongji Hospital. Information on demographic characteristics, exposure history, ocular symptoms, eye drop medication, eye protections, chronic eye diseases, systemic concomitant symptoms, radiologic findings and SARS‐CoV‐2 detection in nasopharyngeal swabs by real‐time PCR was collected from questionnaires and electronic medical records. Results Of 535 patients, 27 patients (5.0%) presented with conjunctival congestion and 4 patients had conjunctival congestion as the initial symptom. The average duration of conjunctival congestion was 5.9 ± 4.5 days (mean [SD]). The other ocular symptoms, including increased conjunctival secretion, ocular pain, photophobia, dry eye and tearing, were also found in patients with conjunctival congestion. Notably, hand–eye contact was independently correlated with conjunctival congestion in COVID‐19 patients. We also found that some COVID‐19 patients had chronic eye diseases, including conjunctivitis (33, 6.2%), xerophthalmia (24, 4.5%) and keratitis (14, 2.6%). Similar to the published studies, the most common clinical symptoms were fever, cough and fatigue. A total of 343 patients (64.1%) had positive SARS‐CoV‐2 detection in nasopharyngeal swabs. Conclusions Conjunctival congestion is one of the COVID‐19‐related ocular symptoms, which could occur as the initial symptoms. Frequent hand–eye contact may be the risk factor for conjunctival congestion in COVID‐19 patients. Screening of patients with conjunctival congestion by ophthalmologists is advocated during the outbreak of COVID‐19. It is essential to provide eye‐care equipment and strengthen education on eye protection.
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Severe acute respiratory syndrome coronavirus (SARS‐CoV)‐2, a novel coronavirus from the same family as SARS‐CoV and Middle East respiratory syndrome coronavirus, has spread worldwide leading the World Health Organization to declare a pandemic. The disease caused by SARS‐CoV‐2, coronavirus disease 2019 (COVID‐19), presents flu‐like symptoms which can become serious in high‐risk individuals. Here we provide an overview of the known clinical features of and treatment options for COVID‐19. We carried out a systematic literature search using the main online databases (PubMed, Google Scholar, MEDLINE, UpToDate, Embase and Web of Science) with the following keywords: ‘COVID‐19’, ‘2019‐nCoV’, ‘coronavirus’ and ‘SARS‐CoV‐2’. We included publications from 1 January 2019 to 3 April 2020 which focused on clinical features and treatments. We found that infection is transmitted from human to human and through contact with contaminated environmental surfaces. Hand hygiene is fundamental to prevent contamination. Wearing personal protective equipment is recommended in specific environments. The main symptoms of COVID‐19 are fever, cough, fatigue, slight dyspnoea, sore throat, headache, conjunctivitis and gastrointestinal issues. Real‐time PCR is used as a diagnostic tool using nasal swab, tracheal aspirate or bronchoalveolar lavage samples. Computed tomography findings are important for both diagnosis and follow‐up. To date, there is no evidence of any effective treatment for COVID‐19. The main therapies being used to treat the disease are antiviral drugs, chloroquine/hydroxychloroquine and respiratory therapy. In conclusion, although many therapies have been proposed, quarantine is the only intervention that appears to be effective in decreasing the contagion rate. Specifically designed randomized clinical trials are needed to determine the most appropriate evidence‐based treatment modality. Abstract
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There are sparse data in literature regarding conjunctivitis incidence in COVID‐19 and its relationship with disease severity. The objective of this metanalysis was to assess the association between conjunctivitis and the severity of COVID‐19 disease. Methods We performed a meta‐analysis with studies that included patients with severe vs non‐severe form of COVID‐19 infection. Severe COVID‐19 infection was defined as severe pneumonia, mortality, acute respiratory distress syndrome (ARDS), use of mechanical ventilation or Intensive Care Unit (ICU) treatment. Results Three studies, including 1167 patients, reported the incidence of conjunctivitis at admission to the hospital. The overall rate of conjunctivitis was 1.1%; it was 3% and 0.7% in severe and non‐severe COVID‐19 patients, respectively. Patients with severe COVID‐19 had an increased incidence of conjunctivitis (O.R.:3.4; 95% C.I.:1.1‐10.2; p=0.030). Conclusions Conjunctivitis is more frequent in severe COVID and may be a warning sign of poor outcomes. This article is protected by copyright. All rights reserved.
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Purpose To report the ocular characteristics and the presence of viral RNA of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival swab specimens in a patient with confirmed 2019 novel coronavirus disease (COVID-19). Participant and methods A 30-year-old man with confirmed COVID-19 and bilateral acute conjunctivitis which occurred 13 days after illness onset. Based on detailed ophthalmic examination, reverse transcription PCR (RT-PCR) was performed to detect SARS-CoV-2 virus in conjunctival swabs. The ocular characteristics, presence of viral RNA and viral dynamics of SARS-CoV-2 in the conjunctival specimens were evaluated. Results Slit lamp examination showed bilateral acute follicular conjunctivitis. RT-PCR assay demonstrated the presence of viral RNA in conjunctival specimen 13 days after onset (cycle threshold value: 31). The conjunctival swab specimens remained positive for SARS-CoV-2 on 14 and 17 days after onset. On day 19, RT-PCR result was negative for SARS-CoV-2. Conclusion SARS-CoV-2 is capable of causing ocular complications such as viral conjunctivitis in the middle phase of illness. Precautionary measures are recommended when examining infected patients throughout the clinical course of the infection. However, conjunctival sampling might not be useful for early diagnosis because the virus may not appear initially in the conjunctiva.
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Importance While the outbreak of coronavirus disease 2019 (COVID-19) has resulted in more than 100 000 infected individuals in China and worldwide, there are few reports on the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with ocular abnormalities. Understanding ocular manifestations of patients with COVID-19 by ophthalmologists and others may facilitate the diagnosis and prevention of transmission of the disease. Objective To investigate ocular manifestations and viral prevalence in the conjunctiva of patients with COVID-19. Design, Setting, and Participants In this case series, patients with COVID-19 treated from February 9 to 15, 2020, at a hospital center in Hubei province, China, were retrospectively reviewed for ocular manifestations. During the period of treatment, the ocular signs and symptoms as well as results of blood tests and reverse transcriptase–polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for SARS-CoV-2 were noted and analyzed. Main Outcomes and Measures Ocular signs and symptoms as well as results of blood tests and RT-PCR for SARS-CoV-2. Results Of the 38 included patients with clinically confirmed COVID-19, 25 (65.8%) were male, and the mean (SD) age was 65.8 (16.6) years. Among them, 28 patients (73.7%) had positive findings for COVID-19 on RT-PCR from nasopharyngeal swabs, and of these, 2 patients (5.2%) yielded positive findings for SARS-CoV-2 in their conjunctival as well as nasopharyngeal specimens. A total of 12 of 38 patients (31.6%; 95% CI, 17.5-48.7) had ocular manifestations consistent with conjunctivitis, including conjunctival hyperemia, chemosis, epiphora, or increased secretions. By univariate analysis, patients with ocular symptoms were more likely to have higher white blood cell and neutrophil counts and higher levels of procalcitonin, C-reactive protein, and lactate dehydrogenase than patients without ocular symptoms. In addition, 11 of 12 patients with ocular abnormalities (91.7%; 95% CI, 61.5-99.8) had positive results for SARS-CoV-2 on RT-PCR from nasopharyngeal swabs. Of these, 2 (16.7%) had positive results for SARS-CoV-2 on RT-PCR from both conjunctival and nasopharyngeal swabs. Conclusions and Relevance In this study, one-third of patients with COVID-19 had ocular abnormalities, which frequently occurred in patients with more severe COVID-19. Although there is a low prevalence of SARS-CoV-2 in tears, it is possible to transmit via the eyes.
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Objective: The novel coronavirus disease (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. Previous study has reported several COVID-19 cases with conjunctivitis. However, the complete profiling of COVID-19 related ocular symptoms and diseases are still missing. We aim to investigate the ocular manifestations and clinical characteristics of COVID-19 patients. Methods: A total of five hundred and thirty-four patients were recruited at Mobile Cabin Hospital and Tongji Hospital. We collected information on demographic characteristics, exposure history, ocular symptoms, systemic concomitant symptoms, eye drop medication, eye protections, radiologic findings, and SARS-CoV-2 detection in nasopharyngeal swabs by RT-PCR from questionnaires and electronic medical records. Results: The median age of patients was 40 and 50 years at Mobile Cabin Hospital and Tongji Hospital, respectively. Of 534 COVID-19 patients, 25 patients (4.68%) presented with conjunctival congestion and 3 patients had conjunctival congestion as the initial symptom. The average duration of conjunctival congestion was 4.9 ± 2.6 days (mean [SD]), ranging from 2 to 10 days. Dry eye (112, 20.97%), blurred vision (68, 12.73%), and foreign body sensation (63, 11.80%) ranked as the top three COVID-19 related ocular symptoms. Notably, a total of 332 COVID-19 patients (62%) had a hand-eye contact history. We also found that some COVID-19 patients had a history of eye disease, including conjunctivitis (33, 6.18%), dry eye (24, 4.49%), keratitis (14, 2.62%), cataract (9, 1.69%), and diabetic retinopathy (5, 0.94%). In consistent with previous studies, the most common clinical symptoms were fever, cough, and fatigue. Patients, 60.5% in Mobile Cabin Hospital and 67.5% in Tongji Hospital, respectively were confirmed with positive SARS-CoV-2 detection. Conclusions: Conjunctival congestion was one of the COVID-19 related ocular symptoms, which may have clinical diagnostic significance. It is essential to provide eye-care equipment and strengthen education on eye protection, as dirty hand-eye contact might be a high risk factor of COVID-19. Further detailed and comprehensive ophthalmological guidance is needed for COVID-19 control.
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There is a new public health crises threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019. There have been around 96,000 reported cases of coronavirus disease 2019 (COVID-2019) and 3300 reported deaths to date (05/03/2020). The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 d. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Diagnosis is by demonstration of the virus in respiratory secretions by special molecular tests. Common laboratory findings include normal/ low white cell counts with elevated C-reactive protein (CRP). The computerized tomographic chest scan is usually abnormal even in those with no symptoms or mild disease. Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The virus spreads faster than its two ancestors the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality. The global impact of this new epidemic is yet uncertain.
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Background: Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods: We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results: The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).
Purpose The SARS‐CoV‐2 RNA has been detected in tears and conjunctival samples from infected individuals. Conjunctivitis is also reported in a small number of cases. We evaluated ocular symptoms and ocular tropism of SARS‐CoV‐2 in a group of patients with COVID‐19. Method Fifty‐six patients infected with SARS‐CoV‐2 were recruited as subjects. Relevant medical histories were obtained from the electronic medical record system. Ocular history and ocular symptoms data were obtained by communicating directly with the subjects. The Ocular Surface Disease Index (OSDI) and Salisbury Eye Evaluation Questionnaire (SEEQ) were used to assess the anterior ocular surface condition before and after the onset of disease. Results Patients classified as severe COVID‐19 cases were more likely to have hypertension compared to mild cases (p = 0.035). Of the 56 subjects, thirteen patients (23%) were infected in Wuhan, 32 patients (57%) were community‐infected, 10 patients (18%) were unknown origin, 1 (2%) was a physician likely infected by a confirmed patient. Three patients wore face mask with precaution when contacting the confirmed patients. Fifteen (27%) had aggravated ocular symptoms, of which 6 (11%) had prodromal ocular symptoms before disease onset. The differences in mean scores of OSDI questionnaire and SEEQ between before and after onset of COVID‐19 were all significant (p < 0.05 for both). Conclusions Ocular symptoms are relatively common in COVID‐19 disease and may appear just before the onset of respiratory symptoms. Our data provided the anecdotal evidences of transmission of SARS‐CoV‐2 via ocular surface.
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.