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Indian Journal of Clinical and Experimental Ophthalmology 2022;8(1):9–12
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Indian Journal of Clinical and Experimental Ophthalmology
Journal homepage: www.ijceo.org
Original Research Article
Clinical profile of patients attending ophthalmic clinic during peaks of covid
pandemic: A descriptive study during peaks of covid pandemic at tertiary institute
in south India
Muralidhar Parri1,*
1Dept. of Ophthalmology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
ARTICLE INFO
Article history:
Received 16-07-2021
Accepted 04-11-2021
Available online 31-03-2022
Keywords:
Foreign body sensation
Redness
Conjunctivitis
Covid
ABSTRACT
Background: In Covid pandemic of India, the first peak occured during September to December 2020.
During this period, the patients avoided coming to OPD unless an emergency. It is not known, if there was
any change in clinical spectrum of patients presenting to outpatient clinic, so this study gives an overview
of the patients presenting to OPD in the pandemic.
Objectives: This study aims to enumerate various ocular symptoms of patients presenting to
Ophthalmology outpatient clinic during covid pandemic period, evaluate their demographic profile and
to identify any ocular manifestations of corona virus amongst these patients.
Materials and Methods: This is a prospective study done between September 2020 and December 2020
after obtaining approval from Institutional Ethics Committee board. Inclusive criteria-All adult patients of
both genders, attending Ophthalmology OPD during study period. Exclusive criteria-Paediatric age group
patients, patients having long standing ocular ailments before pandemic. Ocular examination was done by
Torch light and Slit lamp bio microscopy. P value was calculated by chi- square test.
Results: There were a total of 374 patients during the study period, male-268(71.65%), female
106(28.34%). The common age group (146 patients out of total 374 patients) was between 20 to 40
years. The chief presenting complaints were- itching (186, males 27.61%, females 61.32% P value-
0.004), redness-112 (males-74, females 38, P value-0.117) Foreign body sensation-84 (males-51, females
33, P value-0.011). Defective vision due to cataract -34 (male-18, females-16, P value-0.01109). The
diagnosis related to ocular ailments were refractive errors-112(29.94%), ocular adnexa diseases-24(6.41%),
conjunctiva diseases-147(39.30%), cornea diseases-12, (3.20%), lenticular disease-34, (9.09%), glaucoma
diseases-16(4.27%). Medical treatment was given to most patients (312 patients, 83.42%).
Conclusion: In our study, majority of patients presented with itching, foreign body sensation and diagnosed
mostly as conjunctivitis, predominantly viral. Most of the patients are males and in working age group.
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1. Introduction
Covid pandemic effected millions of people, causing
significant mortality and deterred the economy of nations.
In India, the present pandemic had reached its peak during
* Corresponding author.
E-mail address:drmurali.ophtho@aiimsmangalagiri.edu.in (M.
Parri).
September to December 2020, when the nation is stricken
by first wave. Since the lifting of lockdown in June 2020 in
India, there is an unprecedented surge in Covid cases. The
tragedy of undergoing Covid pandemic is, quiet a number
of patients are asymptomatic and they spread the disease
unknowingly. The early whistle blower doctor for Covid
pandemic is Dr Li Wen Liang from Wuhan city, Hubei
province China, who is an ophthalmologist and who himself
https://doi.org/10.18231/j.ijceo.2022.003
2395-1443/© 2022 Innovative Publication, All rights reserved. 9
10 Parri / Indian Journal of Clinical and Experimental Ophthalmology 2022;8(1):9–12
had contacted the virus while treating an asymptomatic
glaucoma patient.1,2 He latter succumbed to virus. During
this peak of Covid pandemic, it is not known, if there
is any change in clinical spectrum of patients presenting
to ophthalmology out patient department; so, this paper
presents the same.
2. Aims and Objectives
The study aims to enumerate various ocular complaints of
patients presenting to Ophthalmology OPD during covid
pandemic period and evaluate their demographic profile and
to identify any early ocular manifestations of corona virus
amongst these patients.
3. Materials and Methods
This is a prospective study done over a period of 4 months,
i.e., from September 2020 to December 2020 after obtaining
approval from institutional ethics committee board of
our Institute (AIIMS/MG/IEC/20-21/62). Clearance from
Institutional Ethics Committee Board was taken after duly
submitting the detailed project by following declaration
of Helsinki protocols. Random sampling method was
followed. Sample size was calculated based on Open-Epi
software and it is 374. All adult patients presenting to
ophthalmology OPD were included in the study and patients
who had long standing eye ailments before Covid pandemic
and those referred patients from other departments for
screening diabetic retinopathy, ocular trauma, ocular foreign
body and paediatric age group patients were excluded
from the study. Ocular examination was done by Slit lamp
biomicroscopy. P value less than 0.05 was considered
statistically significant. P value was calculated by chi square
test based on Open Epi software 2x2 table.
4. Results
There were a total of 374 patients during the study period,
Male-268 (71.65%), Female 106 (28.34%) (Table 1). The
common age group was between 20 to 40 years, followed
by 40 to 60 years, (Table 2). The chief presenting complaints
were- itching followed by foreign body sensation (Table 3).
The diagnosis related to ocular ailments were detailed in
Table 4. Treatment given was medical, spectacles and laser
procedures (Table 5). Most of the patients had undergone
medical treatment only. Out of 147(39.30%) conjunctival
disease patients, conjunctivitis was identified in 114 patients
and were further advised to undergo RT-PCR test. Forty-
three patients had undergone RT-PCR test, and remaining
patients refused. Eleven patients (25.5% of patients tested)
turned to be Covid positive, others turned to be negative.
Table 1: Gender distribution
Total number of
patients
Males Females
374 268(71.65%) 106(28.34%)
Table 2: Age group distribution
Serial
number
Age group Number of
patients
1 20-40 years 146(39.03%)
2 40-60 years 112(29.94%)
3 60 years and above 16(4.27%)
5. Discussion
Other than effecting various organ systems, Corona virus
effects even eyes also.3The Angiotensin converting
Enzyme-2 protein is also expressed in epithelium/outer
layer of tissues in intestine/eyes/kidneys, although in
smaller concentrations in conjunctiva and cornea of eye.so,
when spike proteins in SARS-COV 2 Virus bind to ACE
receptors in eyes, it causes inflammation of conjunctiva and
other eye disorders.
During the peak period of pandemic in 2020, in India
during which the study was conducted (September to
December), most of the people who attended the OP clinic,
with ocular ailments were young adult males (20 to 40)
years. The reason maybe they are the main workforce in the
society and they have to come out of the house for their daily
requirements. This report of our study was closely similar
to Sen et al study,4where the mean age is 45 +15.3 years,
median is 46.9 years. As explained above may be these
age group people are main workforce of society. Mostly
during pandemic era, these age group people either present
to the hospital as patients or act as asymptomatic carriers,
by spreading the infection to aged people in the house.
In our study during heights of pandemic last year 2020,
when the country is facing the first wave, there is alarming
raise of presenting complaints. 1) Itching of both eyes (186
patients, 49.73%, P value 0.004). 2) Foreign body sensations
(84 patients, i.e, 22.45%, P value 0.0114) were noticed.
It accounted to almost half of presenting complaint of the
patients, during that tenure. The diagnosis was allergic
conjunctivitis.
It was clear that all patients who attended ophthalmology
outpatient clinic are not covid patients and all of them were
routinely screened for fever, cold, cough, body aches and
other covid symptoms before entering outpatient clinic. We
have our own constraints to do RT-PCR test for all patients
with conjunctivitis. Only 43 out of 114 patients advised, had
undergone RT-PCR test, of whom eleven (25.5%) turned out
to be positive. In the studies done by Sen et al,4Ahuja et al, 5
Cheema et al6significant priority is given to conjunctivitis
as presenting sign of Covid. In several studies unilateral
conjunctivitis occurred as first presenting sign of Corona
Parri / Indian Journal of Clinical and Experimental Ophthalmology 2022;8(1):9–12 11
Table 3: Chief presenting complaints
S.No. Chief presenting
complaint
Total number of
patients
Males Females Pvalue
1 Itching 186(49.73%) 121(45.14%) 65(61.32%) 0.004
2 Redness 112(29.94%) 74(27.61%) 38(35.84%) 0.117
3 Foreign body sensation 84(22.45%) 51(19.02%) 33(31.13%) 0.0114
4 Watering 64(17.11%) 41(15.29%) 23(21.69%) 0.1387
5 Defective vision due to
cataract
34(9.09%) 18(6.71%) 16(15.09%) 0.01109)
6 Defective vision due to
Refractive error
97(25.93%) 68(25.37%) 29(27.35%) 0.693
7 Diabetic Retinopathy 14(3.74%) 11(4.104%) 3(2.83%) 0.529
Table 4: Ocular ailments
S.No. Ocular ailments Total number of patients
1 Refractive errors 112(29.94%)
2 Ocular adnexa diseases 24(6.41%)
3 Conjunctiva diseases 147(39.30%)
4 Cornea diseases 12(3.20%)
5 Lenticular diseases 34(9.09%)
6 Glaucoma diseases 16(4.27%)
7 Uvea diseases 6(1.60%)
8 Vitreous diseases 1(0.26%)
9 Retina/Macular diseases 18(4.81%)
10 Neuro ophthalmology diseases 4(1.069%)
Table 5: Management patterns
S.No. Treatment Number of patients
1 Medical Treatment 312(83,42%)
2 Spectacles 88(23,52%)
3 Laser procedures 4(1.06%)
virus disease.7–9 Henceforth with this Research data in
mind, when we noticed nearly 50% of patients presented
with Conjunctivitis, redness of eyes, foreign body sensation,
with significant P values, we advised the patients to undergo
RT-PCR test.
Out of 374 patients, 34 patients (9.09%) have decrease
in vision due to cataract (P value 0.01109). This can be
attributed to the lockdown and stricter Covid regulations,
which deterred the patients to attend their regular eye check-
ups, thereby causing progression of lenticular diseases
and also Diabetic Retinopathy, which significantly caused
Ocular morbidity. Very small number of ailments pertaining
to Glaucoma diseases (4.27%), Uvea diseases (1.60%),
vitreous diseases (0.26%) are noted during this period. This
may be due to fear of Covid pandemic, the patients didn’t
turn up to hospital, unless urgency to decrease in vision is
present.
During the period, medical treatment was given to 312
patients. Spectacles were given to 88 patients. As Tele-
Ophthalmology was also in place, vaccination to corona
virus was not done during that time, we avoided all
elective surgeries. Laser procedure for Diabetic Retinopathy
was done for 4 patients. During pandemic period, it is
not advisableoth for patient and doctor to perform active
surgeries unless needed. Serval study recommended only
emergency ocular surgeries and postponement of elective
surgeries.10 Tele-ophthalmic consultation was adopted in
most of the institutions.11
6. Conclusion
In our study, majority of patients presented with
Itching, Foreign body sensation and diagnosed mostly
as Conjunctivitis, predominantly Allergic and viral. Most
of the patients are males and in working age group. As
asymptomatic patients occupy major role in spreading
pandemic, we advised all the patients presenting to us with
Conjunctivitis to undergo RT-PCR test, as it could be early
sign of COVID, and 25.5% of conjunctivitis patients who
were tested turned out to be positive.
7. Source of Funding
None.
12 Parri / Indian Journal of Clinical and Experimental Ophthalmology 2022;8(1):9–12
8. Conflict of Interest
There are no conflicts of interest.
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Author biography
Muralidhar Parri, Assistant Professor
Cite this article: Parri M. Clinical profile of patients attending
ophthalmic clinic during peaks of covid pandemic: A descriptive study
during peaks of covid pandemic at tertiary institute in south India.
Indian J Clin Exp Ophthalmol 2022;8(1):9-12.
