[6], Old age, living in a congested area, chronic lung diseases, comorbidities including immuno-compromised states, diabetes, obesity, chronic renal, and liver diseases are the risk factors for severe systemic disease. Ocular screening in severe acute respiratory syndrome. Conjunctivitis is inflammation of the thin membrane, called your conjunctiva, which covers the front of your eye and the back of your eyelids. Wu et al. These excluded patients showed no difference in clinical characteristics compared with the included sample. A novel coronavirus (CoV) named severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2) emerged from China in December 2019. Previous reports suggest that SARS-CoV-2 can cause conjunctivitis, either as an early sign of infection or during hospitalization for severe COVID-19 [8, 14]. The onset of conjunctivitis signs and symptoms with respect to the onset of respiratory symptoms was variable (median of 3 days). There was initial data regarding the use of hydroxychloroquine, which later proved ineffective for COVID. Br J Ophthalmol:1–4. On the other hand, adenoviral conjunctivitis tends to worsen during the first days and could last more than 14 days. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Since this a cross-sectional study and as such, patients that had conjunctivitis prior to admission were not evaluated by the investigators, but they were evaluated by primary care physicians. Early after acquiring infection, antibodies to SARS-CoV-2 are detected in serum. https://doi.org/10.23812/Editorial-Conti-3, Yi Y, Lagniton PNP, Ye S, Li E, Xu R-H (2020) COVID-19: what has been learned and to be learned about the novel coronavirus disease. Among the 301 patients, 41.8% were classified as mild, 36.5% cases classified as moderate, and 21.5% classified as severe disease. Chest X-ray results were analyzed separately, since it is not uncommon to find a discrepancy between the radiological and clinical findings, especially in the early stages of the disease. Patients with respiratory symptoms, patients with a history of travel, or contact with a traveler should not be given an appointment unless it is an emergency. The purpose of this study was to evaluate the frequency and clinical presentation of conjunctivitis in hospitalized patients with COVID-19. While the coronavirus is mostly known as a respiratory disease, it can affect other parts of the body, including the eyes. This page has been accessed 12,931 times. The main outcome measure is the overall prevalence of conjunctivitis among inpatients diagnosed with COVID-19. Since this is a tertiary hospital in downtown Madrid that covers a health area with an aging population, a high number of patients had to be excluded due to cognitive impairment, confusional state, and critical conditions, in order to obtain more reliable data. This is the first study that describes the clinical characteristics of conjunctivitis in a large sample of patients with COVID-19. 2 Additionally, retinal disorders, such as retinal vasculitis, 3 4 retinal degeneration 5 6 and blood–retinal barrier breakdown, 7 had been demonstrated in experimental animal models of coronavirus infection. Wearing of masks all the time by the patients, attendants, and the health care personnel. Although fever is a common symptom there are reports of afebrile COVID patients as well. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. The biochemical profiles in men and women also showed differences between them. Topical antibiotics can be given to prevent secondary bacterial infection. It is an enveloped single-stranded RNA virus, which is closely related to the severe acute respiratory syndrome coronavirus. Furthermore, data about ocular manifestations were obtained by ophthalmologists via telephone, so results are determined by patient subjectivity and ophthalmologist’s interpretation. https://doi.org/10.1111/bjh.16725, Hu K, Patel J, Patel BC (2020) Ophthalmic manifestations of coronavirus (COVID-19). Twenty-seven (10.3%) patients with pneumonia and 6 (15.3%) patients without pneumonia presented conjunctivitis. Systemic complications include; acute respiratory distress syndrome, pneumonia, stroke, acute cardiac injury, cardiomyopathy, renal failure, and encephalopathy. Reverse-transcription polymerase chain reaction (RT-PCR) is a specific but less sensitive test in the diagnosis of COVID conjunctivitis. Hui KPY, et al. Since the start of the COVID-19 pandemic in late 2019, there have been more than 6.5 million confirmed cases of the disease worldwide. Moreover, the above-mentioned article is a retrospective study where the patients were not evaluated by an ophthalmologist, and the patient’s data were obtained from patients’ electronic medical records and an electronic questionnaire completed by patients on a smartphone. Google searches for COVID-19 symptoms spiked mid-March as many Americans came to terms with the emerging pandemic, but so did searches for another malady with the potential for overlying symptoms: allergies. Although COVID-19-related conjunctivitis seems to be uncommon, the AAO reminds physicians that other forms of conjunctivitis are common. Yuen KSC, Chan W-M, Fan DSP, et al. COVID conjunctivitis resolves by itself without any morbidity if systemic complications do not occur. These patients tested positive on RT-PCR of naso-pharyngeal swabs and developed no fever, malaise, or respiratory symptoms throughout the course of their illness. However, if we consider SARS-CoV model, the disease occurs in three stages; viral replication followed by immune hyperactivity and then tissue destruction. Minimum examination protocol that can help in diagnosis and management and avoiding additional clinical tests and investigations unless necessary. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. They all fully recovered. Of the 35 cases that presented conjunctivitis, 13 cases suffered it before admission to the hospital, 12 cases in the time interval between admission and our evaluation, and 10 cases presented conjunctivitis at the time of evaluation. N Engl J Med 2020; 382:1708-1720. One of the studies conducted in Wuhan, China, found that nearly a quarter of pediatric patients had this condition. Nalla  AK, Casto  AM, Huang  MW,  et al. The risk factor for COVID conjunctivitis is direct contact with a person having COVID. For this reason and due to the limited resources and restrictive measures of access to patients with COVID-19, RT-PCR from tears and conjunctival specimen was not tested. Patients were asked about symptoms of conjunctivitis (current and previous) and they underwent a basic ophthalmological examination at their bedside by two experienced ophthalmologists on a 72-h period. Also, we did not find any associated complications such as corneal infiltrates and membranes or pseudomembranes, which have not been reported in the literature so far. Infect. Can J Ophthalmol. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). Barbara Burgos-Blasco. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R. Jr. Retinal findings in patients with COVID-19. The patient’s age, sex, the onset of COVID-19 symptoms, chest X-ray, and laboratory tests results were noted. Different RNA gene targets are employed by different manufacturers. Positive clinical findings on physical examination of the patients with COVID-19 include; fever, cough, shortness of breath, myalgias, sore throat, headache, rhinorrhea, new-onset loss of taste or smell and chest pain. Specifically, 3 patients presented subconjunctival hemorrhage, 4 patients had a moderate pterygion, and 2 patients had an hordeolum, which were managed with conservative treatment. conjunctivitis and sex. Overall, 35 patients (11.6%) were diagnosed with acute conjunctivitis. Conjunctivitis, or "pink eye," is an infection or inflammation of the membrane lining the eyeball and eyelid. According to the patient’s self-report, the median duration of ocular symptoms was 3 days (p25-p75: 1–3.5) with a minimum of 1 day and a maximum of 1 week. For entry into the cell, the virus uses angiotensin-converting enzyme 2 receptor (ACE2). However, the current wild spread is due to human-to-human transmission through droplets and direct contact with the mucous membranes including eyes, nose, or mouth. Ocul Surf. This page was enrolled in the International Ophthalmologists contest. It was striking to find the absence of petechiae and subconjunctival hemorrhages in our sample, despite the fact that different articles reported the vascular and thrombotic complications associated with the virus [12, 13]. [published online ahead of print, 2020 Apr 2]. https://doi.org/10.1001/jamaophthalmol.2020.1291, Conti P, Younes A (2020) Coronavirus COV-19/SARS-CoV-2 affects women less than men: clinical response to viral infection. Acta Ophthalmol. https://doi.org/10.1002/jmv.25725, Zhang X, Chen X, Chen L et al (2020) The evidence of SARS-CoV-2 infection on ocular surface. [reference needed]. The overall prevalence results from adding patients who had conjunctivitis at the time of the evaluation and those who reported having conjunctivitis prior to the examination. Earlier diseases related to Coronavirus were severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). However, this article did not compare the differences between women and men, and included critical patients, who were not included in our sample. Belser JA, Rota PA, Tumpey TM. https://doi.org/10.1001/jamaophthalmol.2017.3319, Article  Nature. Dis.2003;9, Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Zhou P, Yang XL, Wang XG, et al. https://doi.org/10.1016/S0140-6736(20)30183-5, Article  COVID-19 has spread rapidly since it was first identified in Wuhan and has been shown to have ocular involvement, mainly conjunctivitis. Use of PPE with eye protection when it is necessary to examine a patient with respiratory symptoms. However, Wu P. et al. No cases of conjunctivitis or any other ocular sign or symptoms were reported with either MERS-CoV or SARS-CoV. Phylogenetic analysis showed that there are more than 100 strains of SARS-CoV-2 with two different types; type L and type S. The receptor-binding region of SARS-CoV-2 is also similar to SARS-CoV. SARS-CoV-2 is expressed at a low rate in tears, which may be a source of infection to GPs caring for patients at high risk of COVID… Graefes Arch Clin Exp Ophthalmol 258, 2501–2507 (2020). Gastrointestinal symptoms including diarrhea, nausea, and vomiting have also been reported. The Lancet. Studies suggest that there are many differences between men and women in the immune response to SARS-CoV-19, affecting more men than women [9, 10]. Google Scholar, Xia J, Tong J, Liu M, Shen Y, Guo D (2020) Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. Part of Springer Nature. Lack of retinal findings may be attributed to failure to perform the retinal examination in the COVID-19 patients. This supported the 14-day quarantine recommendations. However, many ocular symptoms are associated with the term ‘conjunctivitis’ which may be misleading. This makes our study the most comprehensive and extensive of its category. COVID conjunctivitis is an ocular manifestation of a new disease entity called Corona Virus Disease-19 (COVID-19). Emerg. Patients who have no evidence of COVID-19 and no specific risk factors for SARS-CoV-2 infection. IIORC, Universidad Complutense de Madrid, ISCIII (OFTARED), Madrid, Spain, Julián García-Feijoó, Federico Sáenz-Francés, Pedro Arriola-Villalobos, Jose María Martinez-de-la-Casa & Jose Manuel Benítez-del-Castillo, Obstetrics and Gynecology Department, Hospital Clinico San Carlos, Instituto de salud de la mujer. In the space of two months, three patients suffering from COVID-19 in one New York health system developed keratitis, an inflammation of the cornea, which then led to a sight-threatening infection. 2020;395(10237):1610. doi: 10.1016/S0140-6736(20)31014-X. Covid-19 affectes different people in different ways Among the common symptoms that a patient of Covid-19 exhibits are fever, dry cough and tiredness. Use of topical anesthesia may also alter the results.[18]. Preventive measures, which must be adopted by practicing ophthalmologists, to avoid the spread of infection include; Any patient coming to the clinic with a red-eye should be suspected of COVID conjunctivitis until proved otherwise. The signs of COVID-19 conjunctivitis are similar to the presentation of other viral forms. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. A Review of Coronaviruses and Ocular Implications in Humans and Animals. COVID conjunctivitis like any other viral conjunctivitis is self-limiting and can be managed with lubricants and cold compresses unless cornea is involved. 2502 Graefes Arch Clin Exp Ophthalmol (2020) 258:2501–2507 Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center. In addition to this, health care workers are at increased risk of acquiring the infection. Material and methods: This cross-sectional study was carried out between 1 May and 30 June 2020. A study analyzing a sample of 1099 patients hospitalized for COVID-19 disease in China found a prevalence of conjunctivitis symptoms of only 0.8% and other small series have reported a prevalence around 3% [4, 6, 7]. Cell death results in the release of the virus into tears. However, conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. The purpose of this study was to evaluate the prevalence of conjunctivitis in hospitalized patients with COVID-19 and to describe its clinical presentation. [13], COVID-19 conjunctivitis starts as unilateral redness of eye with follicular reaction (inferior palpebral) like any other viral conjunctivitis. https://doi.org/10.1016/j.jtos.2020.03.010, Wu P, Duan F, Luo C et al (2020) Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. Nonetheless, characterizing conjunctival inflammation in this scenario could be of paramount importance in case it proves to be prevalent as it may be a frequent cause for seeking medical attention in patients possibly infected with SARS-CoV-2 [5]. A total of 262 (87.0%) patients suffered from acute viral pneumonia, which was bilateral in 218 cases (82.8% of the pneumonias were bilateral). A recent study carried out in China reported that the prevalence of conjunctival congestion in COVID-19 patients was 5% [17]. We were unable to objectify any relationship between the presence of conjunctivitis and clinical, radiological, or laboratory severity in our sample of 301 cases. https://doi.org/10.1016/j.ophtha.2020.04.028, Chen L, Deng C, Chen X et al (2020) Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: a cross-sectional study. The differential diagnosis of SARS-CoV-2 conjunctivitis includes other viral conjunctivitis such as adenoviral conjunctivitis, based on our findings (Table 5). https://doi.org/10.1111/aos.14472, Department of Ophthalmology, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain, Noemi Güemes-Villahoz & Barbara Burgos-Blasco, Department of Ophthalmology, Hospital Clinico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC). J Clin Virol 127:104362. https://doi.org/10.1016/j.jcv.2020.104362, Xiong M, Liang X, Wei Y-D (2020) Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Conjunctivitis in COVID-19 patients: frequency and clinical presentation. Lancet 2020; 395(10238):1695-1704. https://www.aao.org/headline/alert-important-coronavirus-context, https://www.aao.org/headline/special-considerations-ophthalmic-surgery-during-c, https://www.aao.org/annual-meeting-video/covid-19-pearls-surgical-skills-recovery, https://www.aao.org/practice-management/resources/coronavirus-resources, https://eyewiki.org/w/index.php?title=COVID_conjunctivitis&oldid=59777. “The COVID-19 virus affects the body in many ways, and conjunctivitis is one of them,” he said. The presence and clinical characteristics of conjunctivitis were evaluated. Am J Ophthalmol 2004;137:773–4. All staff interacting with a conjunctivitis patient should wear a procedural mask and eye protection. No case of uveitis is yet reported. [11] Similar to lung tissue, cells in conjunctiva die either by viral-mediated lysis or by immune reactions. The frequency of conjunctivitis in patients with COVID-19 has not been fully quantified to date, reporting very different data regarding its prevalence and incidence. CAS  Additionally, patients were classified according to their clinical severity as mild, moderate, and severe, following the CURB-65 score, physical examination, respiratory assessment (respiratory rate, dyspnea, blood oxygen saturation, ventilation system requirements), or organ failure. A better understanding of the ocular manifestations of the virus will assist in early identification of SARS-CoV-2-infected cases, prioritizing diagnostic testing in patients with clinical findings compatible with conjunctivitis associated with COVID-19. Lancet 2020;395:565-574. [12], Conjunctivitis and keratitis are the only reported ocular signs of COVID-19 to date. However, important causes from a never-ending list of red-eye include; Adenoviral, Bacterial, Allergic conjunctivitis, Herpes simplex virus keratitis, Anterior uveitis, Foreign body, Corneal abrasion, Dry eye syndrome, Exposure keratopathy, and Chemosis. Ann Intern Med 2020;172(9):577-582, Santarpia JL, Rivera DN, Herrera V, Morwitzer MJ, Creager H, Santarpia GW, et al. However, conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. The references in the medical literature regarding the ocular manifestations of this emerging disease are scarce so far and, despite the fact that ocular involvement is not well defined yet, some case reports have highlighted the presence of conjunctivitis [3]. 2020;S0008-4182(20)30305-7. doi:10.1016/j.jcjo.2020.03.003. Virological assessment of hospitalized patients with COVID-2019. Microbiol Mol Biol Rev 2013;77:144–56.doi:10.1128/MMBR.00058-12. described in a series of 38 patients that patients with conjunctivitis were more likely to have higher white blood cell and neutrophil counts and higher levels of procalcitonin, C-reactive protein, and lactate dehydrogenase than patients without ocular symptoms, suggesting that ocular abnormalities occurred more frequently in patients with more severe COVID-19. Typical of viral conjunctivitis is self-limiting and so far no ocular complications have been carried conjunctivitis in covid patients between 1 may 30. Incubation period of coronavirus ( CoV ) named severe acute respiratory syndrome ( SARS ) outbreak SARS-CoV... Patients of COVID-19 and no specific risk factors for SARS-CoV-2 infection from swabs. Also in the analysis of conjunctivitis in COVID-19 patients nausea, and laboratory tests being performed in! Uveitis, retinitis, vasculitis, and also via the oro-fecal route conducted during the study. 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