Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease

Abstract

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.

Keywords: conjunctiva; infection.

Figure 1

Timeline of systemic and ocular symptoms according to day of illness and day of hospitalisation (28 January 2020 to 18 February 2020). COVID-19, 2019 novel coronavirus disease.

Figure 2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected in different types of clinical samples obtained from the case patient. Dynamic alterations of viral loads in nasopharyngeal swabs, sputum, saliva and conjunctival swabs were shown. Cycle threshold (Ct) values were inversely proportional to viral loads. Negative results are shown with a Ct value of 40.

Figure 3

Slit lamp examinations showed evidence of acute viral conjunctivitis. The examination on illness day 13 showed moderate conjunctival injection and inferior palpebral conjunctival follicles (A and D). Examinations on illness day 17 (B and E) and illness on day 19 (C and F) demonstrated that treatment with ribavirin eye-drops gradually improved the patient’s symptoms.

Figure 4

Fundus examinations on illness day 13, hospital day 8. (A) The fundus photographs were unremarkable. (B) The ultrastructure of the central macula was normal. (C) The central macular thickness in both eyes were within normal ranges.