The evidence of SARS-CoV-2 infection on ocular surface

Abstract

This is a cross-sectional study of patients who received a COVID-19 diagnosis between December 30, 2019 and February 7, 2020 at Tongji Hospital. A total of 102 patients (48 Male [47%] and 54 Female [53%]) 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) were confirmed to have COVID-19 by laboratory diagnosis with a SARS-CoV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis were identified from 72 patients with a laboratory confirmed COVID-19. Of those two patients, SARS-CoV-2 RNA fragments were found in ocular discharges by SARS-CoV-2 RT-PCR in only one patient. Our findings suspect the incidence of SARS-CoV-2 infection through the ocular surface is extremely low, while the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. To lower the SARS-CoV-2 nosocomial infection, all health care professionals should wear protective goggles. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-CoV-2.

Keywords: COVID-19; Conjunctival swab; Ocularsurface; Reverse-transcriptase-polymerase-chain-reaction; SARS-CoV-2; Transmission route.

Fig. 1

Clinical photographs and chest CT of the patient with positive conjunctival swab: (A) clear binocular conjunctival congestion which is a classic sign for viral conjunctivitis; (B,C) conjunctivitis completely subsided and did not recur after 4 days following onset; (D–F) dynamic changes of peripheral ground-glass opacities in both lungs (yellow arrows) which illuminate the pneumonia caused by SARS-COV-2 infection.