Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Nov 1;138(11):1201-1204.
doi: 10.1001/jamaophthalmol.2020.3962.

Severe Acute Respiratory Syndrome Coronavirus 2 Nucleocapsid Protein in the Ocular Tissues of a Patient Previously Infected With Coronavirus Disease 2019

Ying Yan  1 , Bo Diao  2 , Yueping Liu  2 , Wenqiang Zhang  1 , Gang Wang  2 , Xiao Chen  1
Affiliations
Case Reports

Severe Acute Respiratory Syndrome Coronavirus 2 Nucleocapsid Protein in the Ocular Tissues of a Patient Previously Infected With Coronavirus Disease 2019

Ying Yan et al. JAMA Ophthalmol. .

Abstract

Importance: Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also infect tissues besides the respiratory system, such as the ocular tissues, remains unclear.

Objective: To determine whether SARS-CoV-2 exists intracellularly in the ocular tissues of a patient previously infected with COVID-19.

Design, setting, and participants: This case study analyzed a patient previously infected with COVID-19 who had an acute glaucoma attack during her rehabilitation. Plasma samples and tissue specimens, including ones from the conjunctiva, anterior lens capsular, trabecular meshwork, and iris, were collected during phacoemulsification and trabeculectomy surgery. Specimens from another patient who had glaucoma but not COVID-19 were used as a negative control.

Main outcomes and measures: Specimens were analyzed using hematoxylin-eosin staining. The nucleocapsid protein antigen of SARS-CoV-2 was measured in the conjunctiva, trabecular meshwork, and iris using immunofluorescence and immunohistochemistry. The expression of angiotensin-converting enzyme 2 receptor on the conjunctiva was measured using immunohistochemistry.

Results: The patient with a previous COVID-19 infection was female and 64 years old, and the control patient without a COVID-19 infection history was male and 61 years old. The nucleocapsid protein antigen of SARS-CoV-2 was detected on the cells of the conjunctiva, trabecular, and iris of the patient infected with COVID-19 but not in the control participant, while angiotensin-converting enzyme 2 receptor proteins were detected on the conjunctiva of both patients.

Conclusions and relevance: The nucleocapsid protein antigen of SARS-CoV-2 existed intracellularly in the ocular tissues of a patient previously infected with COVID-19. Thus, SARS-CoV-2 can also infect ocular tissues in addition to the respiratory system.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Immunohistochemistry Assays of Conjunctiva Samples
A, Conjunctiva from a patient with coronavirus disease 2019 (COVID-19) infection, stained for nucleocapsid protein (NP) antigen. Brown staining indicates the NP antigen positive cells (arrowheads). B, Conjunctiva from the control patient. No NP antigen staining is present. C and D, Conjunctiva from a patient infected with COVID-19 (C) and a control participant (D), stained for angiotensin-converting enzyme 2 (ACE2) receptor. Brown staining indicates the ACE2 receptor–positive cells (arrowheads). The original magnification was ×40.
Figure 2.
Figure 2.. Immunofluorescence Analysis of Iris and Trabecular Meshwork
A, Iris from patient infected with coronavirus disease 2019 (COVID-19), stained for nucleocapsid protein (NP) antigen. Green staining indicates the NP antigen–positive cells (arrowheads). B, Iris sample from the control patient, with no NP antigen staining indicated. C, Trabecular meshwork from patient infected with COVID-19, stained for NP antigen. Green staining indicates the NP antigen–positive cells (arrowheads). D, Trabecular meshwork sample from the control patient with no NP antigen staining indicated. The original magnification was ×40.
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, et al. ; China Novel Coronavirus Investigating and Research Team . A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017 - DOI - PMC - PubMed
    1. Zhou Y, Zeng Y, Tong Y, et al. Ophthalmologic evidence against the interpersonal transmission of 2019. novel coronavirus through conjunctiva. Published online February 12, 2020. https://www.medrxiv.org/content/10.1101/2020.02.11.20021956v1 - DOI
    1. Zhang X, Chen X, Chen L, et al. . The evidence of SARS-CoV-2 infection on ocular surface. Ocul Surf. 2020;18(3):360-362. doi:10.1016/j.jtos.2020.03.010 - DOI - PMC - PubMed
    1. Wu P, Duan F, Luo C, et al. . Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei province, China. JAMA Ophthalmol. 2020;138(5):575-578. doi:10.1001/jamaophthalmol.2020.1291 - DOI - PMC - PubMed
    1. Colavita F, Lapa D, Carletti F, et al. . SARS-CoV-2 isolation from ocular secretions of a patient with COVID-19 in Italy with prolonged viral RNA detection. Ann Intern Med. 2020;173(3):242-243. doi:10.7326/M20-1176 - DOI - PMC - PubMed

Publication types

Substances