key: cord-327787-vlbpijqg
authors: Casalino, Giuseppe; Monaco, Gaspare; Di Sarro, Paolo Plinio; David, Alessandro; Scialdone, Antonio
title: Coronavirus disease 2019 presenting with conjunctivitis as the first symptom
date: 2020-04-28
journal: Eye (Lond)
DOI: 10.1038/s41433-020-0909-x
sha: 
doc_id: 327787
cord_uid: vlbpijqg

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received supportive therapy consisting of oral paracetamol 1 g three times/day and a tapering course of topical tobramycin-dexamethasone in the RE. Given normalization of temperature and improvement of both the respiratory and the ocular symptoms, patient was discharged after 3 days of observation and home isolation for 14 days was advised.

Conjunctivitis seems to be a rare clinical finding among patients with confirmed diagnosis of COVID-19 since it has been reported in <1% of the overall cases in China [3] . However, the presence of a mild conjunctivitis may have been underreported in those patients presenting with a complex and life-threatening clinical scenario.

While we cannot be entirely sure that the conjunctivitis in our case was a direct manifestation of COVID-19, the concomitance of the ocular and systemic flu-like symptoms makes the causal relationship likely. A recent study showed that COVID-19 nucleic acid may be detected in the tears and conjunctival secretions of patients with COVID-19-related pneumonia and conjunctivitis [4] . However, the accuracy of the conjunctival swab test has been questioned by the observation that patients with CoV-2-related conjunctivitis may have negative test results which, by contrast, may be positive in patients without conjunctivitis [5] .

The importance of recognizing possible early ocular manifestation of COVID-19, as well as using protective eyewear among healthcare professionals, has already been outlined in recent editorials [5] [6] [7] . Since it has been speculated that the virus may enters the tears through droplets, which may pass through the nasolacrimal ducts, and then into the respiratory tract [4] , conjunctivitis may represent one of the first symptoms of COVID-19. To the best of our knowledge, we report the first European confirmed COVID-19 case presenting with conjunctivitis as the first symptom. The present case outlines the importance of questioning patients presenting with conjunctivitis about respiratory and other systemic symptoms which should prompt clinicians to rule out COVID-19 infection.

The coronavirus pandemic in five powerful charts

Coronavirus COVID-19 Global Cases by the

China medical treatment expert group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China

Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection

The possibility of COVID-19 transmission from eye to nose. Acta Ophthalmol

Novel coronavirus disease 2019 (COVID-19): the importance of recognising possible early ocular manifestation and using protective eyewear

2019-nCoV transmission through the ocular surface must not be ignored

These authors contributed equally: Giuseppe Casalino, Gaspare MonacoAcknowledgements We thank all the colleagues and allied health professionals supporting our Eye Emergency Department and the other wards of the hospital during this difficult time of pandemic.

Conflict of interest The authors declare that they have no conflict of interest.Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.