key: cord-0843860-9olj6lvo
authors: Mathan, Jeremy J
title: COVID‐19 swab in patients with suspected open globe
date: 2021-10-25
journal: Emerg Med Australas
DOI: 10.1111/1742-6723.13894
sha: dc42d9f494ecec5ad852688ca5051d36dc9d0b65
doc_id: 843860
cord_uid: 9olj6lvo

nan

Dear Editor, SARS-CoV-2 polymerase chain reaction testing by nasopharyngeal swabs are current common practice in EDs in Australia as a significant proportion of patients in the EDs meet the criteria for suspected COVID-19. 1 While collection is generally considered safe, case reports have described uncommon complications such as nasal foreign body, epistaxis and cerebrospinal fluid leak requiring surgical repair. 2, 3 Nasopharyngeal sampling is known to stimulate the gag and cough reflex which precipitates high intrathoracic pressures similar to vomiting. 4, 5 Vomiting is an important cause of further ocular complications in a patient with an open globe. This is avoided by good prophylaxis with anti-emetics prior to further examination and surgical intervention in the operating theatre.

A 49-year-old female was recently referred to the Royal Victorian Eye and Ear Hospital ED for a suspected penetrating eye injury. She presented with a 5-mm inferior corneal laceration secondary to a fencing wire injury with iris prolapse through the corneal laceration. Her examination was limited given nausea, although concerning, it was noted that active iris prolapse and retraction from the wound occurred with eye movement.

Patients who are admitted to our hospital from the ED typically require a COVID-19 swab as a part of the admission process. In this case, it was decided that the COVID-19 nasopharyngeal swab would be deferred until the patient was under a general anaesthetic. This was to avoid possible further extrusion of intraocular contents by stimulating the gag and cough reflex by the nasopharyngeal swab.

For patients with undifferentiated ocular trauma, we would advocate for careful consideration of the best timing of nasopharyngeal swabs. This may be after an open globe has been ruled out following eye assessment or after the patient is under general anaesthesia in a confirmed globe rupture. Topical oropharyngeal anaesthesia delivered either by spray or lozenge may contribute to patient comfort but may not completely prevent the gag and cough reflex. 5 Alternative methods such as saliva testing may be more acceptable but is not as widely available at present.

Epidemiology and clinical features of emergency department patients with suspected and confirmed COVID-19: a multisite report from the COVID-19 emergency department quality improvement project for

Complications of nasal and pharyngeal swabs: a relevant challenge of the COVID-19 pandemic?

Nasal foreign body, an unanticipated complication of COVID-19 care: a case report

Spontaneous pneumomediastinum as a consequence of severe vomiting in diabetic ketoacidosis

Topical lignocaine anaesthesia for oropharyngeal sampling for COVID-19

None declared.