key: cord-0936034-ags07bc5
authors: Zhou, Yunyun; Duan, Chaoye; Zeng, Yuyang; Tong, Yongqing; Nie, Yuhong; Yang, Yang; Chen, Zhen; Chen, Changzheng
title: Ocular Findings and Proportion with Conjunctival SARS-COV-2 in COVID-19 Patients
date: 2020-04-21
journal: Ophthalmology
DOI: 10.1016/j.ophtha.2020.04.028
sha: d938755c393aaf7e99dde91245c0b07f101d35e2
doc_id: 936034
cord_uid: ags07bc5

nan

variable, the Spearman rank correlation analysis was performed to assess the statistical correlation between the proportion of patients with ocular findings and the duration of disease. All statistical analyses were performed using the statistical software package IBM SPSS Statistics version 26.0 (IBM, Chicago, IL).

Of the 121 patients with confirmed COVID-19, 63 patients (52.1%) had mild or moderate disease and 58 patients (47.9%) had severe or critical disease. The median age was 48 years (range, 22e89 years) and the male-to-female ratio was 0.78 (53:68). The mean AE standard deviation of the duration of disease was 15.0 AE 8.8 days. Eight patients (6.6%) showed ocular symptoms; only 1 of them showed positive results for SARS-CoV-2 in the conjunctiva. The ocular symptoms and abbreviated findings included itching (5 [62.5%]), redness (3 [37.5%]), tearing (3 [37.5%]), discharge (2 [25%]), and foreign body sensation (2 [25%]). The 1 patient with ocular symptoms and positive SARS-CoV-2 conjunctival swab results was classified as a severe or critical case. Two patients without ocular symptoms showed positive results for conjunctival SARS-CoV-2, with one of them classified as a severe or critical case and another classified as a mild or moderate case. Of 8 patients with ocular symptoms, 7 were severe or critical cases and 1 was a mild or moderate case. For the correlation analyses of these ocular findings and the duration of disease, we additionally found that the proportion of patients with ocular symptoms was not correlated statistically with the duration of disease (Table 1 ; Spearman rank correlation analysis: correlation coefficient, 0.111; P ¼ 0.22) and that the proportion with positive results for conjunctival SARS-CoV-2 was not correlated statistically with the duration of disease, either (Table 1 ; Spearman rank correlation analysis: correlation coefficient, 0.074; P ¼ 0.42).

The proportion with positive results for conjunctival SARS-CoV-2 detection was 2.5% (3/121), which was significantly different from the nasopharyngeal SARS-CoV-2 detection rate (Table S1 , available at www.aaojournal.org; positive proportion, 2.5% vs. 70.2%; McNemar-Bowker test: chi-square value, 85.571; P < 0.001). Of 3 patients who showed positive results for conjunctival SARS-CoV-2, 2 were severe or critical cases and 1 was a mild or moderate case. The finding of ocular symptoms was not associated significantly with the results of conjunctival SARS-CoV-2 detection (Table S2, Our study has several limitations. First, because of the risk to healthcare workers and the acuity of the condition of patients, we were unable to perform biomicroscopic slit-lamp examination. Second, the conjunctival swabs were collected at only 1 time point. Recent data obtained from an animal study 6 suggest that the presence of the virus may be transient in conjunctiva after ocular conjunctival inoculation. Therefore, the single time point for conjunctival sampling and a wide range of time from diagnosis to sampling may have reduced recovery rates. This may be compounded by the possible false-negative rate of realtime RT-PCR assays. Finally, the study is limited by the small number of patients.

In conclusion, this study characterizes the ocular symptoms in COVID-19 patients, reports the proportion of samples with positive conjunctival and nasopharyngeal RT-PCR results from patients with COVID-19, and incorporates the duration of disease into the analysis. A minority of the 121 patients showed ocular symptoms and findings, which when present were mild. Three of 121 patients showed positive RT-PCR results from conjunctival swabs. The appearance of symptoms and penlight findings or the results of positive conjunctival swab analysis were not correlated significantly with the duration of disease. One patient showed both symptoms and positive conjunctival swab results and was classified as a severe or critical case; 2 patients showed no symptoms but revealed positive swab results, with one classified as a severe or critical case and another was classified as a mild or moderate case. The proportion with positive results for SARS-CoV-2 RNA was significantly different between the conjunctival and nasopharyngeal specimens. However, this study is limited by its small number of patients. The potential for conjunctival transmission of SARS-CoV-2 is worth further exploration. Recognizing the risk for viral exposure, all physicians and ophthalmologists should adopt proper precautions to reduce the risk for disease transmission while caring for patients. Ophthalmology Volume -, Number -, Month 2020

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