Abstract
Objectives
Since there are few reports on the ocular involvement of coronavirus disease 2019 (COVID-19) patients, this study aimed to assess the presence of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) in the tears of patients with COVID-19.
Methods
In this prospective case series, nasopharyngeal and tear sampling of 43 patients with severe COVID-19 were performed. The quantitative reverse transcription polymerase chain reaction (RT-PCR) was conducted to detect SARS-CoV-2. Ocular and systemic signs and symptoms were recorded from their medical history.
Results
The mean age of patients was 56 ± 13 years. The average disease time from initiation of symptoms was 3.27 days, range: 1–7 days. Forty-one patients (95.3%) had fever at the time of sampling. Only one patient had conjunctivitis. Thirty (69.8%) nasopharyngeal and three (7%) tear samples were positive for SARS-CoV-2. The result of tear sample was positive in the patient with conjunctivitis. All patients with positive tear RT-PCR results had positive nasopharyngeal RT-PCR results.
Conclusions
Ocular manifestation was rare in this series of severe COVID-19 patients, however, 7% of the patients had viral RNA in their conjunctival secretions. Therefore, possibility of ocular transmission should be considered even in the absence of ocular manifestations.
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References
McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2005412.
Xia J, Tong J, Liu M, Shen Y, Guo D Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020. https://doi.org/10.1002/jmv.25725.
Lu C-W, Liu X-F, Jia Z-F. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395:e39.
Chan J, Kok K-H, Zheng Z, Chu H, To KK, Yuan S, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020;9:221–36.
Loon SC, Teoh S, Oon L, Se-Thoe SY, Ling AE, Leo YS, et al. The severe acute respiratory syndrome coronavirus in tears. Br J Ophthalmol. 2004;88:861–3.
Seah I, Agrawal R. Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals. Ocul Immunol Inflamm. 2020;28:3915.
Wan Y, Shang J, Graham R, Baric R, Li F. Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS. J Virol. 2020;94. pii: e00127-20. https://doi.org/10.1128/JVI.00127-20.
Holappa M, Vapaatalo H, Vaajanen A. Many faces of renin-angiotensin system-focus on eye. Open Ophthalmol J. 2017;11:122–42.
Guan W-J, Ni Z-y, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of 2019 novel coronavirus infection in China. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2002032.
Seah I, Anderson D, Kang A, Wang L, Rao P, Young BE, et al. Assessing viral shedding and infectivity of tears in Coronavirus disease 2019 (COVID-19) patients. Ophthalmology. 2020. https://doi.org/10.1016/j.ophtha.2020.03.026.
Zhou Y, Zeng Y, Tong Y, Chen C. Ophthalmologic evidence against the interpersonal transmission of 2019 novel Coronavirus through conjunctiva. medRxi 2020. https://doi.org/10.1101/2020.02.11.20021956.
Sun C, Wang Y, Liu G, Liu Z. Role of the eye in transmitting human coronavirus: what we know and what we do not know. Front Public Health. 2020;8:155. https://doi.org/10.3389/fpubh.2020.00155.
Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020. https://doi.org/10.1001/jamaophthalmol.2020.1291.
Deng C, Yang Y, Chen H, Chen W, Chen Z, Ma K, et al. Ocular detection of SARS-CoV-2 in 114 cases of COVID-19 pneumonia in Wuhan, China: an observational study. 2020. https://doi.org/10.2139/ssrn.3543587.
Acknowledgements
The study was supported by the team of physicians, laboratory staff, and nursing of Torfeh Medical Center.
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Karimi, S., Arabi, A., Shahraki, T. et al. Detection of severe acute respiratory syndrome Coronavirus-2 in the tears of patients with Coronavirus disease 2019. Eye 34, 1220–1223 (2020). https://doi.org/10.1038/s41433-020-0965-2
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DOI: https://doi.org/10.1038/s41433-020-0965-2
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