Abstract
In this cross-sectional study, we investigate the presence of Severe Acute Respiratory Syndrome Coronavirus 2 Ribonucleic Acid (SARS-CoV-2 RNA) in the tears of hospitalized COVID-19 patients. After laboratory confirmation of SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR) analysis, tear samples from both eyes of each patient were collected using conjunctival swab for RT-PCR. Detailed demographic profile, systemic and ocular symptoms, comorbidities, clinical, ancillary, and ocular manifestations were evaluated. Of the 83 patients enrolled in the study, 7 (8.43%) had SARS-CoV-2 RNA detected in the tear samples. Neutrophils’ count, C-reactive protein, and D-dimer were higher in patients with SARS-CoV-2 detected in tears than in patients without virus in ocular surface samples. One patient with SARS-CoV-2 in tears showed mild ocular eyelid edema, hyperemia, and chemosis. No relevant ocular manifestations were detected in the other patients. Although the levels of viral RNA on ocular surface samples were low for most patients (5/7), with positivity only for gene N and CT higher than 30, two patients were positive for all viral targets tested (N, E, and RpRd), with viral load near 1 × 105 ePFU/mL, indicating that the ocular transmission of SARS-CoV-2 is a possibility that needs to be considered, especially in the hospital environment. Further studies need to be conducted to demonstrate whether infective viral particles could be isolated from tears.
Highlights
COVID-19 is an emerging disease characterized by the presence of fever, fatigue, and myalgia that can progress to severe symptoms, such as dyspnea, hypoxia, respiratory failure, shock, and multiple organ dysfunction.[1,2] ocular manifestations are not frequently observed, some studies have reported patients with conjunctival hyperemia, chemosis, and epiphora among COVID-19 patients.[3]Around the world, more than 150 million cases have been reported so far.[4]
In this cross-sectional study, we investigate the presence of Severe Acute Respiratory Syndrome Coronavirus 2 Ribonucleic Acid (SARS-CoV-2 RNA) in the tears of hospitalized COVID-19 patients
Further studies need to be conducted to demonstrate whether infective viral particles could be isolated from tears
Summary
More than 150 million cases have been reported so far.[4] Brazil is one of the most affected countries, with more than 14 million cases registered and over 400,000 deaths until the end of April 2021.5 This disease is caused by a new member of the genus Betacoronavirus, named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).[6] The transmission of SARS-CoV-2 occurs through respiratory droplets during sneezing, coughing, speaking, or by direct contact with mucous membranes. This virus can be transmitted by fomites when respiratory secretions or droplets from infected individuals can contaminate objects or surfaces or airborne when aerosols are generated during medical procedures.[1] Besides, SARS-CoV-2 has been detected in other biological samples, such as feces, urine, tears, and blood. The possibility of transmission during the incubation period or by asymptomatic individuals can contribute to the rapid spread of SARS-CoV-2 worldwide.[7]
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