Ocular events following the surge of cough and cold medications use during the Omicron outbreak in Hong Kong.

Abstract

To the Editor Coronavirus disease 2019 (COVID-19) situation worsened since the Omicron spread in Hong Kong,1 numerous infected but mildly ill patients accumulated in our community.2,3 We report a surge in acute primary angle closure (APAC) since the local outbreak of Omicron. This letter highlights the potential ocular sequelae of antitussive and nasal decongestants usage and serves to alert practitioners to wear adequate personal protective equipment upon attending APAC cases. In second to third week of March, we encountered consecutive eight eyes (seven patients) of APAC (Table 1) in our hospital, which was more than triple of usual. Five (71.4%) were without past ocular history. The remaining two (28.6%) were known to be primary angle-closure suspect (PACS). All admitted prior cough mixture or cold medications uses for relief of upper respiratory tract symptoms, including promethazine compound linctus, diphenhydramine compound linctus, actified syrup (pseudoephedrine and triprolidine), chlorpheniramine and different over-the-counter anti-histamine and nasal decongestant. Four (57.1%) patients were known cases of COVID-19, when the first week of March was the peak of the Omicron surge. The remaining three (42.9%) were not yet tested upon attendance, yet symptomatic with cough, sputum and runny noses. All were SARS-CoV-2 RNA positive by polymerase chain reaction subsequently. Investigation gonioscopy of the contralateral eye revealed PACS in all cases.