Conjunctival Secretions Research Articles

Ocular transmission and manifestation for coronavirus disease: a systematic review.

BackgroundThere is currently a lack of information regarding ocular tropism and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Globally, the cumulative number of coronavirus disease 2019 (COVID-19) cases is increasing daily. Thus the potential for ocular transmission and manifestations of SARS-CoV-2 requires more investigation.MethodsA systematic search of electronic databases for ocular transmission and manifestations of SARS-CoV-2 was performed. Pooled cross-sectional studies were used for conducting a meta-analysis to estimate the prevalence of ocular transmission of SARS-CoV-2 to the respiratory system and ocular manifestations (associated symptoms) of SARS-CoV-2.ResultsThe highest prevalence of SARS-CoV-2-positive tears using reverse transcription polymerase chain reaction was found to be 7.5%. However, the highest prevalence of ocular conjunctivitis associated with SARS-CoV-2 was 32%. Thus, SARS-CoV-2 can evidently infect the eye, as revealed in the conjunctival secretions of COVID-19 patients.ConclusionThe available data reflect the influence of the ocular structure on SARS-CoV-2. The analysis showed that ocular manifestation is an indication for SARS-CoV-2, particularly conjunctivitis. Moreover, there is no evidence that the ocular structure can be an additional path of transmission for SARS-CoV-2, however, it warrants further investigation.

Commentary: Potential transmissibility of SARS-CoV-2 infection via donor corneal tissue.

Commentary: Potential transmissibility of SARS-CoV-2 infection via donor corneal tissue.

Recurrence Possibility of COVID-19 in India

Recurrence Possibility of COVID-19 in India

SARS-CoV-2 infects human adult donor eyes and hESC-derived ocular epithelium.

The SARS-CoV-2 pandemic has caused unparalleled disruption of global behavior and significant loss of life. To minimize SARS-CoV-2 spread, understanding the mechanisms of infection from all possible routes of entry is essential. While aerosol transmission is thought to be the primary route of spread, viral particles have been detected in ocular fluid, suggesting that the eye may be a vulnerable point of viral entry. To this end, we confirmed SARS-CoV-2 entry factor and antigen expression in post-mortem COVID-19 patient ocular surface tissue and observed productive viral replication in cadaver samples and eye organoid cultures, most notably in limbal regions. Transcriptional analysis of ex vivo infected ocular surface cells and hESC-derived eye cultures revealed robust induction of NF-κB in infected cells as well as diminished type I/III interferon signaling. Together these data suggest that the eye can be directly infected by SARS-CoV-2 and implicate limbus as a portal for viral entry.

Evaluation of Anti-SARS-CoV-2 IgA in the Conjunctival Secretions of COVID-19 Patients.

PurposeTo assess the presence of anti-SARS-CoV-2 IgA in the conjunctival secretions of confirmed COVID-19 patients by nasopharyngeal swabs and correlate its presence with the severity of the disease, patient’s age, sex and ocular symptoms.MethodsThis study included 44 positive COVID-19 patients confirmed with nasopharyngeal swabs during the period 17–28 February 2021 at Sohag Tropical Medicine Hospital. Tears and conjunctival secretions were examined for the presence of anti-SARS-CoV-2 IgA.ResultsWhile non-reactive results are strongly correlated to low titre and vice versa, severity showed significant correlation with neither IgA reactivity nor titre. Meanwhile, IgA reactivity did not show significant correlation with either age or sex. The reactivity and IgA titre are correlated with ocular symptoms.ConclusionThe anti-SARS-CoV-2 IgA could be found in ocular secretions in SARS-CoV-2 patients. There is no correlation with age or sex or severity of the disease; however, they are correlated with ocular symptoms.

SARS-COV2 Virus in Tears and Conjunctival Secretions of COVID-19 Patients

Purpose: To determine the presence of SARS-COV 2 viruses in tears and conjunctival secretions of patients with diagnosed COVID-19.
 Study Design: Prospective interventional case series.
 Place and Duration of Study: Rawalpindi Institute of Urology, Department of infectious diseases, Holy Family Hospital, Rawalpindi Medical University, from September 2020 to October 2020.
 Methods: Samples of conjunctival and tear secretions were collected from 60 hospitalized patients of COVID-19 who were confirmed with nasopharyngeal swabs test. Disposable conjunctival swab sticks were used for sampling. Samples were taken within 3 days of admission. SARS-COV 2 virus evaluation in tears and conjunctival secretions was done by Qualitative RT-PCR (Reverse transcriptase polymerase chain reaction) analysis. Ocular features were documented. Regarding systemic course of illness, details were noted from their hospital records.
 Results: Mean age of the patients was 56.63 ± 16.373 years. Out of 60 patients, 42 were males and 18 were females. Twenty two (36.6%) patients had mild disease and moderate and severe disease was present in 19 patients (31.6%) each. Six (10%) patients had positive conjunctival and tear secretions for SARS-COV 2 viral RNA. All patients with positive ocular secretions for viral RNA were in first week of course of disease and 3 patients had severe COVID 19 disease signifying high viral load. Only one patient had conjunctivitis and ocular symptoms of redness and foreign body sensation.
 Conclusion: There is likelihood of SARS-COV 2 virus transmission via ocular secretions as frequency of patients with SARS-COV 2 viral RNA detected in tears was 10% in current study therapeutic services.
 Key Words: SARS-COV 2 Virus, COVID 19, Conjunctivitis, Qualitative RT-PCR, Ocular Manifestations

The Presence of SARS-CoV-2 in Conjunctival Secretions of COVID-19 Patients

ABSTRACT Purpose: To evaluate the presence of SARS-CoV-2 in conjunctival secretions of COVID-19 patients. Material and Methods: In this retrospective study, the records were examined of patients who were treated in the hospital with the diagnosis of COVID-19 between March-May 2020 and were referred to the eye clinic due to ocular symptoms. Conjunctival swabs from both confirmed and suspected COVID-19 cases during hospitalization were analyzed. Results: A total of 35 patients (22 suspected, 13 laboratory-confirmed COVID-19) were referred to the eye clinic. Conjunctival swab samples from 3 patients yielded positive PCR results. These three patients were being treated in the intensive care unit, and all were suspected COVID-19 patients. Conclusion: SARS-CoV-2 may be detected in patients with suspected COVID-19. Even with conjunctivitis findings, SARS-CoV-2 may not be detected in most conjunctiva swab samples of COVID-19 patients.

Coronavirus and the risk of ocular transmission

Coronaviruses are a common class of respiratory viruses that can cause human infections. 2019 novel coronavirus(2019-nCoV), a new coronavirus that has recently caused a pandemic, has affected millions of people and put tremendous pressure on the health systems of almost every country in the world. Coronaviruses are known to spread from person to person through droplets or contact. The 2019-nCoV has also been found in the conjunctival secretions and tears of some clinically diagnosed patients. To assess whether the eye is one of the transmission routes of the virus, we review literature, and summarize the anatomy of the eye-nose pathway, the expression of the virus receptor in the eye, the preclinical animal studies, and the clinical data. We analyze the possibility of eyes as a means of transmission and propose some suggestions of ocular protection. (Chin J Ophthalmol, 2021, 57: 305-310).

Ocular Complication of a Child with Confirmed 2019 Novel Coronavirus Disease: A Case Report

Introduction: The first cases of coronavirus disease 2019 (COVID-19) were identified in Wuhan, China, in December 2019, and then it immediately spread to other parts of the world. Conjunctivitis has been reported as one of the manifestations of the disease. In this study, we report a three-year-old child with a confirmed diagnosis of COVID-19 developing conjunctivitis in Iran. Case Presentation: The patient was a three-year-old male child who was referred to Namazee Hospital (Shiraz) due to fever, dry cough, tachypnea, and respiratory distress. He was admitted with the impression of a COVID-19 infection. On the sixth day of admission, the patient developed unilateral red-eye and foreign body sensation in the left eye. A conjunctival swab was done for collecting tears and conjunctival secretions from the lower eyelid fornix without topical anesthesia and was sent for assessing the presence of SARS-CoV-2 RNA, which was demonstrated to be positive after two days. Conclusions: Our findings suggest that the COVID-19 virus can be present in tears and conjunctiva. Additionally, it should be taken into account that ocular complications may not appear in the early stages of infection.

Risk and prevention of COVID-19 in ophthalmic practice

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in China in December 2019. Recent reports have confirmed that SARS-CoV-2 is primarily transmitted through secretions of the respiratory tract; however, it remains controversial whether or not COVID-19 affects the eye. This study presents a review of current evidence related to ocular transmission of SARS-CoV-2 for gaining a better understanding of the ocular manifestations of patients with COVID-19. The study also summarizes appropriate measures to be taken to protect healthcare providers in the ophthalmology department from being exposed to infected tears or conjunctival secretions. Some studies reported that SARS-CoV-2 can be transmitted through infected tears and conjunctival secretions of patients with COVID-19. Ocular manifestations such as injection, increased discharge, or epiphora, which are consistent with those of viral conjunctivitis, are more commonly reported. Therefore, during the ongoing COVID-19 pandemic, personnel working in the ophthalmology department should be provided with adequate and appropriate personal protection equipment. The exact mechanism and pathophysiology of ocular transmission of SARS-CoV-2 remain unclear, thus warranting further studies.

COVID-19: Additional Precautions against Aerosols for the Slit Lamp User.

To the Editor: We read with great interest the article by Lam et al,1 which describes the special precautions in ophthalmic practice required due to COVID-19. However, precautions related to aerosol transmission may need to be emphasized due to evolving understanding of transmission of the disease. Early in the COVID-19 pandemic, droplet and contact transmission were postulated to be the main modes of transmission. Droplets were defined as being “large” and measuring 20 to 100 μm. Upon expulsion, these droplets rapidly drop to land within 1 m of the infected individual. Transmission may also occur by direct contact with an infected individual or a surface that the person has touched. Recently, the World Health Organization (WHO) has relooked into the modes of transmission for COVID-19.2 Aerosols are generally defined as respiratory particles <10 μm. Generation of aerosols has been normally associated with coughing or sneezing but notably, may be produced even by normal breathing and speech. In fact, SARS-CoV-2 RNAs have been detected in air samples near infected patients despite them not coughing during sample taking.3 Pertinently, aerosols can remain suspended in the air and viral particles have been found in greater concentrations closer to the infected person.4 These aerosols may be carried by air currents to distances above 10 m, which may greatly increase its transmissibility. Furthermore, aerosols are thought to be able to penetrate the lower respiratory tract including the alveoli. Since SARS-CoV-2 in aerosols can be viable for up to 3 hours,5 these may pose an increased risk to those in proximity to infected individuals through breathing and normal speech. THREAT TO THE SLIT LAMP USER Ophthalmologists have been identified as an at-risk specialty for contracting respiratory disease due to the proximity at the slit lamp and higher likelihood of potential exposure to patients’ conjunctival and respiratory secretions.1 In view of the evolving knowledge of aerosol transmission in the chain of spread of COVID-19, we wish to bring attention to current personal protective equipment (PPE) recommendations which may not adequately protect the ophthalmologist. EXISTING PPE RECOMMENDATIONS AND PITFALLS Various ophthalmological societies have provided guidelines on the use of PPE. The Royal College of Ophthalmologists and the American Academy of Ophthalmology (AAO) recommend ophthalmologists to wear surgical masks and eye protection when examining patients. In addition, the AAO has also recommended the use of commercially available slit lamp breath shields to protect against droplets from coughs and sneezes. In view of the mounting evidence of aerosol transmission particularly in indoor environments, there is an increased risk of COVID-19 infection to the ophthalmologists due to inadequate PPE. This is considerably so as presymptomatic transmission may be as high as 50% to 60%.6 IMPLICATIONS TO THE SLIT LAMP USER Administrative procedures such as the setting up of triage stations at hospital entrances which include symptom-based questionnaires and temperature screening have been recommended as part of infection control measures.7 This should be complemented with universal masking for those who wish to seek ophthalmic care as COVID-19 patients may not exhibit any symptoms. Surgical masks have been shown to reduce coronavirus RNA in aerosols and droplets from exhaled air samples8 and could be used to reduce transmission risk. This has already been adopted in the current AAO guidelines. Universal patient mask-wearing at the slit lamp seems particularly prudent. To mitigate against aerosol transmission at the slit lamp, ophthalmologists must adhere to the wearing of a protective mask and eye protection. Despite some evidence of surgical masks and respirators providing similar levels of protection,9 respirators have been shown to have stronger association with reduced infection rates compared to surgical masks.10 Where local resources permit and prevailing rates of community transmission are high, the use of respirators should be preferred to surgical masks. CONCLUSIONS In the presence of evolving evidence of aerosol and presymptomatic transmission in COVID-19, it is timely to reevaluate existing PPE recommendations to ophthalmologists. Slit lamp shields may reduce contamination and exposure to large droplets but aerosols will circumvent these to reach the ophthalmologist. Universal masking within eye clinics should be considered to reduce presymptomatic transmission. PPE recommendations for ophthalmologists could also be reviewed to include the use of a respirator during routine slit lamp examination. In the context of frequent close contact with many patients over the course of a day and in communities with high prevalence of COVID-19 cases, this makes good sense. However, the ideal protective measures will depend on the availability of resources locally. An alternative is the use of surgical masks for both ophthalmologists and patients.

Pattern of ocular manifestations and the prevalence of severe acute respiratory syndrome coronavirus-2 in tears of hospitalized coronavirus disease 2019 patients

PURPOSE:Severe acute respiratory syndrome coronavirus2 (SARSCoV2) can affect eyes in various forms. Furthermore, ocular surface can act as potential port of entry and ocular secretions as possible route of transmission of SARSCoV2. The aims of the study are to identify ocular manifestation in confirmed coronavirus disease 2019 (COVID19) patients and to evaluate conjunctival secretions as the possible route of transmission of this disease.MATERIALS AND METHODS:A prospective, populationbased, observational study was done. Ocular symptoms and signs of every hospitalized patient with SARSCoV2 infection between September 15, 2020, and November 15, 2020, were recorded. Tear samples of the first 60 participants (30 each of patients with severe and moderate illness, can be removed) with ocular manifestations were selected for real-time polymerase chain reaction (RTPCR). Data were analyzed using the Statistical Package for the Social Science Software (SPSS) program, version 23. When comparing mean values, ttest was used otherwise Chisquare test.RESULTS:Out of 804 admitted patients during study period, 309 (38.4%) patients were identified with ocular manifestations, out of which 78% (241) had conjunctival hyperemia, 65.6% (203) had follicular reaction in palpebral conjunctiva, 58% (180) had chemosis, and 58% (99) had discharge and 18.4% (57) complained of burning in their eyes. Mean duration from systemic manifestation to onset of ocular symptoms was 4.52 ± 1.47 days while 8 patients (1%) had conjunctivitis as the presenting symptom. SARSCoV2 was detected in 18.3% patients (11 out of 60) using RTPCR.CONCLUSION:The presence of SARSCoV2 in ocular secretions of patients with ocular manifestations suggests that COVID19infected patients with ocular manifestations should wear protective glasses to prevent secretions contamination to healthy persons.

Glaucoma care during the coronavirus disease 2019 pandemic.

The current article reviews the impact of the coronavirus disease 2019 (COVID-19) pandemic on the delivery of ophthalmic, and specifically, glaucoma care. Literature from the review period includes case series demonstrating the presence of severe acute respiratory syndrome coronavirus 2 RNA in the conjunctival secretions of patients with laboratory-confirmed COVID-19. The global ophthalmology community published reports outlining the enhanced infection control measures undertaken by different institutions around the world to mitigate transmission of the novel coronavirus. Telemedicine has been increasingly implemented in glaucoma practices to reduce in-office patient volume. New data regarding the efficacy and feasibility of tools for home monitoring of intraocular pressure, virtual visual field testing, and remote disc photography are reviewed. COVID-19 has posed a global public health threat due to the severity of its contagion and associated morbidity and mortality. Glaucoma specialists have responded to the pandemic with innovative modifications to reduce viral transmission and optimize patient and staff safety in the office and operating room. The role of teleglaucoma has expanded and will continue to evolve as remote diagnostic devices undergo further refinement and validation.

Conjunctivitis Related to not Severe COVID-19: A Case Report

ABSTRACT Purpose The purpose of this article is to report a bilateral conjunctivitis case in a patient with confirmed 2019 novel coronavirus disease (COVID-19). Case report/observations A 24-year-old healthy man developed severe conjunctivitis in his right eye, followed by his left eye 4 days after fever and myalgia. He reported yellowish conjunctival discharge, foreign body sensation, redness, and tearing, and those symptoms were resolved in 10 days. Analyses of nasopharyngeal secretions identified SARS-CoV-2 by polymerase chain reaction (PCR). Conclusion Mild COVID-19 can cause severe bilateral conjunctivitis. The ophthalmologist may be aware of conjunctival secretions, a possible path of infection, during eye checkup.

Update and Recommendations for Ocular Manifestations of COVID-19 in Adults and Children: A Narrative Review.

The coronavirus disease 2019 (COVID-19) pandemic has instigated severe global turmoil both medically and socioeconomically. Research continues to rapidly develop in order to fully comprehend the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study focuses on the rare ophthalmologic manifestations of the SARS-CoV-2 disease process in both adults and children. There is evidence to suggest that viral transmission can occur via tears and conjunctival secretions, although it is not a predominant finding. This review considers all the published studies describing ocular findings and SARS-CoV-2 viral transmission through the eye. The review addresses the ongoing debate over the importance of ocular manifestations during this pandemic. The most updated safety guidelines, protocols, timelines of ocular manifestations during the disease course, and treatment recommendations are discussed. The majority of patients with COVID-19 with eye symptoms presented with them initially. It is possible that the virus becomes inoculated at the site of the eye and spreads via the nasolacrimal duct to the respiratory system. There are also some reports which show that ocular findings present later in the disease course, suggestive of a correlation between ocular manifestation and increased disease severity as the infection becomes systemic. We highlight the importance of recognizing conjunctivitis as an early finding of COVID-19, and that testing or appropriate follow-up could be beneficial in both the pediatric and adult populations.

Implications of COVID-19 for Ophthalmologists

PurposeTo describe and explain the implications of coronavirus disease 2019 (COVID-19) for ophthalmologists considering the rapid developments in our understanding of the virology, transmission, and ocular involvement.DesignEvidence-based perspective.MethodsReview and synthesis of pertinent literature.ResultsRetrospective studies highlight that <1% of patients display COVID-19–related conjunctivitis. However, prospective studies suggest the rate is higher (~6%). Viral RNA has been identified in tears and conjunctival secretions in patients with active conjunctivitis as well as asymptomatic cases. Overall, conjunctival swabs are positive in 2.5%. Samples taken earlier in the disease course are more likely to demonstrate positive virus. Viral transmission through ocular tissues has not been substantiated. Ophthalmologists are in the high-risk category for COVID-19 infection for several reasons: high-volume clinics, close proximity with patients, equipment-intense clinics, and direct contact with patients' conjunctival mucosal surfaces. COVID-19 is predominantly contracted through direct or airborne transmission by inhalation of respiratory droplets. Evidence that aerosol transmission occurs is increasing in particularly prolonged exposure to high concentrations in a relatively closed environment. Based on the current evidence, ophthalmologists should consider measures that include social distancing, wearing masks, sterilization techniques, and managing clinic volumes.ConclusionsA major challenge to containing COVID-19 is that many infected people are asymptomatic. Droplet spread, contaminated environmental surfaces, and shared medical devices are areas that require management by ophthalmologists. More studies are required to explore the role of the conjunctiva and ocular tissues in the transmission of disease.

Detection of SARS-CoV-2 in conjunctival secretions from patients without ocular symptoms.

PurposeTo evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in conjunctival secretions from patients without ocular symptoms.MethodsConjunctival swabs were prospectively collected from laboratory-confirmed Coronavirus disease 2019 (COVID-19) patients without ocular symptoms for reverse transcription-polymerase chain reaction (RT-PCR) and viral culture.ResultsA total of 158 conjunctival swabs were obtained from 49 laboratory-confirmed COVID-19 patients. The median duration of illness when the first conjunctival swab was obtained was 10 days (range 2–27 days). Four conjunctival swabs from four different patients (4/49, 8.2%) were positive for SARS-CoV-2 RNA by RT-PCR. The Ct values ranged from 32.7 to 37.7 (mean 35.4). Viral cultures were negative for all four RT-PCR-positive conjunctival swabs.ConclusionConjunctival secretions of a minority of COVID-19 patients without ocular symptoms may contain relatively low levels of SARS-CoV-2 RNA, but their infectiousness remains undetermined. Appropriate infection control measures should be implemented during ophthalmological assessment of COVID-19 patients to prevent potential nosocomial transmission of SARS-CoV-2.

Ocular Manifestations and Viral Prevalence in Conjunctival Secretions of Patients with COVID 19 – A Meta–Analysis

PubMed was searched using key words “COVID-19”, “coronavirus”, and “SARS CoV‑2” in conjunction with “ophthalmology” and “eye” on 17th May 2020. Total 483 articles were identified. After screening eleven articles were included in the analysis. The frequencies of ocular manifestations and the presence of virus in conjunctiva were analyzed and final results were compiled.Ten out of eleven articleswere analyzed for ocular manifestations. In our analysis a total of 2115 cases had Covid 19, out of which 77 patients developed ocular manifestations (3.64%, 95% CI 2.88 – 4.53). The most common being conjunctival congestion. Twelve patients had SARS – CoV-2 in their ocular secretions confirmed by RT PCR test (2.61%, 95% CI 1.36 – 4.52). This meta-analysis concludes that conjunctiva is neither a preferred site of infection nor a preferred gateway for entry of SARS CoV-2 in the body. As a low risk of infection does exist, eye protective equipment should be used when treating COVID – 19 patients.&#x0D; Key Words: SARS CoV 2, COVID 19, Conjunctiva, Ophthalmology.

Seasonal flu, vaccinations and COVID-19

Seasonal flu, vaccinations and COVID-19

Assessment of Coronavirus in the Conjunctival Tears and Secretions in Patients with SARS-CoV-2 Infection in Sohag Province, Egypt.

PurposeTo assess SARS-CoV-2 virus in conjunctival tears and secretions of positive confirmed COVID-19 patients.MethodsA case series study that included 28 positive COVID-19 patients confirmed with nasopharyngeal swab in the period 18–28 May 2020 at Sohag Tropical Medicine Hospital. Tears and conjunctival secretions of these confirmed positive cases were collected with disposable sampling swabs at interval of 3 days after admission due to respiratory symptoms. They were examined for the presence of SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT‐PCR) assay.ResultsThirteen (46.43%) patients were stable, 4 (14.28%) patients suffered from dyspnea, 3 (10.72%) patients suffered from high fever, 5 (17.85%) patients suffered from cough, and 3 (10.72%) patients were on mechanical ventilation. Ten (35.71%) patients suffered from conjunctivitis. Tear and conjunctival swabs were positive in 8 (28.57%) patients, while other patients’ swabs were negative (71.43%). Out of 10 patients with conjunctival manifestations, 3 patients had SARS-CoV-2 in their conjunctiva using (RT‐PCR) test. Out of the 18 patients with no conjunctival manifestations, 5 patients had positive SARS-CoV-2 in their conjunctiva using (RT‐PCR) test.ConclusionThe SARS-CoV-2 virus could be found in tears and conjunctival secretions in SARS-CoV-2 patients with or without conjunctivitis.