Eye in COVID-19: A Brief Review
delivery of healthcare within a COVID-19 affected
healthcare system.
report from Thailand, out of 48 patients who tested
positive for SARS-CoV-2 and underwent a complete
ocular examination including direct ophthalmoscopy
and corneal scrapings in suspected cases, no ocular
manifestations were found9.
MATERIAL AND METHODS
A literature search was carried out using Pubmed,
Google Scholar and WHO database of publications on
COVID. Keywords used in the search were eye, ocular
manifestations, ophthalmology, COVID-19, nCoV-
2019, and coronavirus disease. All available articles
were reviewed and those pertinent to the study topic
were included. Considering the dearth of information
available, ophthalmology journals were also searched
separately for relevant articles.
Apart from anecdotal evidence for red eye as a
manifestation of COVID-19, no objective evidence is
available regarding any other ocular signs and
symptoms. However, considering the ocular
manifestations reported with other coronaviruses
previously, especially SARS10, it is imperative that
medical practitioners should be on the lookout for
suspicious ocular symptoms in patients with suspected
or confirmed COVID-19, and that such patients should
undergo a complete ocular examination, conjunctival
swabs, and follow up ocular examination as well.
The earliest ocular manifestation of COVID-19,
reported by Guangfa Wang, a member of the Chinese
National Expert Panel on Pneumonia in January 2020,
included redness of the eyes, which had occurred
several days prior to the onset of pneumonia and
positive testing for SARS-CoV-25. This raised the
suspicion that the exposed eye could be a possible
extra-respiratory transmission route for the virus,
following which the Chinese CDC recommended eye
protection to healthcare workers exposed to COVID-
19.
Preventive Measures for Healthcare
Professionals
The first ocular manifestations were reported from
centers where wearing eye protection was not within
the normal routine of donning personal protection
equipment5. In many countries, ophthalmologists do
not normally use eye protection in the form of goggles
or face shields during daily clinical activities9. In the
context of COVID-19, it was found in a survey
conducted on accident and emergency (A&E)
ophthalmologists that 79% had no training in using
PPE; more than 50% were dissatisfied with the
guidelines that did not recommend PPE for
ophthalmology practitioners; and a similar number
were unaware of the recommended PPE for close
patient contact11. Considering that ophthalmologists
have close contact with patients for slit lamp eye
examinations, and face a high burden of eye disease on
daily basis, it is important that they are aware of the
correct preventive measures that need to be undertaken
in the healthcare settings. Infection control measures
for ophthalmologists need to be stepped up, with
proper training of healthcare staff and utilization of a
triage system and telemedical services to reduce
An observational study was carried out in a
Chinese hospital on 114 patients who underwent
consecutive nasopharyngeal and conjunctival swab
tests for detection of SARS-CoV-2 on RT-PCR. The
study reported negative conjunctival samples from all
the patients, 79% of whom had tested positive for
COVID-19 on nasopharyngeal swabs. Furthermore, no
obvious ocular symptoms were documented in the
study; it was suggested, however, that the presence of
the virus in the conjunctival sac or tear fluid might
occur for a very brief period of time, and in suspected
patients presenting with red eye, testing with
conjunctival swabs concurrent with nasopharyngeal
swabs would hold diagnostic significance6,7.
In a non-peer reviewed retrospective cohort study,
67 confirmed and suspected cases of COVID-19
unnecessary patient presentation12,13
.
underwent
concurrent
nasopharyngeal
and
conjunctival swabs; 1 patient with confirmed COVID
had positive conjunctival PCR for SARS-Cov-2, while
2 others had probable positive PCR results from
conjunctival swabs. Interestingly, however, none of
the patients with positive conjunctival swabs had any
ocular manifestations, and the patient who reported red
eye prior to testing were found negative for SARS-
CoV-2 on conjunctival swab PCR8. In another brief
Based on the guidelines issued by the Royal
College of Ophthalmologists14 and the American
Academy of Ophthalmology (AAO)15, we present the
following brief recommendations for prevention of
COVID-19 in ophthalmology healthcare workers:
1. Eye protection and face protection should be used
by HCPs working in the inpatient department
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (3): 308-311
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