The Frequency of Hand-to-Eye/Nose Contact can Increase the Risk of Ocular Symptoms in SARS-CoV-2-Infected Patients

Abstract PurposeSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the capacity to use the eye for transocular entry. The characteristics of lacrimal drainage remind us to pay attention to the transmission route passing through the nasolacrimal ducts and then into the respiratory tract. The aim of this study was to assess ocular symptoms and hand-to-eye/nose contact behaviour in SARS-CoV-2-infected patients. MethodsA questionnaire was designed by brain storing method according to practical requirements, then the survey of ocular symptoms and hand-to-eye/nose contact behaviour in SARS-CoV-2-infected patients was administered in person. The patients answered the items under the guidance of a nurse. The data of ocular symptoms and basic information was collected analysed. The correlation between ocular symptoms and hand-to-eye/nose contact behaviour was evaluated.Results The most common ocular symptoms were increased discharge (in 53.19% of patients), foreign body sensation (44.68%), tearing (44.68%), conjunctival congestion (40.43%) and mild eye pain (40.43%). In total, 61.7% of patients had nasal obstruction and running. A total of 40.4% of patients blew their nose more frequently than usual because of nasal symptoms. A total of 63.8% of patients rubbed their eyes with their hands 1-5 times per day. Only 44.68% of patients washed their hands immediately when arriving at home more than 6 days per week. Increased frequencies of blowing noses (p=0.032), washing hands (p=0.025), and rubbing eyes (p=0.005) can affect ocular symptoms. The frequency and the way of face washing had no correlation with ocular symptoms.ConclusionsOcular symptoms in SARS-CoV-2-infected patients are much more common than currently reported but nonspecific. This prompt us pay more attention to the true incidence of conjunctivitis in SARS-CoV-2-infected patients. The frequency of hand-to-eye/nose contact can increase the risk of presenting ocular symptoms. However, hand washing can decrease the risk. These results provide direct evidence of behaviour change and smooth the concerns for many people.

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Recurrent keratoconjunctivitis as the sole manifestation of COVID-19 infection: A case report

European Journal of Ophthalmology ◽

10.1177/11206721211006583 ◽

2021 ◽

pp. 112067212110065

Author(s):

Satria Audi Hutama ◽

Firas Farisi Alkaff ◽

Ryan Enast Intan ◽

Citra Dewi Maharani ◽

Luki Indriaswati ◽

...

Keyword(s):

Case Report ◽

Foreign Body ◽

Foreign Body Sensation ◽

Polymerase Chain Reaction Test ◽

Nasopharyngeal Swab ◽

Conjunctival Hyperemia ◽

Blurred Vision ◽

Ocular Symptoms ◽

Body Sensation ◽

Fluorescence Test

Introduction: Ocular symptoms are uncommon manifestations of coronavirus disease 2019 (COVID-19) infection. Earlier study reported that dry eye, blurred vision, foreign body sensation, tearing, itching, conjunctival secretion, conjunctival congestion, ocular pain, and photophobia are among the ocular symptoms that could be found in COVID-19 patients. However, there are only a few reports available regarding corneal involvement in this disease. Here we report a case of keratoconjunctivitis as the only symptom of COVID-19 infection. Case description: A 27-year-old man who worked as an obstetrics and gynecology resident came to the outpatient clinic with the chief complaints of eye discomfort, foreign body sensation, conjunctival hyperemia, lacrimation, and photophobia in his right eye for the past 3 weeks. Fluorescence test showed a small corneal lesion. The patient was then diagnosed with keratoconjunctivitis. A week after the treatment, all symptoms were resolved. A month later, the patient came to the emergency room with the same eye complaints but with a more severe pain. The fluorescence test showed wider corneal lesion compared to last month. The result from the corneal swab is negative for bacterial or fungal infection, indicating a viral infection. Afterwards, reverse transcriptase polymerase chain reaction test from nasopharyngeal swab was performed and revealed that the patient was positive for COVID-19. Conclusions: This case report showed that keratoconjunctivitis may occur as the only manifestation of COVID-19 infection. Thus, patient presented with unexplainable eye symptoms should be evaluated for COVID-19 infection.

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Unilateral Cranial Autonomic Symptoms in Migraine

Cephalalgia ◽

10.1046/j.1468-2982.2002.00358.x ◽

2002 ◽

Vol 22 (4) ◽

pp. 256-259 ◽

Cited By ~ 124

Author(s):

P Barbanti ◽

G Fabbrini ◽

M Pesare ◽

N Vanacore ◽

R Cerbo

Keyword(s):

Large Scale ◽

Nasal Congestion ◽

Migraine Treatment ◽

Conjunctival Injection ◽

Autonomic Symptoms ◽

Therapeutic Implications ◽

Ocular Symptoms ◽

Cranial Autonomic Symptoms ◽

Nasal Symptoms ◽

Autonomic Reflex

Unilateral cranial autonomic symptoms (UAs) such as lacrimation, conjunctival injection, eyelid oedema and nasal congestion, which are the hallmark of trigeminal autonomic cephalgias, may also occur in an as yet undetermined proportion of migraine patients. We studied 177 consecutive migraineurs to assess the frequency of UAs and the clinical characteristics of such patients. UAs were reported by 81 patients (45.8%), ocular symptoms alone or in combination with nasal symptoms being the most frequent. The headache was more severe ( P< 0.0002) and more strictly unilateral ( P< 0.0004) in patients who reported UAs than in those without. Thus, the presence of UAs suggests an activation of the trigeminal-autonomic reflex, probably related to an over-activation of the trigeminal afferent arm. These findings could have therapeutic implications, given the potential large-scale recruitment of peripheral neurovascular 5-HT1B/1D receptors (the target of acute migraine treatment) in such patients.

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Faster onset of action with topical levocabastine than with oral cetirizine

Mediators of Inflammation ◽

10.1155/s0962935195000779 ◽

1995 ◽

Vol 4 (7) ◽

pp. S5-S10 ◽

Cited By ~ 6

Author(s):

Michel A. Drouin ◽

William H. Yang ◽

Frederick Horak

Keyword(s):

Nasal Spray ◽

Therapeutic Efficacy ◽

Allergic Rhinoconjunctivitis ◽

Eye Drops ◽

Open Label ◽

Onset Of Action ◽

Study Drug Administration ◽

Treatment Groups ◽

Ocular Symptoms ◽

Nasal Symptoms

This international multicentre, open-label, parallel-group trial was undertaken to compare the therapeutic efficacy and tolerability of topical levocabastine and oral cetirizine in patients with perennial allergic rhinoconjunctivitis, with particular reference to the comparative onset of action of the two drugs. A total of 207 patients were randomized to receive either levocabastine nasal spray (0.5 mg/ml, two sprays in each nostril twice daily) plus levocabastine eye drops as required (0.5 mg/ml, one drop in each eye twice daily p.r.n.) or cetirizine orally (10 mg once daily) with a treatment duration of 2 weeks. Onset of action was found to be significantly more rapid with levocabastine than with cetirizine for both nasal and ocular symptoms (p < 0.001). Within 15 min of study drug administration, 36% of levocabastine-treated patients reported relief from nasal symptoms and 32% relief from ocular symptoms compared with 10% and 17% of patients on cetirizine, respectively. At 1 h, the percentages of patients reporting relief were 76% and 38% for nasal symptoms, and 81% and 48% for ocular symptoms in the levocabastine and cetirizine treatment groups, respectively. At 8 h there were no differences between the two treatments. Overall therapeutic efficacy was found to be comparable in the two treatment groups over the 2-week study period with no significant intergroup differences in symptom severity or global therapeutic efficacy. Both drugs were well tolerated with no significant differences in the incidence or type of adverse reactions between the two groups. In conclusion, levocabastine eye drops and nasal spray are as effective and well tolerated as oral cetirizine for the treatment of perennial allergic rhinoconjunctivitis with the advantage of a significantly faster onset of action for both nasal and ocular symptoms.

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Leukotriene receptor antagonist addition to intranasal steroid: systematic review and meta-analysis

Rhinology Journal ◽

10.4193/rhin20.126 ◽

2021 ◽

Vol 59 (1) ◽

pp. 2-9

Author(s):

K. Seresirikachorn ◽

J. Mullol ◽

K. Limitlaohaphan ◽

V. Asvapoositkul ◽

K. Snidvongs

Keyword(s):

Adverse Events ◽

Receptor Antagonist ◽

Symptom Score ◽

Meta Analysis ◽

Leukotriene Receptor Antagonist ◽

Night Time ◽

Ocular Symptoms ◽

Nasal Symptoms ◽

Leukotriene Receptor ◽

Disease Specific

Background: Intranasal corticosteroids (INCS) and leukotriene receptor antagonist (LTRA) have different mechanisms of action. The combination of INCS and LTRA (INCS+LTRA) are utilized to control the allergic rhinitis (AR) symptoms. The effects of this com- bination have not been made evident yet. Methodology: Randomized controlled trials studying the effects of INCS+LTRA vs INCS in monotherapy on rhinoconjunctivitis symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life (QOL), and adverse events. Results: Six studies (358 participants) met the inclusion criteria. There were no differences between INCS+LTRA and INCS mono- therapy on composite nasal symptom score, total daytime symptom score, total night time symptom score, disease-specific QOL and adverse events. The results favoured the effects of INCS-LTRA on ocular symptoms. Conclusions: The effects of the INCS+LTRA combination are not different from INCS in monotherapy in the improvement of both nasal symptoms and patient's QOL. The combination may, however, be better on improving ocular symptoms.

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Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i1.8256 ◽

2021 ◽

Author(s):

Naser Nasiri ◽

Hamid Sharifi ◽

Azam Bazrafshan ◽

Atefeh Noori ◽

Mohammad Karamouzian ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cross Sectional ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Body Sensation ◽

Pooled Prevalence ◽

Using Data ◽

Meta Analyses

Several studies have reported the characteristics of Coronavirus disease 2019 (COVID-19), yet there is a gap in our understanding of the ocular manifestations of COVID-19. In this systematic review and meta-analysis, we investigated the prevalence of ocular manifestations in COVID-19 patients. We searched Pubmed, Embase, Scopus, Web of Science, and medRxiv from December 1, 2019 to August 11, 2020. Two independent reviewers screened the articles, abstracted the data, and assessed the quality of included studies in duplicate. Thirty-eight studies were eligible after screening of 895 unique articles, with a total of 8,219 COVID-19 patients (55.3% female; n = 3,486 out of 6,308 patients). Using data extracted from cross-sectional studies, we performed randomeffects meta-analyses to estimate the pooled prevalence of ocular symptoms along with 95% confidence interval (CI). The prevalence of ocular manifestations was estimated to be 11.03% (95% CI: 5.71–17.72). In the studies that reported the details of observed ocular symptoms, the most common ocular manifestations were dry eye or foreign body sensation (n = 138, 16%), redness (n = 114, 13.3%), tearing (n = 111, 12.8%), itching (n = 109, 12.6%), eye pain (n = 83, 9.6%) and discharge (n = 76, 8.8%). Moreover, conjunctivitis had the highest rate among reported ocular diseases in COVID-19 patients (79 out of 89, 88.8%). The results suggest that approximately one out of ten COVID-19 patients show at least one ocular symptom. Attention to ocular manifestations, especially conjunctivitis, can increase the sensitivity of COVID-19 detection among patients.

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Prevalence of pterygium in a tertiary hospital in North-Western Nigeria

Journal of Chitwan Medical College ◽

10.3126/jcmc.v5i3.16525 ◽

2017 ◽

Vol 5 (3) ◽

pp. 46-51

Author(s):

M K Fasasi ◽

I R Azonobi ◽

F O Olatunji ◽

E S Saka

Keyword(s):

Inflammatory Process ◽

Middle Age ◽

Tertiary Hospital ◽

Ocular Symptoms ◽

Body Sensation ◽

History Of ◽

Surgical Options ◽

Recurrent Pterygium ◽

Pterygium Surgery ◽

North Western

Pterygium is a wing shaped conjunctival growth that encroaches onto the cornea. It was initially believed to be a conjunctival degeneration arising from pinquecula. However, it is now believed to be an active invasive inflammatory process leading to fibrovascular proliferation. The ocular symptoms of pterygium includes: tearing, redness, foreign body sensation and blurring of vision. Treatment option includes use of steroid and non-steroidal anti-inflammatory drug and various surgical options. A retrospective study was conducted from 1st January 2014- 31st December 2014. Folders of patients seen over this period were retrieved and reviewed. The following information were extracted; socio-demographics (age, gender, occupation, tribe), complaints, visual acuity at presentation, grade of pterygium, treatment offered, history of pterygium surgery, laterality and use of antimetabolities during surgery. The data was recorded and analysed using SPPS version 18. Out of 2760 patients, 98 patients presented with pterygium with a prevalence of 3.6%. Among these, 60.2% were males and 39.8% were females with a range of 22years-73 years (mean 40.28 ± 11.78years). Majority of the patients (31.6%) were between 30years to 39years. Most of the patients were house wives (31.6%) and Hausa (79.6%) by tribe. Most of them had bi-lateral pterygium (66.5%). Majority of the pterygium (46.9%) were of grade 1 followed by 39.8% grade 2. Only 9.2% had surgical procedure and intraoperative application of 5 Fulourouracil (5FU). Three out of 9 cases operated had recurrent pterygium. The prevalence of pterygium is low in this population, majority of cases affecting young and middle age population.

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Experience Of Ocular Symptoms Among Allergic Rhinitis Patients Depending On The Type Of Aeroallergens

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2015-0035 ◽

2015 ◽

Vol 16 (4) ◽

pp. 313-318

Author(s):

Vesna Velickovic ◽

Sladjana Simovic ◽

Tatjana Sarenac ◽

Natasa Mihailovic ◽

Svetlana Ristic ◽

...

Keyword(s):

Allergic Rhinitis ◽

Nasal Congestion ◽

Statistical Significance ◽

Runny Nose ◽

Ocular Symptoms ◽

Nasal Symptoms ◽

Study Population ◽

Ige Mediated ◽

Indoor Aeroallergens ◽

Indoor And Outdoor

Abstract The aim of this study was to determine the frequency of ocular symptoms and compare the demographic and clinical characteristics in AR patients depending on sensitisation to various types of aeroallergens. Allergic rhinitis is defined as an IgE-mediated inflammation of the lining of the nose that is characterized by nasal symptoms, including nasal congestion, sneezing, itching of nose and runny nose. Patients suffering from allergic rhinitis frequently experience ocular symptoms such as ocular redness, eye itching and tears. The frequency of ocular symptoms in our study population was 27,6%. No statistical significance was found in the mean ages of the patients who did or did not experience ocular symptoms p>0,05 (p=0,243). Our results indicated that there were no statistical differences (p>0,05) among the groups of allergic rhinitis patients based on experiencing nasal symptoms according to the types of aeroallergens. Our results indicated that there were significant experiences of ocular symptoms in patients who were sensitised to outdoor aeroallergens (p<0,001) and significant sensitisation to both outdoor and indoor aeroallergens (p<0,05). Experiencing the examined ocular symptoms, including ocular redness, eye itching and tears, demonstrated highly statistical significance (p<0,001) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and outdoor aeroallergens, and there was statistical significance (p<0,05) among the groups of allergic rhinitis patients who were sensitised to indoor aeroallergens and both types of aeroallergens (indoor and outdoor). Ocular symptoms are more common in patients who are sensitised to outdoor aeroallergens.

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An investigation of the relationship between tear meniscus height and the subjective severity of ocular symptoms in keratoconus

African Vision and Eye Health ◽

10.4102/aveh.v74i1.306 ◽

2015 ◽

Vol 74 (1) ◽

Author(s):

Deanne L. Nicholas ◽

Wayne D.H. Gillan

Keyword(s):

Dry Eye ◽

Objective Measures ◽

Ocular Surface Disease Index ◽

Ocular Symptoms ◽

Body Sensation ◽

Associated Conditions ◽

Tear Meniscus ◽

Tear Meniscus Height ◽

Ocular Comfort ◽

The Relationship

Keratoconus is a debilitating disease in which the cornea does not develop its characteristic round shape but develops into a conical form affecting both functional vision as well as ocular comfort. Depending on the severity of the keratoconus as well as the presence of any associated conditions, keratoconic individuals may complain of various symptoms that include discomfort, irritation, dryness, reflex tearing and foreign body sensation. There are various subjective and objective measures that can be used to determine the severity of these symptoms. A subjective method that is widely used is the ocular surface disease index (OSDI) which has been shown to be fairly accurate when diagnosing dry eye disease; however, these symptoms do not correlate with objective measures of dry eye. Research has revealed the various structural and biochemical changes that take place within a keratoconic cornea; however, the tear dimensions of keratoconic subjects have not been extensively investigated. It is possible that the symptoms experienced by many keratoconic individuals might be linked to alterations within the quantity of the tears of these patients. The present study compared the symptoms experienced by keratoconic individuals with the symptoms of control patients. The differences in tear meniscus heights between keratoconic individuals and those of control individuals were also compared using the Oculus Keratograph 4 (OK4). The results of the study show the absence of a relationship between the subjective symptoms experienced and the height of the tear meniscus.

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Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892419844459 ◽

2019 ◽

Vol 33 (5) ◽

pp. 591-600 ◽

Cited By ~ 4

Author(s):

Kachorn Seresirikachorn ◽

Wirach Chitsuthipakorn ◽

Dichapong Kanjanawasee ◽

Likhit Khattiyawittayakun ◽

Kornkiat Snidvongs

Keyword(s):

Quality Of Life ◽

Allergic Rhinitis ◽

Receptor Antagonist ◽

Meta Analysis ◽

Leukotriene Receptor Antagonist ◽

Ocular Symptoms ◽

Nasal Symptoms ◽

Subgroup Analyses ◽

Leukotriene Receptor

Background Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA. Objective This study aimed to investigate the effects of the combination of H1-antihistamine and leukotriene receptor antagonist (AH-LTRA) in patients with AR. Methods Randomized controlled trials studying the effects of AH-LTRA versus AH alone on rhinoconjuncitivits symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life, and adverse events. Meta-analyses were performed to compare the outcomes between AH-LTRA and AH. Subgroup analyses by AR subtype, asthma, and pediatric patients were performed. Results Fourteen studies (3271 participants) met the inclusion criteria. The results favored the effects of AH-LTRA on (1) composite nasal symptom score (standardized mean difference [SMD]: −0.20; 95% confidence interval [CI]: −0.36, −0.03), (2) rhinorrhea (SMD: −0.14; 95% CI: −0.27, −0.02), and (3) sneezing (SMD: −0.15; 95% CI: −0.27, −0.02). Subgroup analyses revealed that results favored the effects of AH-LTRA for perennial AR (SMD: −0.57; 95% CI: −0.87, −0.26) but not in the seasonal AR subgroup (SMD: −0.09; 95% CI: −0.21, 0.04), P = .004. There were no differences between AH-LTRA and AH on nasal obstruction, itching, ocular symptoms, Rhinoconjunctivitis Quality of life Questionnaire and adverse events. Due to limited number of included studies, effects on asthma and pediatric subgroups could not be assessed. Conclusion For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

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Efficacy of Mometasone Furoate and Fluticasone Furoate on Persistent Allergic Rhinoconjunctivitis

Allergy & Rhinology ◽

10.2500/ar.2013.4.0065 ◽

2013 ◽

Vol 4 (3) ◽

pp. ar.2013.4.0065 ◽

Cited By ~ 6

Author(s):

W. Hamizan Aneeza ◽

Salina Husain ◽

Roslenda Abdul Rahman ◽

Dexter Van Dort ◽

Asma Abdullah ◽

...

Keyword(s):

Symptom Score ◽

Nasal Symptom ◽

Allergic Rhinoconjunctivitis ◽

Mometasone Furoate ◽

Fluticasone Furoate ◽

Ocular Symptoms ◽

Nasal Symptoms ◽

Total Nasal Symptom Score ◽

Significant Difference ◽

Symptom Scores

Allergic rhinoconjunctivitis denotes both nasal and ocular manifestation of allergy, which may be solely treated with intranasal steroid. This study compares the efficacy of mometasone furoate nasal spray (NS) and fluticasone furoate NS in treatment of allergic rhinoconjunctivitis. The secondary objective is to study the severity of baseline ocular symptoms in allergic rhinoconjunctivitis. Seventy-eight patients with allergic rhinoconjunctivitis were assessed subjectively and objectively using twice-daily symptom scores for nasal (reflective total nasal symptom score [rTNSS] and instantaneous TNSS [iTNSS]) and ocular (reflective total ocular symptom score [rTOSS] and instantaneous TOSS [iTOSS]) symptoms, rhinoconjunctivitis quality-of-life questionnaires (RQOLQs), and acoustic rhinometry. All measurements were taken at baseline and at 4 and 8 weeks of treatment. Sixty-three patients who were randomized into the mometasone furoate group (n = 36) and the fluticasone furoate group (n = 27) completed the study. Seventy-six percent of patients had mild ocular symptoms, 20.5% had moderate symptoms, and only 2.6% had severe symptoms at baseline based on the iTOSS; 65.1% had mild nasal symptoms and 3% had severe nasal symptoms. There was significant reduction in the symptom scores after 1 week (p < 0.05). Both groups had significant improvement in RQOLQ scores after 1 month, which further improved at 2 months (p < 0.05). The nasal dimensions also improved in both groups (p < 0.05) but there was no statistically significant difference between groups. Both mometasone furoate and fluticasone furoate are effective as single-modality treatment of allergic rhinoconjunctivitis. The majority of patients manifest mild ocular symptoms that may be solely treated with intranasal steroids.

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