COVID-19 AND THE HUMAN EYE – CONJUNCTIVITIS A LONE COVID-19 FINDING - A case-control study

Background: The worldwide sudden appearance and drastic increase in the number of infected cases with the severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) determined the World Health Organization to declare it as a pandemic situation. The ‘Corona Virus Disease 2019’ (COVID-19) has varied clinical manifestations, from asymptomatic to severe cases, and conjunctivitis, seems not only to be one of them, but sometimes found to be lone initial symptom present. Aim and method: The aim was to identify the prevalence of conjunctivitis as the first symptom in COVID-19 patients, in a primary healthcare unit. A retrospective study was conducted analyzing the presenting complains/symptoms and results of COVID-19 confirmatory tests. Results: Out of the 672 cases that were sent for RT-PCR testing only 121 (18%) were found to be positive. Among this 2.67% of patients who had both conjunctivitis and COVID-19, 77.77% of patients had unilateral eye affected while 22.22% had bilateral conjunctivitis of varying degrees. 15 patients diagnosed to have both acute conjunctivitis and COVID-19, presented other symptoms associated with COVID-19 infection. While 3 patients had only acute conjunctivitis during their entire course of COVID-19. Conclusions: Conjunctivitis is a symptom of COVID-19 and maybe the first sign of the infection, until the onset of the classical manifestations, the patient serves to be a viral reservoir. The physicians should not miss unilateral conjunctivitis, as it can be the only presenting complain of the COVID-19 disease at the initial phase, which might worsen if underwent undetected and can aid in the spread of the contagion.

Ocular related emergencies in Spain during the COVID-19 pandemic, a multicenter study

Purpose To evaluate ophthalmological emergencies (OE) during the COVID-19 pandemic comparing them with the same period of the previous year. Methods Retrospective observational study of all OE visits in four tertiary hospitals in Spain comparing data from March 16th to April 30th, 2020 (COVID-19 period) and the same period of 2019 (pre-COVID-19 period). Severity of the conditions was assessed following Channa et al. publication. Data on demographics, diagnosis and treatments were collected from Electronic Medical Records. Results During lockdown, OE significantly declined by 75.18%, from 7,730 registered in the pre-COVID-19 period to 1,928 attended during the COVID-19 period (p < 0.001). In 2019, 23.86% of visits were classified as emergent, 59.50% as non-emergent, and 16.65% could not be determined. In 2020, the percentage of emergent visits increased up to 29.77%, non-emergent visits significantly decreased to 52.92% (p < 0.001), and 17.31% of the visits were classified as “could not determine”. During the pandemic, people aged between 45 and 65 years old represented the largest attending group (37.89%), compared to 2019, where patients over 65 years were the majority (39.80%). In 2019, most frequent diagnosis was unspecified acute conjunctivitis (11.59%), followed by vitreous degeneration (6.47%), and punctate keratitis (5.86%). During the COVID-19 period, vitreous degeneration was the first cause for consultation (9.28%), followed by unspecified acute conjunctivitis (5.63%) and punctate keratitis (5.85%). Conclusions OE visits dropped significantly during the pandemic in Spain (75.18%), although more than half were classified as non-urgent conditions, indicating a lack of understanding of the really emergent ocular pathologies among population.

Changes in the organ of vision in children and adults with confirmed COVID-19 and anti-epidemic measures

The COVID-19 pandemic revealed several aspects of the problems directly related to the Ophthalmologists: damage to the eyes of patients with the SARS-CoV-2 virus; organization of medical work in a pandemic, including in a medical department redesigned to treat patients infected with SARS-CoV-2; side effects of personal protective equipment usage and anti-epidemic measures aimed to protect the organ of vision. Ocular manifestations were noted in 15–23% of children and 4–31% of adults with COVID-19. They were usually limited to acute conjunctivitis with «clear» discharge, hyperemia, edema and folliculosis of the conjunctiva, which reduced in 7–14 days without any treatment or on symptomatic therapy. The presence of SARS-CoV-2 in the tear and epithelium of the conjunctiva does not always correlated with the presence and severity of conjunctivitis and therefore had no clinical significance. There were also other problems associated with anti-epidemic measures (dry eye syndrome when wearing personal protective equipment, computer visual syndrome, etc.), which also requires attention of Ophthalmologists. Key words: COVID-19, SARS-CoV-2, ocular manifestations in children and adults.

Diagnosing Conjunctivitis

Conjunctivitis accounts for a significant share in the structure of eye disease. The reasons for their occurrence are very diverse. At first glance, it seems that such a disease as conjunctivitis does not cause difficulties in making a diagnosis. However the wide variety of its clinical forms and the need for strictly specific treatment in some cases, in addition to modern laboratory diagnostics, requires careful collection of anamnesis, sufficient clinical experience, and knowledge of related medical specialties. In this case the probable etiology, mainly of acute conjunctivitis, can be established by anamnesis, a set of clinical symptoms observed in the dynamics of its development. In other words, each of the acute infectious or allergic lesions of the eyelid mucosa is characterized by its own symptom complex, while the effective treatment in such cases is specific therapy (antibacterial, antiviral, anti-allergic, etc.). Differentiation of various forms of conjunctivitis is usually based on the assessment of the nature of the discharge, the localization of follicular hyperplasia, and lymphadenopathy. At the same time, the patient's gender and age, living and working conditions, concomitant diseases, contact with an infectious patient, etc. are taken into account. As for chronic forms of mucosal inflammation, in contrast to acute conjunctivitis, they are characterized more by subjective complaints of patients than by objective changes. Since it is often not possible to establish their etiology from the biomicroscopic picture and other data due to the erased clinical picture, it is often necessary to resort to laboratory diagnostics to verify chronic conjunctival ophthalmic infections. Key words: conjunctivitis, clinical picture, diagnosis.

Ocular related emergencies in Spain during the COVID-19 pandemic, a multicenter study.

PURPOSE: To evaluate ophthalmological emergencies (OE) during the COVID-19 pandemic comparing them with the same period of the previous year. METHODS: Retrospective observational study of all OE visits in four tertiary hospitals in Spain comparing data from March 16th to April 30th, 2020 (COVID-19 period) and the same period of 2019 (pre-COVID-19 period). Severity of the conditions was assessed following Channa et al. publication. Data on demographics, diagnosis and treatments were collected from Electronic Medical Records. RESULTS: During lockdown, OE significantly declined by 75.18%, from 7,730 registered in the pre-COVID-19 period to 1,928 attended during the COVID-19 period (p<0.001). In 2019, 23.86% of visits were classified as emergent, 59.50% as non-emergent, and 16.65% could not be determined. In 2020, the percentage of emergent visits increased up to 29.77%, non-emergent visits significantly decreased to 52.92% (p<0.001), and 17.31% of the visits were classified as “could not determine”. During the pandemic, people aged between 45 and 65 years old represented the largest attending group (37.89%), compared to 2019, where patients over 65 years were the majority (39.80%). In 2019, most frequent diagnosis was unspecified acute conjunctivitis (11.59%), followed by vitreous degeneration (6.47%), and punctate keratitis (5.86%). During the COVID-19 period, vitreous degeneration was the first cause for consultation (9.28%), followed by unspecified acute conjunctivitis (5.63%) and punctate keratitis (5.85%). CONCLUSIONS: OE visits dropped significantly during the pandemic in Spain (75.18%), although more than half were classified as non-urgent conditions, indicating a lack of understanding of the really emergent ocular pathologies among population.

Ocular related emergencies in Spain during the COVID-19 pandemic, a multicenter study.

Purpose: To evaluate ophthalmological emergencies (OE) during the COVID-19 pandemic comparing them with the same period of the previous year. Methods: Retrospective observational study of all OE visits in four tertiary hospitals in Spain comparing data from March 16th to April 30th, 2020 (COVID-19 period) and the same period of 2019 (pre-COVID-19 period). Severity of the conditions was assessed following Channa et al. publication. Data on demographics, diagnosis and treatments were collected from Electronic Medical Records. Results: During lockdown, OE significantly declined by 75.18%, from 7,730 registered in the pre-COVID-19 period to 1,928 attended during the COVID-19 period (p<0.001). In 2019, 23.86% of visits were classified as emergent, 59.50% as non-emergent, and 16.65% could not be determined. In 2020, the percentage of emergent visits increased up to 29.77%, non-emergent visits significantly decreased to 52.92% (p<0.001), and 17.31% of the visits were classified as “could not determine”. During the pandemic, people aged between 45 and 65 years old represented the largest attending group (37.89%), compared to 2019, where patients over 65 years were the majority (39.80%). In 2019, most frequent diagnosis was unspecified acute conjunctivitis (11.59%), followed by vitreous degeneration (6.47%), and punctate keratitis (5.86%). During the COVID-19 period, vitreous degeneration was the first cause for consultation (9.28%), followed by unspecified acute conjunctivitis (5.63%) and punctate keratitis (5.85%). Conclusions: OE visits dropped significantly during the pandemic in Spain (75.18%), although more than half were classified as non-urgent conditions, indicating a lack of understanding of the really emergent ocular pathologies among population.

Chlamydia trachomatis Mimicking COVID-19 Chronic Follicular Conjunctivitis

Purpose. To characterize the clinical presentation and report lab findings of Chlamydia trachomatis follicular conjunctivitis in two patients with a positive history of active COVID-19 infection. Participants. Two patients with follicular conjunctivitis with a recent history of COVID-19 infection. Design. Retrospective, noncomparative, case report. Methods. Demographic data including age, gender, and place of residence were recorded. A full exam with an emphasis on inflammatory characteristics and systematic workup. Sample follicles were surgically excised in selected cases, and molecular and histopathological analyses were performed. Results. Both patients were initially treated for viral conjunctivitis. After symptoms failed to resolve, biopsy results indicated that both patients were positive for chlamydia conjunctivitis and treated accordingly. Conclusions. These cases illustrate the role of biopsy as an investigative tool in chronic conjunctivitis and the importance of having a broad differential when treating patients with acute conjunctivitis.

Covid-19 and acute conjunctivitis: Controversial data from a tertiary refferral Italian center

Purpose: Although acute conjunctivitis has been listed from the beginning as a possible sign of COVID-19, the likelihood of this association remains unclear. The aim of this study was to investigate the relationship between COVID-19 and conjunctivitis. Methods: In this retrospective, observational study, we recruited all patients with signs and symptoms of acute conjunctivitis seen at the Eye Emergency Department (ED), Turin Eye Hospital, between 01/01/2020 and 12/05/2020 and cross-checked our data with the Piedmont Region online COVID-19 registry in the same period. Results: Among 10,065 patients seen at our ED during the timespan considered, 88 underwent a nasopharyngeal swab (NS) for SARS-CoV-2 detection within 4 weeks before/after our examination. On average, NS was performed −0.72 ± 1.8 weeks before/after eye examination. Of the 77 patients with a negative NS, 26 (33.8%) had a diagnosis of acute conjunctivitis, whereas the remaining 51 (66.2%) had other eye disorders. Among the 11 patients with COVID-19, 7 (63,6%) had a diagnosis of acute conjunctivitis. We found a non-statistically significant increase in NS positivity rate (21.2%) among cases examined at our ED for acute conjunctivitis, compared to the NS positivity rate (7.3%) in patients examined for all other eye conditions ( p = 0.092). The Odds Ratio of having a positive NS in patients with acute conjunctivitis was 3.43 (95% I.C. = 0.9–12.8, p = 0.06). Considering online-registry data of Turin population during the same time-span, among 2441 positive NS cases only 27 (1.1%) presented with acute conjunctivitis. Conclusion: Our results do not reveal a statistically significant correlation between COVID-19 and acute conjunctivitis. Synopsis The present study analyzes retrospectively data from a tertiary eye referral center to investigate the relationship between COVID-19 infection and conjunctivitis.

COVID-19 ocular findings in paediatric population

Purpose To investigate and describe ocular findings in COVID-19 paediatric patients. Methods A total of 17 COVID-19 patients aged between 0 and 17 years old were recruited at the Paediatric Hospital of La Paz University Hospital (Madrid, Spain). A complete ophthalmological examination was performed in all patients. Results Of 17 patients, 50% had a known COVID-19 previous exposure. PCR from nasopharyngeal swabs was positive in 35.29%, whereas IgM and/or IgG serology tests were positive in 81%. Clinical manifestations were: 6 COVID-19associated Paediatric Inflammatory Multisystem Syndrome (PIMS), 7 pneumonias and 2 cutaneous purpura and/or chilblains. Ocular findings were ocular hyperaemia (5 patients), as bilateral acute conjunctivitis (3 patients) or unilateral episcleritis (2 patients). Mean best corrected visual acuity was 1/1 in all tested cases. Only one patient, presenting unilateral optic neuritis, had visual symptoms as unilateral inferior temporal quadrantanopsy. Retinal involvement was found in one patient, where ocular fundus exam showed unilateral retinal vasculitis. Conclusion SARS-CoV-2 infection could produce ocular pathology in children, frequently presented weeks after the acute phase of the disease. We should take into account COVID-19 when performing differential diagnosis of children presenting with conjunctivitis, episcleritis, retinal vasculitis and/or optic neuritis, meanwhile this world-wide pandemic lasts.