Phylogenetic analysis showed that there are more than 100 strains of SARS-CoV-2 with two different types; type L and type S. The receptor-binding region of SARS-CoV-2 is also similar to SARS-CoV. 2020; 581:465–469.Doi:10.1038/s41586-020-2196-x. Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center. Am J Ophthalmol 2004;137:773–4. JAMA Ophthalmol 135(10):1119–1121. Navel V, Chiambaretta F, Dutheil F. Haemorrhagic conjunctivitis with pseudomembranous related to SARS-CoV-2. Likewise, the association between the laterality of the pneumonic process was not significantly associated with the presence of conjunctivitis (P = 0.18). Conjunctivitis in COVID-19 patients: frequency and clinical presentation, https://doi.org/10.1016/j.tmaid.2020.101606, https://doi.org/10.1016/S0140-6736(20)30183-5, https://doi.org/10.1136/bjophthalmol-2020-316304, https://doi.org/10.1001/jamaophthalmol.2017.3319, https://doi.org/10.1016/j.jtos.2020.03.010, https://doi.org/10.1001/jamaophthalmol.2020.1291, https://doi.org/10.23812/Editorial-Conti-3, https://doi.org/10.1016/j.jcv.2020.104362, http://www.ncbi.nlm.nih.gov/pubmed/32310553, https://doi.org/10.1016/j.jcjo.2020.03.003, https://doi.org/10.1016/j.ophtha.2020.04.028, https://doi.org/10.1007/s00417-020-04916-0. Conjunctivitis is inflammation of the thin membrane, called your conjunctiva, which covers the front of your eye and the back of your eyelids. [15] [16]It may also be associated with tender lymphadenopathy. Laroche recommends that anyone who is a high-risk patients such as seniors, those who are obese or have health issues such as cardiovascular disease or diabetes, should always wear a face mask to prevent contracting the disease which could trigger conjunctivitis. PubMed  Although COVID-19-related conjunctivitis seems to be uncommon, the AAO reminds physicians that other forms of conjunctivitis are common. However, bilateral conjunctivitis in COVID-19 has also been described [3]. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Graefes Arch Clin Exp Ophthalmol 258, 2501–2507 (2020). JAMA Ophthalmol:1–8. StatPearls 9:1–9 http://www.ncbi.nlm.nih.gov/pubmed/32310553, CAS  Different RNA gene targets are employed by different manufacturers. Google Scholar, Xia J, Tong J, Liu M, Shen Y, Guo D (2020) Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. 2 Additionally, retinal disorders, such as retinal vasculitis, 3 4 retinal degeneration 5 6 and blood–retinal barrier breakdown, 7 had been demonstrated in experimental animal models of coronavirus infection. Prevalence will be presented as a percentage of those with conjunctivitis along with its 95% confidence interval (CI). Lancet 2020;395(10229): 1054-1062. For entry into the cell, the virus uses angiotensin-converting enzyme 2 receptor (ACE2). The authors declare that they have no conflict of interest. According to the chi-squared test, there is not a relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). Also, we did not find any associated complications such as corneal infiltrates and membranes or pseudomembranes, which have not been reported in the literature so far. However, conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. In addition to this, health care workers are at increased risk of acquiring the infection. Tonometer should be sterilized using a 10% diluted sodium hypochlorite solution. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R. Jr. Retinal findings in patients with COVID-19. PubMed  https://doi.org/10.7150/ijbs.45134, Yeu E, Hauswirth S (2020) A review of the differential diagnosis of acute infectious conjunctivitis: implications for treatment and management. Of the 301 subjects included in the study, 180 patients (59.8%) were male and the median age was 72 years (IQ 59–82; 70 years in men and 75 years in women, P = 0.13). Likewise, the distribution of the quantitative covariates (leucocytes, neutrophils, lymphocytes, C-reactive protein, ferritin, D-dimer, creatinine, and LDH) will be depicted through the median, first, and third quartile, using the Mann-Whitney U test to assess their differences depending on the presence of conjunctivitis and sex. Nature. [reference needed]. Since the start of the COVID-19 pandemic in late 2019, there have been more than 6.5 million confirmed cases of the disease worldwide. Of the 301 subjects included, 180 patients (59.8%) were male and the median age was 72 years (IQ 59–82). In the space of two months, three patients suffering from COVID-19 in one New York health system developed keratitis, an inflammation of the cornea, which then led to a sight-threatening infection. Laboratory, radiological, and clinical results in patients with and without conjunctivitis stratified by sex were analyzed. https://doi.org/10.1136/bjophthalmol-2020-316304, Guan W, Ni Z, Hu Y et al (2020) Clinical characteristics of coronavirus disease 2019 in China. The conjunctivitis patient should be screened for COVID … Coronavirus disease 2019 (COVID-19) has shown several clinical manifestations at respiratory, gastrointestinal, and neurological levels, among others [2, 4]. Lancet 2020; 395(10238):1695-1704. https://www.aao.org/headline/alert-important-coronavirus-context, https://www.aao.org/headline/special-considerations-ophthalmic-surgery-during-c, https://www.aao.org/annual-meeting-video/covid-19-pearls-surgical-skills-recovery, https://www.aao.org/practice-management/resources/coronavirus-resources, https://eyewiki.org/w/index.php?title=COVID_conjunctivitis&oldid=59777. Conjunctivitis, or "pink eye," is an infection or inflammation of the membrane lining the eyeball and eyelid. The distribution of gender, acute pneumonia, and bilateral pneumonia depending on the outcome status (conjunctivitis or not) will be presented as percentages and the differences addressed through the chi-squared test (of the Fisher’s exact test in case the frequencies be low). [7], The incubation period of COVID-19 is within 14 days with maximum numbers occurring within 4 to 5 days of exposure. They all fully recovered. Lu R, Zhao X, Li J, et al. Our results show an 11.6% prevalence of conjunctivitis among hospitalized patients with COVID-19, differing from previous results. Conjunctivitis in COVID-19 patients: frequency and clinical presentation. Preventive measures, which must be adopted by practicing ophthalmologists, to avoid the spread of infection include; Any patient coming to the clinic with a red-eye should be suspected of COVID conjunctivitis until proved otherwise. To examine the patients, the investigators wore double gloves, a fluid-resistant gown, a full face shield, and both FFP2 and surgical masks. https://doi.org/10.1002/jmv.25725, Zhang X, Chen X, Chen L et al (2020) The evidence of SARS-CoV-2 infection on ocular surface. In fact, some coronavirus patients have been reported to have pink eye, or … Lack of retinal findings may be attributed to failure to perform the retinal examination in the COVID-19 patients. Virus spread may occur through droplets, contact with infected surfaces, mucous membranes of infected persons, and also via the oro-fecal route. Zhou P, Yang XL, Wang XG, et al. For this reason and due to the limited resources and restrictive measures of access to patients with COVID-19, RT-PCR from tears and conjunctival specimen was not tested. The causative organism is a beta coronavirus, which belongs to Coronaviridae family. Studies suggest that there are many differences between men and women in the immune response to SARS-CoV-19, affecting more men than women [9, 10]. Based on data so far, doctors believe that 1%-3% of people with COVID-19 will get conjunctivitis, also called pinkeye. The COVID-19 virus can cause ocular complications such as conjunctivitis, though not necessarily in the early stages of the disease, according to researchers. The purpose of this study was to evaluate the prevalence of conjunctivitis in hospitalized patients with COVID-19 and to describe its clinical presentation. Conjunctivitis as a presenting manifestation of coronavirus and the relationship between conjunctivitis and the development of serious pulmonary disease are important questions for ophthalmologists worldwide. J Med Virol:1–6. Given the current situation of the SARS-CoV-2 pandemic, describing the clinical characteristics of conjunctivitis associated with the novel coronavirus has relevant implications in the future identification of suspected COVID-19 patients and the differential diagnosis from other forms viral conjunctivitis. None of the patients of our study reported blurry vision associated. The risk factor for COVID conjunctivitis is direct contact with a person having COVID. Of the 483 patients admitted to the COVID unit at the time of the study, 301 patients met the inclusion and exclusion criteria. The fact that none of the patients reported associated blurred vision nor shown relevant epithelial corneal keratitis agrees with the case series of Wu et al. Coronavirus had been previously reported to be associated with conjunctivitis in humans. It is also unknown whether ocular symptoms were different in chronic sufferers of anterior eye diseases, when they were experienced or how long they lasted for compared with other COVID-19 symptoms. Twenty-seven (10.3%) patients with pneumonia and 6 (15.3%) patients without pneumonia presented conjunctivitis. Can J Ophthalmol. [9][9], Recently, viral RNA was detected in the samples collected from the rooms of COVID-19 patients admitted in the hospital, which further confirmed spread through direct contact with the surfaces contaminated with virus particles. [8] found that as high as 31.6% (95% CI, 17.5–48.7) of hospitalized COVID-19 patients presented ocular signs and symptoms compatible with conjunctivitis. The patient’s age, sex, the onset of COVID-19 symptoms, chest X-ray, and laboratory tests results were noted. Patients with red eyes frequently present to general practitioners (GPs). However, based on previous results, the extremely low positive rate of SARS-CoV-2 RNA test by RT-PCR in tears and conjunctival secretions from patients with laboratory-confirmed SARS-CoV-2 implies that negative test results could be false negative, not excluding the presence of the virus [8, 16]. All staff interacting with a conjunctivitis patient should wear a procedural mask and eye protection. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The overall prevalence results from adding patients who had conjunctivitis at the time of the evaluation and those who reported having conjunctivitis prior to the examination. However, in the analysis of conjunctivitis patients by clinical severity, there were statistically significant differences by sex (Table 4). Nalla  AK, Casto  AM, Huang  MW,  et al. © 2021 Springer Nature Switzerland AG. However, out of the 535 patients included, only 343 patients (64.1%) had laboratory-confirmed SARS-CoV-2 infection from nasopharyngeal swabs. A study analyzing a sample of 1099 patients hospitalized for COVID-19 disease in China found a prevalence of conjunctivitis symptoms of only 0.8% and other small series have reported a prevalence around 3% [4, 6, 7]. This virus causes the coronavirus disease 2019 (COVID-19), which is having an extraordinary impact worldwide [1, 2]. We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). Clin Ophthalmol 14:805–813. For all patients with conjunctivitis. Although the most frequent symptoms include respiratory symptoms, such as fever, cough, and dyspnea, the presence of conjunctivitis has also been reported [3]. [11] Similar to lung tissue, cells in conjunctiva die either by viral-mediated lysis or by immune reactions. Avoiding air puff tonometer as it poses a danger of aerosol spread. Lancet 2020;395:565-574. Among the 301 patients, 41.8% were classified as mild, 36.5% cases classified as moderate, and 21.5% classified as severe disease. Wölfel  R, Corman  VM, Guggemos  W,  et al. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Earlier diseases related to Coronavirus were severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Disinfection of instruments and surfaces having potential patient contact, before and after the examination. [14]It may resolve by itself or progress to involve coarse epithelial keratitis, pseudomembranous conjunctivitis and bilateral hemorrhagic, pseudomembranous conjunctivitis or pseudodendritic keratitis. For surface disinfection, 0.1% of sodium hypochlorite or 70% ethanol for 1 minute is recommended. Published yesterday, the first study found that 49 of 216 pediatric COVID-19 patients (23%) hospitalized from Jan 26 to Mar 18 had conjunctival discharge and congestion and eye rubbing. J Clin Virol 127:104362. https://doi.org/10.1016/j.jcv.2020.104362, Xiong M, Liang X, Wei Y-D (2020) Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. [13], COVID-19 conjunctivitis starts as unilateral redness of eye with follicular reaction (inferior palpebral) like any other viral conjunctivitis. Around 12% of patients affected by COVID-19 can present conjunctivitis symptoms associated with the disease and usually occurs early in the disease. Laboratory work-up included the levels of leukocytes, neutrophils, lymphocytes, C-reactive protein, ferritin, D-dimer, creatinine, and LDH, considering the blood test results that represented the greater severity prior to the date of the ophthalmological examination. However, important causes from a never-ending list of red-eye include; Adenoviral, Bacterial, Allergic conjunctivitis, Herpes simplex virus keratitis, Anterior uveitis, Foreign body, Corneal abrasion, Dry eye syndrome, Exposure keratopathy, and Chemosis. https://doi.org/10.1007/s00417-020-04916-0, DOI: https://doi.org/10.1007/s00417-020-04916-0, Over 10 million scientific documents at your fingertips, Not logged in [8][8] According to another study, the mean incubation period for SARS-CoV-2 was 5 to 7 days, and patients were typically infectious for several days prior to symptom onset. The study was approved by the Clinical Research Ethics Committee of this institution and was conducted in accordance with the tenets of the Declaration of Helsinki. Conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. conjunctivitis and sex. However, very mild retinal microvascular abnormality involving the ganglion cell and inner plexiform layers of the retina is described by Marinho et al. While the coronavirus is mostly known as a respiratory disease, it can affect other parts of the body, including the eyes. Am J Ophthalmol 2020;19:100735. Five cases of non-remitting conjunctivitis turned out to be the sole presenting sign and symptom of COVID-19. No cases of conjunctivitis or any other ocular sign or symptoms were reported with either MERS-CoV or SARS-CoV. It was striking to find the absence of petechiae and subconjunctival hemorrhages in our sample, despite the fact that different articles reported the vascular and thrombotic complications associated with the virus [12, 13]. https://doi.org/10.1016/j.jcjo.2020.03.003, Zhou Y, Duan C, Zeng Y et al (2020) Ocular findings and proportion with conjunctival SARS-COV-2 in COVID-19 patients. volume 258, pages2501–2507(2020)Cite this article. Int J Biol Sci 16(10):1753–1766. https://doi.org/10.1016/j.ophtha.2020.04.028, Chen L, Deng C, Chen X et al (2020) Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: a cross-sectional study. Several vaccines are in progress as well. The main outcome measure is the overall prevalence of conjunctivitis among inpatients diagnosed with COVID-19. The median time interval between the onset of COVID-19 symptoms and the appearance of conjunctivitis was 6 days (p25-p75: 2–13). Our observations can help ophthalmologists and other physicians to identify possible COVID-19 patients presenting with red eye or discharge as main complain for seeking care, especially in women who could present conjunctivitis earlier in the disease. Lancet Respiratory Med, published on line May 7, 2020. https://doi.org/10.1016/S2213-2600(20)30193-4.Accessed May 8, 2020. Emerg. N Engl J Med:1–13. 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