Indian COVID-19 Restrictions Caused Delay in Infectious Keratitis Treatments

Daily Life Amid Coronavirus Pandemic In India
MUMBAI, INDIA SEPTEMBER 18: A BMC health worker collects swab samples for Covid-19 test of passengers arriving on outstation trains at Dadar station, on September 18, 2021 in Mumbai, India. (Photo by Satish Bate/Hindustan Times via Getty Images)
Many patients developed irreversible blindness, according to the report.

Travel restrictions due to the COVID-19 pandemic has caused many patients with infectious keratitis to delay medical care, causing an increase in corneal perforation and treatment failure, according to findings published in Cornea.

Data from 6 tertiary eye care hospitals in India were retrospectively assessed for patients (N=258) with infectious keratitis between March 24 and May 31 2020, during which time India had implemented travel restrictions due to the SARS-CoV-2 pandemic. Clinical presentation and outcomes were assessed and compared with historical data.

Patients were 61.2% men, aged mean 49.2 (SD, 16.5) years, 74.4% had a traumatic eye injury, and 50.8% presented with best-corrected visual acuity ≤1/60. Patients were living in orange (63.2%) or red (35.4%) zones which had the most extreme restrictions on travel.

Patients presented at the clinic after symptom onset on days 1 to 3 (8.5%), 4 to 7 (39.2%), 8 to 15 (40.7%), or 16 to 30 (11.6%). Individuals living in regions with fewer restrictions tended to seek medical care earlier in their disease course.

Late presenting patients (n=135) were more likely to have severe ulcers (52.6% vs 30.1%; P <.001), corneal perforation (17.0% vs 7.3%; P =.02), to receive inappropriate treatment (63.6% vs 2.5%; P <.001), and to be lost to follow-up (17.8% vs 6.5%; P =.006) compared with early presenters (n=123).

At 6 months, late presenters had more instances of anatomical failure (26.7% vs 9.6%; P <.001) and fewer instances of treatment success (27.0% vs 63.5%; P <.001).

Corneal perforation associated with severe ulcers (odds ratio [OR], 5.6; P <.001), inappropriate treatment (OR, 4.0; P <.001), presenting 16-30 days after symptom onset (OR, 4.3; P =.002), and 8 to 15 days after symptom onset (OR, 2.1; P =.009).

Anatomical failure associated with corneal perforation at presentation (OR, 6.7; P <.001), severe ulcers (OR, 5.4; P <.001), inappropriate treatment (OR, 4.3; P <.001), absence of therapeutic penetrating keratoplasty (OR, 3.9; P =.01), and presenting 8-15 days after symptom onset (OR, 3.4; P <.001).

Compared with data collected in 2019, during the COVID-19 pandemic patients presented with more severe ulcers (60.0% vs 22.1%; P <.001), total corneal perforations (47.3% vs 11.8%; P <.001), corneal perforation at presentation (18.2% vs 4.4%; P =.002), anatomical failure (23.6% vs 2.2%; P <.001), more attempted self-treatment with traditional medicines (36.4% vs 5.1%; P <.001), and fewer anatomical successes (69.1% vs 95.6%; P <.001) or treatment successes (50.9% vs 71.3%; P =.007).

This study may have been biased as fewer patients were living in regions with liberal COVID-19 travel restrictions.

The study authors observed that the COVID-19 pandemic likely contributed to the delayed presentation for medical care among patients with infectious keratitis and the reduced availability of donor tissues needed for emergency keratoplasty, leading to irreversible blindness for many patients.


Christy JS, Mathews P, Rhagavan A, et al. Impact of COVID-19 pandemic on infectious keratitis outcomes: a retrospective multicenter study in tertiary eye hospitals of South India. Cornea. Published online July 22, 2021. doi:10.1097/ICO.0000000000002829