Swabbing Protocols May Predict Conjunctivitis in COVID-19 Patients

Thai Myopia child checking his eye test besides the optician at the hospital, Bangkok Thailand
Physicians identified that SARS-CoV-2 with ocular manifestations may be more quickly identifiable by performing conjunctival swabs and nasopharyngeal swabs simultaneously.

Ophthalmologists may be able to detect potential ocular infection more quickly among patients who may have COVID-19 with ocular manifestations by performing conjunctival swabs and nasopharyngeal swabs simultaneously, clinicians wrote in a letter published in JAMA Ophthalmology.1

At a mobile hospital in China, ophthalmologists were able to detect SARS-CoV-2 in the samples that they took from two patients to test whether they had conjunctivitis as their symptoms had suggested.1 The physicians noted, however, that the detection rate of the coronavirus in the tears or conjunctiva is only about 0% to 5.26%.2

“Furthermore, it remains unclear whether the virus has the capacity to transmit from person to person via the conjunctival route,” the investigators said.1

The physicians documented the course of 2 cases of confirmed COVID-19 with conjunctivitis in a mobile hospital. The first case, a 29-year-old male patient, noted conjunctival congestion of his right eye before admission. Health care workers did not notice the patient’s ocular symptoms and the potential transmission risk by conjunctivitis. The conjunctiva of both this patient’s eyes were swabbed and SARS-CoV-2 was detected. While unproven as a treatment, antiviral ganciclovir eye drops were administered. Additionally, the patient was isolated away from other patients to potentially prevent nosocomial infection. 

In the second case, a 51-year-old woman presented with ocular symptoms 10 days after admission. She had conjunctival congestion, epiphora, and watery secretions in her right eye. Similar findings were noted in the left eye 2 days later. She too had  SARS-CoV-2 detected in her tears. Chest computed tomography demonstrated lung infection compared with her previous computed tomography results. The patient showed symptoms of hypoxemia and was transferred to a tertiary hospital for further intensive treatment. She also received antiviral ganciclovir drops.

The findings from this second case were consistent with  findings from a prior study that suggested patients in China with ocular abnormalities may progress more frequently to more severe systemic symptoms of COVID-19.3

Both patients received antiviral ganciclovir eye drops as a treatment for the conjunctivitis.1 The physicians suggested additional research be performed to see if ganciclovir can help stop the spread of the coronavirus.1


1. Deng C, Chen L, Chen X, et al. Documenting Course of 2 Cases of Conjunctivitis in Mobile Hospitals During the Coronavirus Disease 2019 Pandemic. Letter. JAMA Ophthalmol. Published online August 27, 2020. Accessed September 1, 2020. doi: 10.1001/jamaophthalmol.2020.3029. 

2. Xia J, Tong J, Liu M, et al. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. Published online March 12, 2020. doi:10.1002/jmv.257257, 2

3. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;1-4. doi:10.1001/jamaophthalmol.2020.1291