Swabbing Protocols May Predict Conjunctivitis in COVID-19 Patients

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.

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