BACKGROUND AND PURPOSE:

• Conjunctivitis has been reported with SARS-CoV-2 infection
• As with SARS, unprotected ocular exposure may be a route of infection
• Colavita et al. (Annals of Internal Medicine, 2020) present their findings on the early detection of infectious SARS-CoV-2 in ocular fluids from a patient with the first confirmed case of COVID-19 in Italy

METHODS:

• Case report
• Setting
  • National Institute for Infectious Diseases (INMI), Rome
• Patient
  • A 65-year old woman who travelled from Wuhan, China, to Italy
  • Confirmed infection with SARS-CoV-2 (real-time RT-PCR sputum assay)
• To confirm infectivity of viral genome in ocular fluid samples
  • Ocular sample inoculated into Vero E6 cells (used to propagate and study viruses)

RESULTS:

• Patient
  • Travel from Wuhan to Italy: January 23, 2020
  • Hospitalized: January, 29 2020 (1 day after symptom onset)
• Presenting symptoms
  • Nonproductive cough
  • Sore throat
  • Rhinitis
  • Bilateral conjunctivitis
• Day 4: Additional symptoms
  • Fever 38°C
  • Nausea
  • Vomiting
• Conjunctivitis:
  • Improved at day 15 and was resolved at day 20
• Viral RNA presence in ocular samples (using real-time RT-PCR)
  • Day 3: Virus first detected
  • Subsequent (almost) daily samples: Positive up to day 21
  • Day 27: SARS-CoV-2 RNA was again detected
• SARS-CoV-2 RNA was detected in ocular swabs days after it was undetectable in nasal swabs (nasal swabs last positive on day 16)
  • Viral load in ocular samples were lower than in nasal swabs
  • Suggests sustained replication in conjunctiva
• To confirm that virus in eye sample was still infectious, cytopathic effect was still observed 5 days after cells were inoculated with the virus

CONCLUSION:

• Ocular fluids from COVID-19 can contain infectious SARS-CoV-2
  • Ocular involvement may occur early in the course of disease
• The authors suggest
  • Ophthalmologists use proper PPE when performing eye exams, as ocular fluids may be a source of contagion
  • Transmission control: Reinforce avoidance of touching face and eyes

Learn More – Primary Sources:

SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection

Related ObG Topics:

Is Conjunctivitis a Feature of COVID-19 Infection?

Surgical Masks Reduce Viral Shedding

Loss of Taste and Smell: Key Symptoms of COVID-19 Infection