Since December 2019, coronavirus disease 2019 (COVID-19) became a global pandemic. There have been several reports of eye redness and irritation in COVID-19 patients, both anecdotal and published, suggesting that conjunctivitis. Lack of eye protection was a primary risk factor in SARS-CoV transmission from SARS patients to healthcare workers which was seen in a study done in 2003 in Toronto, prompting a concern that respiratory illness could be transmitted through ocular secretions.
As conjunctivitis is a common eye condition, ophthalmologists may be the first medical professionals to evaluate a patient with COVID-19. Indeed, one of the first persons to voice concerns regarding the spread of Coronavirus in Chinese patients was Li Wenliang, MD, an ophthalmologist. He later died from COVID-19 and was believed to have contracted the virus from an asymptomatic glaucoma patient in his clinic. SARS-CoV-2 is a novel enveloped, positive single-stranded RNA beta coronavirus that causes COVID-19, originally linked to an outbreak in Wuhan of China’s Hubei province. Direct contact with mucous membranes, including the eye, is a suspected route of transmission. Various Viruses have been found to responsible for all sorts of eye disease from vision threatening retinitis to minor conjunctivitis. The studies regarding effects of corona virus on eyes are going on across the globe with some studies like one published from Hubei province suggesting conjuctival signs like chemosis, congestion and epiphora in eyes.
Patients infected with SARS-CoV-2 can present with symptoms of conjunctivitis, including eye redness, ocular irritation, foreign body sensation, tearing, and chemosis. These symptoms have more commonly affected patients with severe systemic symptoms of COVID-19, though they can rarely present as an initial manifestation of the disease. Though there have been no reports of COVID patients experiencing diminution or loss of vision.
A thorough research should be conducted regarding onset of symptoms, duration and characteristics. Anterior segment examination at the slit lamp or bedside can confirm findings of conjunctivitis. Measurement of visual acuity, intra-ocular pressure, and dilated fundus examination may be warranted to rule out more harmful ocular diseases. SARS-COV2 can be detected in eye secretions by RT-PCR. All patients should be questioned about recent fever, respiratory symptoms, exposure, and travel history to assess the need for further evaluation of COVID-19.
Although ocular transmission from the virus is low but new data and studies are emerging daily. Eye care workers may be more susceptible to catch infection due to closeness of the ophthalmic examination. Patients should be encouraged to speak as little as possible during examination. Disinfection and sterilization practices should be employed and encouraged. Same instruments like trial frames, tonometres, pinholes occluders and b scan probes should be disinfected routinely. It has been found that aerosols can travel up to 6 m after sneezing and coughing. Protective barriers should be used. people in general should be advised not to cough or sneeze in public places despite the other person wearing a mask, can catch the disease because eyes can be a potential source of contamination. Meanwhile winter is approaching, seasonal flu will be on rise, behavior of SARS-COV2 cannot be predicted, so we should all err on the side of caution.
Dr Rayees Ahmad is Assistant Professor Ophthalmology GMC Anantnag, Kashmir