AAO Releases COVID-19 Updates for Ophthalmologists

Nicola M. Parry, DVM

March 06, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

In light of recent reports of conjunctivitis in patients with COVID-19, the American Academy of Ophthalmology (AAO) has issued updates aimed at limiting transmission of the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The updates were posted online March 6.

AAO highlights key steps physicians should take to screen patients for SARS-CoV-2, protect themselves against infection while caring for these patients, and minimize office-based spread of the virus.

To date, this novel virus has been associated with 93,090 cases of disease and 3198 deaths in at least 76 countries. In the United States alone, 129 confirmed and presumptive cases and nine deaths have been reported in 12 states.

Two recent studies now also suggest the virus may cause conjunctivitis.

In one of the studies, conjunctivitis was reported in 1 of 30 patients hospitalized for COVID-19 in China. This patient was also the only one who was found to have SARS-CoV-2 in their ocular secretions. The researchers report their findings in an article published online online February 26 in the Journal of Medical Virology.

In the second study, published online February 28 in the New England Journal of Medicine, "conjunctival congestion" was recorded in 9 of 1099 patients (0.8%) with laboratory-confirmed COVID-19 from 30 hospitals throughout China.

Although COVID-19-related conjunctivitis seems to be uncommon, the AAO reminds physicians that other forms of conjunctivitis are common. Patients with conjunctivitis frequently present to eye clinics or emergency departments, which increases the chance that ophthalmologists may be the first clinicians to examine patients who could have COVID-19.

Ophthalmologists and infectious disease physicians must therefore take measures to protect themselves and their other patients while caring for patients who are infected with SARS-CoV-2.

It is very important to screen patients who may be infected with SARS-CoV-2, Sonal Tuli, MD, spokesperson for the AAO and professor and chair in the Department of Ophthalmology, the University of Florida, Gainesville, told Medscape Medical News.

Persons who should be screened include those who have a history of recent travel to regions in which there are high rates of infection, as well as those who have symptoms suggestive of lower respiratory tract infection, such as shortness of breath, fever, and flu-like illness.

"We also have signs near check-in and at the front door to ask patients to let us know if they are experiencing any of the symptoms of COVID-19," she said. These patients and their family members are immediately isolated, and a mask is placed on their face.

"Our clinic has identified an area that we would use in case of a suspected patient, which is isolated away from common patient areas so that we can immediately take any suspected patients there while we evaluate them and plan how to take care of them," Tuli added.

She also recommends that clinics arrange to have specific physicians conduct these patient screenings. In addition to screening patients for signs and symptoms of lower respiratory tract infection, physicians should also look for signs of conjunctivitis, "especially follicular conjunctivitis, which is usually associated with viral infections," she added.

Although she noted that conjunctivitis has been reported in only 1% to 3% of patients with COVID-19, Tuli advised that physicians use disposable tonometer tips when checking intraocular pressure, because the virus has been found in the tears of some patients who have conjunctivitis.

Tuli said that, as with other symptoms associated with COVID-19, only supportive treatment options are currently available for these patients who have conjunctivitis. These treatments often include use of artificial tears, she added.

When caring for patients who are potentially infected with SARS-CoV-2, Tuli recommends that physicians use personal protective equipment, including "gown, gloves, protective mask, and goggles or some sort of good eye protection, as aerosols from coughing or sneezing could infect any mucus membrane, including in the mouth, nose, and eyes.

"Make sure physicians and staff wear gloves before touching any patients with conjunctivitis," she stressed. Because the virus may spread through contact with tears, she reminded physicians to ensure that patients with conjunctivitis also wash their hands after touching their eyes.

Before sending a patient suspected of having COVID-19 to the emergency department, physicians should inform emergency services about the potential infection so that they can be prepared to receive the patient and can take precautions to limit the spread of infection.

Because SARS-CoV-2 is likely to be susceptible to the same disinfectants that ophthalmologists frequently use to disinfect ophthalmic instruments and office furniture, the AAO recommends following routine disinfection practices before and after each patient visit to limit office-based spread of this novel virus.

"After the patient leaves the clinic, it is important to clean any surfaces with dilute bleach," said Tuli.

"Make sure any employees or physicians that have respiratory illness do not come to work," she said, "and the most important thing is to hand wash and not touch any of the mucus membranes."

Tuli has disclosed no relevant financial relationships.

AAO. Alert: Important Coronavirus Updates for Ophthalmologists. Published online March 6, 2020. Full text

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