Coronavirus May Be Present in Eye Secretions, Putting Health Workers at Risk

By Megan Brooks

March 24, 2020

NEW YORK (Reuters Health) - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, may be present in conjunctival secretions of infected patients, according to a report from China.

However, whether the virus can be transmitted through conjunctiva remains to be determined, say Liang Liang and Ping Wu from Yichang Central People's Hospital in Hubei, which has borne the brunt of the epidemic.

According to their report in Acta Ophthalmologica, 37 patients with COVID-19 pneumonia underwent reverse transcriptase PCR to look for evidence of the virus in conjunctival secretion; 12 of these patients had severe and the others mild COVID-19. Three patients also had conjunctival congestion and other inflammatory ocular findings.

One of the 37 patients had evidence of the virus in conjunctival secretion and this patient had no conjunctivitis. The other 36 patients were negative.

"The viral load of conjunctival sac secretion of COVID-19 patients is relatively low, and we estimate the viral load is directly proportional to the severity of the disease," write Liang and Wu.

In email to Reuters Health, Liang said it's important for ophthalmologists to realize the patient's conjunctival secretions may carry a virus. "When checking the patient's eyes, the doctor must wear protective goggles and gloves and wash hands after the exam." When examining patients for eye diseases, "it is best to use ophthalmic equipment to check, and try to avoid manual detection," said Liang.

The authors of a related paper in Acta Ophthalmologica, who are also from China, speculate that the virus may enter the tears through droplets, which may pass through the nasolacrimal ducts and then into the respiratory tract.

"Combined with all this information, we assert that, when coming into contact with confirmed or suspected cases of COVID-19, healthcare workers should wear eye safety goggles. This should become one of the critical measures for preventing the spread of COVID-19," write Zongming Song and colleagues from Henan Eye Institute in Zhengzhou.

In a paper in Graefe's Archives for Clinical Experimental Ophthalmology, clinicians from Hong Kong offer guidance on stepping up infection control measures in ophthalmology during the coronavirus outbreak, based on their experience on the frontlines of the epidemic. (https://bit.ly/396XQpW)

A report last month in The Lancet also raised concern that ocular surfaces may be a potential target for SARS-CoV-2 invasion. (https://bit.ly/2JaxetK)

The American Academy of Ophthalmology (AAO) has advised ophthalmologists to suspend routine patient visits and provide only urgent care, with appropriate precautions, during the COVID-19 outbreak. (https://bit.ly/3bhNYv1)

SOURCE: https://bit.ly/2WJOFZM and https://bit.ly/2Ubw8nK Acta Ophthalmologica, online March 18, 2020.

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