Nearly One Quarter of Chinese Children Hospitalized With COVID-19-Developed Eye Symptoms

By Linda Carroll

August 31, 2020

(Reuters Health) Among Chinese children hospitalized for COVID-19, nearly a quarter developed ocular symptoms, a new study finds.

Most children developed eye symptoms later in the disease, but in nine ocular manifestations were the first sign of SARS-CoV-2 infection. Ocular symptoms resolved in all the children, researchers reported in JAMA Ophthalmology.

"This study described ocular manifestations and outcomes in children with confirmed COVID-19 and identified relevant affecting factors," said Dr. Jiang Fagang, a professor in the department of ophthalmology at Union Hospital and the Tongji Medical College at the Huazhong University of Science and Technology in Wuhan.

"Among 216 children hospitalized with COVID-19 in Wuhan, China, 49 (22.7%) had ocular manifestations including conjunctival discharge, eye rubbing, and conjunctival congestion," Dr. Fagang said in an email. "Children with systemic symptoms or cough were more likely to develop ocular symptoms, which were mild and recovered or improved by minimal eye-drops or self-healing."

Diagnosis of COVID-19 was confirmed by SARS-CoV-2 RT-PCR analysis of nasopharyngeal swabs.

The researchers examined the children's medical records along with answers to electronic questionnaires designed to obtain additional information on ocular involvement, including onset and duration of ocular symptoms, as well as topical medication if applicable.

Most of the children, 193, had an exposure to a family member with confirmed (173) or suspected (20) COVID-19. Among the 216 children, 93 had no systemic or respiratory symptoms prior to being tested. The most common symptoms among symptomatic children were fever (81) and cough (79). All the children with mild (101) or moderate (115) symptoms recovered.

The initial symptoms were predominantly fever (81) and cough (79). Other symptoms included diarrhea (11), fatigue (10), nasal discharge (7), nasal congestion (6), conjunctival discharge (5) and conjunctival congestion (4).

Overall, 49 children had ocular manifestations - most often, conjunctival discharge (27), eye rubbing (19) and conjunctival congestion (5).

Children with systemic symptoms appeared more likely to have ocular symptoms and "it is plausible that cough can lead to ocular infection through inevitable hand-eye contact in children and/or that the force of the cough could push nasopharyngeal secretions from the nasolacrimal duct into the conjunctival sac," the researchers note.

Experts weren't surprised by the new findings.

"The bottom line is this is not unexpected," said Dr. Douglas Fredrick, a professor of ophthalmology and pediatrics at the Icahn School of Medicine at Mount Sinai and chief of pediatric ophthalmology at the Mount Sinai Health system. "We know viral illnesses of most types can cause nonspecific symptoms when they involve mucus membranes and the respiratory tract. The eyes are physically connected to the nose and throat so any virus that is in the mouth, nose and throat has a direct passageway to the eyes."

It's important to note that most of the children had other symptoms before the ocular manifestations emerged, Dr. Fredrick said. "So it's not like they got pink eye first and then fever and cough later. If that were the case we'd be more worried that children could spread this by pink eye from one child to another."

Still, Dr. Fredrick said, the study doesn't completely rule out that type of transmission.

The new findings aren't likely to change practice much, said Dr. Michael Repka, a professor of ophthalmology and pediatrics at Johns Hopkins Medicine.

Children who show up with pink eye are more likely to have a virus other than COVID-19, Dr. Repka said. "But it goes without saying, in the era of COVID-19, staff need to protect themselves," he added.

The new findings are reassuring in that all the children recovered from their eye symptoms, Dr. Repka said.

SOURCE: JAMA Ophthalmology, online August 26, 2020.