About one-third of a small sample of COVID-19 patients in China had ocular abnormalities, and the virus was present in tears in two patients, researchers found.
Twelve of 38 patients with COVID-19 had abnormalities involving the eye, such as conjunctivitis, chemosis, or swelling of the conjunctiva, or epiphora, an overflow of tears onto the face, reported Liang Liang, MD, of China Three Gorges University in Yichang, China, and colleagues.
Moreover, two patients tested positive for SARS-CoV-2, the virus that causes COVID-19, in both conjunctival and nasopharyngeal swabs, they wrote in a brief report in JAMA Ophthalmology.
Liang and colleagues noted the low prevalence of the virus in tears, but suggested it may nevertheless be possible to transmit it via eye secretions.
It's the first report to "identify a direct relationship between SARS-CoV-2 and the eye," they wrote.
Patients in the study were treated at a hospital in Hubei province, the epicenter of the outbreak in China, from Feb. 9 to 15. Of the 38 patients, 25 were men, with a mean age of about 66. Viral RNA was found in nasopharyngeal swabs from 28. The other 10 patients were hospitalized based on fever and respiratory symptoms corresponding with guidelines from China.
Half of the 12 cases with ocular manifestations were considered critical, four were moderate, and two were mild.
Notably, epiphora was the first symptom of COVID-19 in one patient, though none experienced blurred vision. Eleven of the 12 patients with ocular abnormalities tested positive for COVID-19 via nasopharyngeal swabs, the authors said.
Patients with ocular symptoms were more likely to have laboratory abnormalities, such as higher white blood cell and neutrophil counts, as well as higher levels of prolactin and C-reactive protein, compared with patients without ocular symptoms.
The authors noted "more severe systemic manifestations or abnormal findings on blood tests" among most patients with COVID-19 and ocular abnormalities, suggesting ocular symptoms "commonly appear in patients with severe pneumonia."
Study limitations included its small sample size, a lack of detailed ocular examinations to exclude intraocular disease, and only sampling once from the eye of each patient, "which can decrease the prevalence owing to false-negatives," they noted.
The study was supported by the National Natural Science Foundation of China.
Liang and co-authors disclosed no relevant relationships with industry.
Source Reference: Wu P, et al "Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China" JAMA Ophthalmol 2020; DOI: 10.1001/jamaophthalmol.2020.1291.