Ocular Symptoms Present in Almost a Third of COVID-19 Patients

New research published in JAMA Ophthalmology is detailing ocular symptoms presenting in a cohort of patients with coronavirus disease 2019 (COVID-19) in China.

Results of the 38-patient case series suggest nearly 1 in 3 hospitalized patients had ocular manifestations, including conjunctivitis and increased secretions.

“Our investigation suggests that among patients with COVID-19, 31.6% have ocular abnormalities, with most among patients with more severe systemic manifestations or abnormal findings on blood tests. These results suggest that ocular symptoms commonly appear in patients with severe pneumonia,” wrote study investigators.

In an effort to assess ocular manifestations of COVID-19 in patients, a team of investigators from the Yichang Central People’s Hospital and Sun Yat-Sen University performed a retrospective analysis of patients treated between February 9-15, 2020 at a hospital center in the Hubei Province of China.

All patients included in the current study were required to have data related to symptoms, ocular manifestations, chest CT scans, and results of blood tests and RT-PCR from nasopharyngeal and conjunctival swabs for SARS-CoV-2. Of the 38 consecutive patients included in the study, 25 were men and the mean age of the cohort was 65.8 (16.6) years.

Investigators noted 28 of the 38 had positive findings for COVID-19 on RT-PCR from nasopharyngeal swabs and 2 had positive findings for SARS-CoV-2 in their conjunctival and nasopharyngeal specimens. The remaining 10 patients were diagnosed with COVID-19 based on the presence of fever and/or respiratory symptoms and computed tomography imaging features of COVID-19 pneumonia.

Upon analysis, 12 (31.6%) of the 38 patients examined had ocular manifestations (95% CI, 17.5-48.7), including 1 whose first COVID-19 was epiphora. Other ocular manifestations included those consistent with conjunctivitis, conjunctival hyperemia, chemosis, and increased secretions.

Of the 12 patients with ocular symptoms, 6 had COVID-19 cases classified as critical while 2 were considered severe and 4 were considered moderate. None of the 12 reported experiencing blurred vision.

Results of a univariate analysis indicated patients with ocular symptoms were more to have higher white blood cell and neutrophil counts as well as higher levels of procalcitonin, C-reactive protein, and lactate dehydrogenase than those without symptoms. Of note, 11 of the 12 patients with ocular symptoms had positive results for SARS-CoV-2 on RT-PCR from nasopharyngeal swabs and 2 of the 11 had positive results on RT-PCR from both conjunctival and nasopharyngeal swabs.

Investigators noted multiple limitations within their analysis. Limitations included small sample size, absence of detailed ocular examinations to exclude intraocular disease owing to the logistical challenges, and only sampling once from the eye each patient.

“Our investigation suggests that among patients with COVID-19, 31.6% have ocular abnormalities, with most among patients with more severe systemic manifestations or abnormal findings on blood tests. These results suggest that ocular symptoms commonly appear in patients with severe pneumonia,” investigators wrote.

This study, “Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China,” is published in JAMA Ophthalmology.