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August 27, 2020

Documenting Course of 2 Cases of Conjunctivitis in Mobile Hospitals During the Coronavirus Disease 2019 Pandemic

Author Affiliations
  • 1Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
JAMA Ophthalmol. 2020;138(10):1107-1109. doi:10.1001/jamaophthalmol.2020.3029

Owing to the pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medical resources, including respirators and intensive care beds, are increasingly in shortage. In this context, a number of large indoor stadiums and exhibition centers were transformed into mobile hospitals for treatment of patients with mild COVID-19. These may have played a key role in controlling the outbreak.1 However, within these relatively crowded units for patients, even with strict disinfection and infection control management, it still may be difficult to control the risk of some manifestations of infectious diseases, such as conjunctivitis.

Report of Cases

We document the course of 2 cases of confirmed COVID-19 with conjunctivitis in a mobile hospital. One (Figure 1) is a 29-year-old male patient, who noted conjunctival congestion of the right eye before admission to the mobile hospital. Health care workers did not notice the patient's ocular symptoms and the potential transmission risk by conjunctivitis. After the patient entered the mobile hospital, an ophthalmologist noted and reported the conjunctivitis. Conjunctival swab of both eyes was performed and SARS-CoV-2 was detected in the sample. Digital polymerase chain reaction was used for the detection of virus, and the copy number was 89.3 copies/mL (>50 copies/mL is considered as positive for the detection). While unproven as a treatment, antiviral ganciclovir eyedrops were given; the patient was isolated from other patients to potentially prevent nosocomial infection (Figure 1). Further investigation is warranted to elucidate the potential antiviral efficacy of ganciclovir against COVID-19.

Figure 1.  Timeline of Ocular Symptoms, Chest CT, and Topical Treatment in a 29-Year-Old Male Patient (Case 1)
Timeline of Ocular Symptoms, Chest CT, and Topical Treatment in a 29-Year-Old Male Patient (Case 1)

+ indicates positive; −, negative; COVID-19, coronavirus disease 2019; CT, computed tomography; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

In a second case (Figure 2), a 51-year-old woman presented with ocular symptoms 10 days after admission to the mobile hospital. She had conjunctival congestion, epiphora, and watery secretions in the right eye, and similar findings were noted in the left eye 2 days later. Severe acute respiratory syndrome coronavirus 2 detection was detected in the tears. Digital polymerase chain reaction was used for the detection of virus, and the copy number was 116.1 copies/mL (the threshold for determining a positive test was >50 copies/mL). Chest computed tomography demonstrated lung infection compared with her previous computed tomography results. The patient showed symptoms of hypoxemia and was transferred to a tertiary hospital for further intensive treatment (Figure 2), and in the meantime, antiviral ganciclovir eyedrops were also given to the patient. While the association of conjunctivitis with worsening of the pulmonary infection cannot be determined from one case, these findings are consistent with a study2 that suggested that patients in China with ocular abnormalities may progress more frequently to more severe systemic symptoms of COVID-19.

Figure 2.  Timeline of Ocular Symptoms, Chest Computed Tomography, and Topical Treatment in a 51-Year-Old Female Patient (Case 2)
Timeline of Ocular Symptoms, Chest Computed Tomography, and Topical Treatment in a 51-Year-Old Female Patient (Case 2)

+ indicates positive; -, negative; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

According to another reported case, the virus may exist in the tear or conjunctival sac for several days, when ocular symptoms are present.3 Interestingly, the patient started to manifest bilateral acute conjunctivitis 13 days after illness onset,3 which is similar to the second case in this report (Figure 2). Thus, for patients with suspected COVID-19 with ocular manifestations (eg, conjunctival congestion) as the initial or concomitant symptoms, performing conjunctival swabs simultaneously with nasopharyngeal swabs might detect potential ocular infection in advance.

However, the detection rate of SARS-CoV-2 in the tears or conjunctiva appears to be very low, ranging from 0% to 5.26%.2,4-6 Furthermore, it remains unclear whether the virus has the capacity to transmit from person to person via the conjunctival route.

In summary, as the number of people infected with SARS-CoV-2 continues to increase, a large number of mild cases may be treated in mobile hospitals around the world. Although this method might alleviate the shortage of medical resources and decrease transmission routes in the community, the ophthalmologist still may play a role in ocular screening and eye disease treatment as part of the fight during the pandemic.

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Article Information

Corresponding Author: Xufang Sun, MD, Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Ave 1095, 430030, Wuhan, Hubei Province, PR China (sunxufang2016@163.com).

Published Online: August 27, 2020. doi:10.1001/jamaophthalmol.2020.3029

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by the National Natural Science Foundation of China (81974136 and 81900859) and Huazhong University of Science and Technology (2020kfyXGYJ068).

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the patients for granting permission to publish this information.

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