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Comment & Response
December 23, 2020

Conjunctival Findings in Patients With Coronavirus Disease 2019

Author Affiliations
  • 1National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
  • 2Singapore Eye Research Institute, Singapore
  • 3Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
  • 4School of Material Science and Engineering, Nanyang Technological University, Singapore
  • 5Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
JAMA Ophthalmol. 2021;139(2):253. doi:10.1001/jamaophthalmol.2020.5810

To the Editor We read with interest the article by Wu et al1 on ocular findings in coronavirus disease 2019 (COVID-19). We wish to understand more about the study in the following aspects.

First, the authors reported conjunctivitis in 12 of 38 patients with COVID-19 in a consecutive case series. Notably, the prevalence of conjunctival congestion was merely 0.8% (9 of 1099 patients) in another larger study from China.2 Could the authors clarify if they are implying that the conjunctivitis was associated with COVID-19 affecting the conjunctiva (ie, viral conjunctivitis) or nonspecific signs from conjunctival congestion or chemosis from COVID-19’s systemic manifestations,3 intensive care,4 or other benign causes (eg, dry eyes, conjunctival irritation)?

Second, 2 patients had positive conjunctival swab results, with each having different ocular manifestations. What do the authors hypothesize are the infective mechanisms? For example, could it be direct conjunctival invasion or infection via nasopharyngeal secretions?

Third, could the authors provide detailed clinical features of suspected cases? Do they have any clinical photographs? Also, how were the assessments performed, and what instruments were used to assess the conjunctivitis (eg, slitlamp biomicroscopy, portable slitlamp, or handheld flashlight)? The authors reported 4 features: epiphora, chemosis, hyperemia, and secretions. However, each was used in isolation to diagnose conjunctivitis, which may not be specific. Could the authors indicate if there were supportive features, such as subjective complaints (itch and pain), the character of the discharge, and any papillary or follicular reaction of the palpebral conjunctiva?

Lastly, could the authors provide more about the course and outcome of the reported cases of conjunctivitis? What treatments were used? Were there any ophthalmic sequelae, such as corneal, episcleral, or scleral involvement? We thank the authors for considering these clarifications and providing some additional information.

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Article Information

Corresponding Author: Rupesh Agrawal, MMed, MD, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433 (rupesh_agrawal@ttsh.com.sg).

Published Online: December 23, 2020. doi:10.1001/jamaophthalmol.2020.5810

Conflict of Interest Disclosures: None reported.

Wu  P, Duan  F, Luo  C,  et al.  Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei province, China.   JAMA Ophthalmol. 2020;138(5):575-578. doi:10.1001/jamaophthalmol.2020.1291PubMedGoogle ScholarCrossref
Guan  WJ, Ni  ZY, Hu  Y,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref
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