Coronavirus disease in ophthalmology practice: Current scenario; available evidence; and its implications

Abstract

Severe acute respiratory syndrome coronavirus 2 causes a highly contagious coronavirus disease named COVID-19 by the World Health Organization (WHO). It has emerged as a pandemic; number of affected individuals is only increasing and so is the spectrum of its clinical presentations. To control morbidity and mortality caused by COVID-19, all physicians including ophthalmologists, need to know its established as well as probable clinical presentations. Conjunctivitis can be the first presenting symptom of the disease. Ophthalmologists are at higher risk of contracting this infection due to close contact with the patient during different examinations and procedures. Examining such otherwise asymptomatic patients further increases the risk of infection. The present review updates about the current literature on COVID 19 in relation to ophthalmology. We need to control its spread at all levels, among patients and ophthalmologists, among staff as well as the community. Frequent disinfection and social distancing should be the new norm in clinics. Teleconsultation services need to be boosted and strengthened for future use along with efforts to end the pandemic. Across the world, we are dealing with an unprecedented crisis and we are fraught with uncertainty. On December 31, 2019, the first case of pneumonia of an undetermined cause was reported from Wuhan in China. Since then similar cases flooded across the world and the disease was declared as Public Health Emergency internationally on January 30, 2020. [1,2] On February 11, 2020, the World Health Organization (WHO) gave name to this coronavirus disease-2019 (COVID-19): COVID-19, and called the causative virus as "severe acute respiratory syndrome coronavirus 2 (SARS-COV-2)." [1] Globally, as on, June 4, 2020, there are 6,416,828 confirmed cases of COVID-19, including 382,867 deaths, reported to the WHO. [3] SARS-COV-2 has far higher infectivity and low mortality than previously known human corona virus. [4] It shows a rapid transmission during the incubation-period and may have milder symptoms in adults. [5] Human-to-human transmission is commonly by fomites, droplets, aerosol, etc., similar to SARS virus. Risk of environmental contamination is also there, more by patients with the upper respiratory tract involvement. It has been shown that current decontamination measures are sufficient and hence there is a need for strict adherence to environmental and hand hygiene. [6] Clinical Presentation of COVID-19 COVID-19 can have a variable presentation. Fever and cough have been reported as the most common symptoms. [7] In a study of 1099 Covid-19 confirmed patients [7] from China, fever was seen at presentation in 43.8% of the confirmed OVIOD 19 patients and developed after hospitalization in 88.7%. The study also reported a difference in pathogenicity of the virus from SARS-CoV, and other seasonal influenza like illness, in view of absence of gastrointestinal symptoms. Other common symptoms include cough (67.8%), fatigue (38.1%), sputum production (33.7%), shortness of ...

Ophthalmic pathology treated during Covid-19 at the Ophthalmology Clinic of “Sf. Spiridon” County Clinical Emergency Hospital in Iaşi, Romania

“…The main involvement being at the conjunctival level, the patient may present acute hemorrhagic conjunctivitis, with watery secretions, with pseudo-membranes that do not bleed by removal, being very important periocular and eyelid hygiene, topical treatments with antibiotics and antiinflammatory drugs. Other manifestations such as superficial punctate keratitis have been reported as intraocular (3,5,6). Basak Bostanci Ceran and Serdar Ozates demonstrated the presence of ocular manifestations in the acute phases of the infection, thus including 93 confirmed COVID-19 patients in their study, who were having ocular symptoms besides systemic manifestations.…”

“…All had temperatures above 37 degrees, laboratory changes (neutrophilia, elevated CRP, elevated ESR, lymphopenia), all of which were associated in the study with ocular impairment (6). The authors of the study claim that all patients with conjunctivitis are considered COVID-19 suspects and should be consulted in a special room by an ophthalmologist wearing protective equipment (3).…”

“…Another route of transmission cited by studies is through the nasolacrimal duct, from where the virus migrates to the lower meatus. Ocular symptoms may occur 2 weeks after infection (3,5). The main involvement being at the conjunctival level, the patient may present acute hemorrhagic conjunctivitis, with watery secretions, with pseudo-membranes that do not bleed by removal, being very important periocular and eyelid hygiene, topical treatments with antibiotics and antiinflammatory drugs.…”