COVID-19 case presented initially with keratoconjunctivitis: A case report

Abstract

Introduction Ocular complaints are considered non-classical presentations for COVID-19 infection; the initial diagnosis of keratoconjunctivitis is even rarer. Indeed, this puts treating clinicians in danger of getting infected, especially when patients present without the classic respiratory symptoms. Case Here we report a case of COVID-19 that was initially presented with keratoconjunctivitis with the appearance of respiratory symptoms four days later. The case showed improvement within four days of successful treatment for both covid pneumonia and ocular disease. Discussion Countable cases reported initial ocular symptoms to co-occur with systemic symptoms or even before. Only two cases reported the diagnosis of keratoconjunctivitis in COVID-19. The two cases differ in the proposed mechanism of developing such disorder. One by direct invasion of the virus, the other one by cytokines-induced epithelial injury. Our case did not show positivity for SARS-CoV 2 in the eye secretion, which aligns with the later proposed mechanism of pathology. Conclusion It is crucial to report such cases to increase the awareness of atypical presentation for COVID-19 infection. This is too important for two reasons: first, to diagnose the disease itself, and second, to take infection control precautions when treating such cases, with unexpected initial presentation.

The Review of Ophthalmic Symptoms in COVID-19

“…The first theory suggests direct damage to the corneal epithelium as a result of the virus’s entry, while the second indicates the damaging effect of cytokines on the corneal epithelium. 41–44 …”

How Does SARS-CoV-2 Affect Our Eyes—What Have We Learnt So Far about the Ophthalmic Manifestations of COVID-19?

“…The most common complaint was a foreign body sensation, which was reported in 16% of the ocular cases, followed by redness (13.3%) and tearing (12.8%). Most ophthalmic conditions were associated with conjunctivitis (88.8%), while 4.4% of cases were diagnosed with either keratitis or keratoconjunctivitis [ 18 ]. Another meta-analysis suggested that there is a relation between conjunctivitis and the worsening of the manifestations of COVID-19 [ 19 ].…”

“…Alnajjar et al, reported a case of a 24-h lag between the presentation of the keratoconjunctivitis symptoms and the onset of respiratory manifestations [ 18 ]. There was a four-day gap between taking a nasopharynx swab and an eye swab, with PCR results of positive (CT value 26) and negative (i.e., CT > 40 cycle) values, respectively.…”