Ocular manifestation as first sign of Coronavirus Disease 2019 (COVID-19): Interest of telemedicine during the pandemic context

Abstract

Nous rapportons le cas d'un homme de 27 ans qui a consulté par télémédecine lors de la pandémie de Coronavirus Disease 2019 (COVID-19), pour une sensation de corps étranger et une rougeur à l'oeil gauche. L'examen a révélé un oedème palpébral unilatéral et une hyperémie conjonctivale diffuse modérée. Quelques heures plus tard, le patient a présenté des céphalées intenses, de la fièvre, de la toux et une dyspnée sévère, et une PCR nasopharyngée est revenue positive au SARS-CoV-2, posant le diagnostic de COVID-19. Ce cas démontre la possibilité d'une conjonctivite inaugurale lors de l'infection COVID-19. Il illustre l'intérêt de la télémédecine en ophtalmologie lors de la pandémie, une hyperémie conjonctivale modérée pouvant être le premier signe d'une détresse respiratoire sévère. Abstract We report here the case of a 27-year-old man who consulted by telemedicine during the Coronavirus Disease 2019 (COVID-19) pandemic, due to foreign body sensation and left eye redness. Examination revealed unilateral eyelid edema and moderate conjunctival hyperemia. A few hours later the patient experienced intense headache and developed fever, cough and severe dyspnea. A nasopharyngeal swab proved positive for SARS-CoV-2. This case demonstrates that conjunctivitis can be the inaugural manifestation of the COVID-19 infection. It illustrates the interest of telemedicine in ophthalmology during the COVID-19 pandemic, since moderate conjunctival hyperemia can be the first sign of a severe respiratory distress. Page 4 of 7 J o u r n a l P r e -p r o o f Legend Figure 1: Smartphone photograph of a left eye conjunctivitis as first presentation of Coronavirus Disease 2019 during teleophthalmology consultation. A. Left eyelid edema. B. Moderate temporal conjunctival hyperemia of the left eye. C. Inferior bulbar conjunctival hyperemia of the left eye. <InlineImage1>

<p>The Role of the Ocular Tissue in SARS-CoV-2 Transmission</p>

“…In several cases, conjunctivitisrelated discomfort was part of the initial chief complaint. 19,22,24,25 One patient self-reported having 4 days of conjunctivitis and 3 days of fever prior to admission. 22 Another case report described a man who presented with unilateral eyelid edema and moderate conjunctival hyperemia but then developed headache, fever, cough, and dyspnea hours after ocular discomfort.…”

Current Evidence of 2019 Novel Coronavirus Disease (COVID-19) Ocular Transmission: A Systematic Review and Meta-Analysis

“…In support of the laboratory data, much clinical evidence indicates the possibility of ocular surface transmission. Studies have reported ocular manifestation as the first sign of COVID-19 in patients [ 27 – 29 ]. In one COVID-19 case [ 29 ], conjunctivitis was even reported to be the only presenting sign and symptom of COVID-19.…”

What ophthalmologists need to know about pandemic of Corona Virus 19

“…retinitis, anterior uveitis and optic neuritis) are reported in animal models and not in human beings [14,15]. The above-mentioned ocular manifestations were reported in patients days before appearance of general manifestations and even can be unilaterally presented [16].…”