Relapsing viral keratoconjunctivitis in COVID-19: a case report

Abstract

Background: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, many studies have reported the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the conjunctival sac of patients infected with this virus, with several patients displaying symptoms of viral conjunctivitis. However, to our best knowledge, there is no in-depth report on the course of patients with COVID-19 complicated by relapsing viral conjunctivitis or keratoconjunctivitis. Case presentation: A 53-year-old man confirmed with COVID-19 developed symptoms of viral conjunctivitis in the left eye approximately 10 days after the onset of COVID-19. The results of a nucleic acid test were positive for SARS-CoV-2 in the conjunctival sac of the left eye. The symptoms were relieved 6 days after treatment. However, the patient was subsequently diagnosed with viral keratoconjunctivitis in both eyes 5 days after the symptoms in the left eye were satisfactorily relieved. The disease progressed rapidly, with spot staining observed at the periphery of the corneal epithelium. Although SARS-CoV-2 could not be detected in conjunctival secretions, the levels of inflammatory factors, such as interleukin-6, were increased in both eyes. Both eyes were treated with glucocorticoids, and symptoms were controlled within 5 days. There was no recurrence. Conclusions: In this case report, the pathogenesis, clinical manifestations, treatment, and outcome of a case with COVID-19 complicated by relapsing viral keratoconjunctivitis is described, and the involvement of topical cytokine surge in the pathogenesis of COVID-19 as it relates to viral keratoconjunctivitis is reported.

Evidence of SARS-CoV-2 Transmission Through the Ocular Route

“…The patient tended to rub his eyes without washing his hands. 46 The difference between the two eyes may be caused by hand-eye transmission.…”

Update and Recommendations for Ocular Manifestations of COVID-19 in Adults and Children: A Narrative Review

“…Guo et al described a 53-year-old-man who developed unilateral conjunctivitis 10 days after the onset of symptoms at which time RT-PCR testing of conjunctival secretion was positive for the virus. Interestingly, the patient's symptoms resolved with levofloxacin drops, but returned as bilateral keratoconjunctivitis 5 days later, this time with negative PCR testing [35]. However, the vast majority of studies placed ocular manifestation as early in the disease course, apparent on Fig.…”

Ophthalmological Considerations for COVID-19 Vaccination in Patients with Inflammatory Eye Diseases and Autoimmune Disorders

“…The timing of presentation is variable; conjunctivitis may appear as the sole presenting sign, an initial symptom, synchronously with other well-known constitutional and respiratory symptoms, or in the late stage after serological clearance [ 50 , 51 , 53 , 54 ]. Whilst mostly resolved within 1–2 weeks without complications, relapse has been reported in a case report [ 52 , 55 ]. Keratitis and episcleritis.…”