The evidence of SARS-CoV-2 infection on ocular surface

Abstract

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Role of the Eye in Transmitting Human Coronavirus: What We Know and What We Do Not Know

“…This patient presented with excessive tearing and redness in both eyes, which were typical ocular manifestations of viral conjunctivitis, accompanied by a moderate fever of 38.2 • C that occurred 1 day earlier. 2019-nCoV RT-PCR tests for the conjunctival and oropharyngeal swabs sampled 2 days after the onset of fever was positive, but for those sampled 9, 18, and 20 days after the onset of fever were all negative (28). Xia and colleagues reported unilateral conjunctivitis in one patient out of 30 confirmed CoVID-19 cases; conjunctival swabs sampled from this patient 3 and 5 days after the onset of CoVID-19 were both positive for 2019-nCoV by RT-PCR, whereas 58 conjunctival swab samples from the other 29 CoVID-19 patients were all negative for 2019-nCoV (31).…”

“…The eye is rarely involved in human CoV infection. Until now, conjunctivitis has been reported in only five cases with 2019-nCoV infection, and in four cases with HCoV-NL63 infection, whereas no conjunctivitis or other ocular complications have been reported in patients with SARS-CoV and MERS-CoV infection (4,(27)(28)(29)(30)(31). Recently, human CoV RNA in tears and conjunctival scraping samples were tested by reverse transcription-polymerase chain reaction (RT-PCR) assay in patients with SARS and CoVID-19, yet the positive rate of the RT-PCR test was extremely low (4, 30-37).…”

“…More recently, two investigative groups from China simultaneously reported conjunctivitis and 2019-nCoV RNApositive tests in conjunctival swab samples from CoVID-19 patients (28,31). Zhang and colleagues, in a preprint posted at medRxiv, reported conjunctivitis in two patients out of 72 laboratory-confirmed CoVID-19 cases; however, 2019-nCoV was detected in conjunctival swab samples by RT-PCR in only one patient who was a nurse working in the Emergency Department (28). This patient presented with excessive tearing and redness in both eyes, which were typical ocular manifestations of viral conjunctivitis, accompanied by a moderate fever of 38.2 • C that occurred 1 day earlier.…”

“…Although tears have been reported by the World Health Organization in 2003 to be one of the body fluids that might contain SARS-CoV, the infectivity and clinical importance is not yet understood (35). Recent investigations have revealed that highly infectious human CoVs (mainly SARS-CoV and 2019-nCoV) are rarely detected by RT-PCR and never isolated by virus culture in tears and conjunctival secretions from SARS and CoVID-19 patients (27)(28)(29)(30)(31)(32)(33)(34)36). Hence, it is hard to assess the infectivity of tears and conjunctival secretions and their roles in virus transmission.…”

“…Previous reports on the sensitivity of RT-PCR in excretions reported a range from 50% to 60% (33,37). In current clinical practice, some suspected 2019-nCoV cases often had 2∼3 repeated tests of nasopharyngeal swabs before the positive results were obtained (28). The need remains for a highly sensitive and specific PCR test to diagnose human CoV infections.…”