by Dr.Vishal S Kakhandki , Ophthalmologist and Retina Surgeon
KLECCH Hospital, Yellur Road, Belagavi
SARS-CoV-2 is highly transmissible and has a significant fatality rate, especially in the elderly and those with comorbidities such as immune suppression, respiratory disease and diabetes mellitus.
Patients typically present with respiratory illness, including fever, cough and shortness of breath; diarrhoea is common early in infection, and conjunctivitis has also been reported. Less specific symptoms include headache, eye pain and fatigue. Complications in severe cases include pneumonia, renal failure, cardiomyopathy, stroke and encephalopathy. Symptoms can appear as soon as 2 days or as long as 14 days after exposure.
Transmission
The virus is believed to spread primarily via person-to-person through respiratory droplets produced when an infected person coughs or sneezes. It also could be spread if people touch an object or surface with virus present from an infected person, and then touch their mouth, nose or eyes. Viral RNA has also been found in stool samples from infected patients, raising the possibility of transmission through the fecal /oral route.
The median duration of viral shedding in a study of 191 COVID-19 positive inpatients in China was 20 days, the longest duration observed was 37 days. the reports point to asymptomatic and pre-symptomatic transmission as a significant source of spread.
Eye manifestation
Several published reports and a recent news article suggest that SARS-CoV-2 can cause red eye due to conjunctivitis, either as an early sign of infection, or during hospitalization for severe COVID-19 disease. Thus, it is possible that SARS-CoV-2 is transmitted to the conjunctiva by aerosol or through hand to eye contact. There is also evidence for SARS-CoV-2 RNA in tears of COVID-19 patients with conjunctivitis, although infectious virus has not yet been cultured from the conjunctiva of any COVID-19 patient.
Concluding remark
However, because conjunctivitis is a common condition overall, and patients with conjunctivitis frequently present to eye clinics or emergency departments, it may happen that ophthalmologists are the first providers to evaluate patients possibly infected with COVID-19. Based on the studies above, it is possible that a patient with COVID-19 associated conjunctivitis could have infectious virus in their ocular secretions. Patients with itching, pink eye must visit eye specialists and wear spectacles to avoid transmission to others.
