Dr. Gurdeep Singh
We are amidst a pandemic of COVID-19 and we have currently over 1.5 lac infected patients in India and over 5.5 million all over the world. What started off as a respiratory infection, presenting as pneumonia of unknown origin in Wuhan in December 2019, has given rise to a large spectrum of manifestations, leading to significant morbidity and mortality since then.
Spread of virus through conjunctival secretions
As ophthalmologists, even though we are not primarily involved as front-line healthcare professionals handling this pandemic, we have been in the news right from the early days of its onset. One of the first providers to voice concerns regarding the spread of Coronavirus in Chinese patients was Li Wenliang, MD, an ophthalmologist. He later died from COVID-19 and was believed to have contracted the virus from an asymptomatic glaucoma patient in his clinic. Since then many eye surgeons all over the world have been infected and some have even succumbed to this disease. This gave rise to concerns regarding spread of virus through conjunctival secretions.
A study done in 2003 during the Severe Acute Respiratory Sydrome (SARS) outbreak suggested lack of eye protection was a primary risk factor of SARS-CoV transmission from patients to healthcare workers in Toronto, prompting a concern that respiratory illness could be transmitted through ocular secretions. Similar concerns have been raised with the novel COVID-19. There have been a few studies regarding ocular involvement in COVID-19.
Reverse transcriptase-polymerase chain reaction
Ocular signs and symptoms were documented and reverse transcriptase-polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for COVID-19 were analyzed in a series of 38 clinically confirmed cases at a hospital in the Hubei Province of China in February 2020. 28 patients had positive results for COVID-19 on RT-PCR from nasopharyngeal swabs, but only 2 had positive results on RT-PCR from conjunctival swabs as well, suggesting low prevalence of virus in tears. 12 patients (32%) had eye findings which included conjunctival redness, swelling and watering with secretions. Of note was that 6 out of these patients had severe illness.
A recent larger study in press in Ophthalmology found that only 8 of 121 COVID-19 positive patients displayed ocular symptoms (itching, redness, tearing, discharge, and foreign body sensation) and that only 3 patients had positive results on RT-PCR from conjunctival swabs. The ocular findings noted in this study are largely nonspecific and may not necessarily be intrinsic to the coronavirus infection. Additional research and detailed assessment of patients are needed to validate these results.
Wear face masks, eye shield/goggles
As conjunctivitis is a common eye condition, ophthalmologists may be the first medical professionals to evaluate a patient with suspected COVID-19. Protocols as formalized by the All India Ophthalmic Society (AIOS) suggest triaging of patients suffering with conjunctivitis. A thorough history of all symptoms including history of fever, travel history is mandatory before examining any patient. Minimal or no touch techniques have to be followed. Ophthalmologists, ophthalmic assistants and all hospital staff should wear face masks, eye shield/goggles, gloves and disposable gowns at all times while in contact with patients.
Persons suffering from conjunctivitis need to maintain hand hygiene, use the prescribed medicines and keep their belongings especially towels, handkerchiefs etc away from others to prevent spread of disease. In the present scenario, any kind of eye flu like symptoms should not be taken lightly and such cases be very carefully investigated.
Dr. Gurdeep Singh completed his MBBS and MS in Ophthalmology from Gandhi medical college Bhopal. He did his FICO fellowship from Kiryu eye hospital Japan, FOMS from St. Vincent Hospital, Karlsruhe, Germany. After that, he went to work in Melbourne Australia to pursue training in Vitreoretinal surgery at the Royal Victoria hospital. He was one of the pioneers to implant intraocular lens during cataract surgery in Madhya Pradesh in 1986.
Dr Gurdeep is Director and Senior Eye Surgeon at Hi-Tech Eye Care & Laser Centre, A super speciality eye hospital in Bhopal.