Vaccination

Eye Problems Give Clues To Systemic Impact Of COVID-19

Follicular conjunctivitis is seen in 3 to 13.6 per cent of all patients with COVID-19 and may be the first sign of illness. The conjunctiva is vulnerable to SARS-CoV-2 infection by direct inoculation or spread from the nasolacrimal duct or lacrimal gland. Conjunctival tissue destruction causes release of virus particles into tears, which can be detected in tear PCR testing in a small proportion of patients.1–5

Therefore, it is important to ask patients presenting with a pink eye about exposure to COVID-19, test for COVID-19, and don personal protective equipment (including eye protection) during examination.

COVID-19 follicular conjunctivitis is usually self-limiting and can be treated with cool compresses and artificial tears. However, complications requiring ophthalmology referral can occur. These include pseudomembranous conjunctivitis, conjunctival scarring, corneal pseudodendrites and superimposed bacterial keratitis.2–6 Checking visual acuity, examining the lids for pseudomembranes, and assessing the corneal surface with fluorescein will identify these patients.

The presence of conjunctivitis is also associated with the severity of systemic COVID-19 illness. Patients requiring hospital admission for acute respiratory distress syndrome are at least three times more likely to have a positive conjunctival COVID-19 swab than those with less severe respiratory disease.3,5 Conjunctivitis in a patient with COVID-19 should alert the GP that this patient may have, or may develop, severe disease. They should be monitored regularly for clinical deterioration requiring hospital admission.

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