Two new JAMA Ophthalmology studies detail cases of conjunctivitis in hospitalized children and adults with COVID-19 in Wuhan, China, one of them finding that nearly a quarter of pediatric patients had this condition.
Conjunctivitis, or "pink eye," is an infection or inflammation of the membrane lining the eyeball and eyelid.
Published yesterday, the first study found that 49 of 216 pediatric COVID-19 patients (23%) hospitalized from Jan 26 to Mar 18 had conjunctival discharge and congestion and eye rubbing. Those with systemic coronavirus symptoms or cough were most likely to have ocular symptoms but improved or recovered with only eye drops or no treatment.
The most common ocular signs and symptoms included conjunctival discharge (27 [55%]), eye rubbing (19 [39%]), and conjunctival congestion (5 [10%]). The first reported COVID-19 symptom in 9 of the children involved their eyes. Median age of patients with ocular manifestations was 4.1 years, compared with the overall median age of 7.3 years.
Of children with ocular signs and symptoms, 27 (55%) had increased conjunctival discharge, described as white mucoid (9 [18%]), thin/watery (7 [14%]), or yellow-green pus (11 [22%]), and conjunctival congestion (5 [10%]). Other issues included eye rubbing (19 [39%]), eye pain (4 [ 8%]), excessive tears (tearing; 2 [4%]), and eyelid swelling (4 [8%]).
While children of all ages had eye rubbing and conjunctival discharge, tearing occurred only in those aged 1 to 5 years, and eyelid swelling was observed only in those 10 to 16 years old.
Mild, self-limiting signs and symptoms
Two of 49 patients (4%) previously had allergic conjunctivitis. Treatment for ocular symptoms included observation without treatment (self-healing in 23 participants [47%]) or antibacterial, antiviral, or antiallergic eye drops. Median duration of ocular symptoms was 7 days.
Of 49 patients with ocular signs and symptoms, 41 (84%) had contact with a family member with COVID-19, and 6 (12%) were exposed to a family member with suspected infection. Most often noted in the children's medical history were runny nose (12%), hives (3%), respiratory disease (3%), cardiovascular disease (2%), surgery (1%), endocrine disease (1%), and other issues (4%).
The most common presenting symptoms included fever (38%) and cough (37%). Other symptoms were diarrhea (5%), fatigue (5%), runny nose (3%), stuffy nose (3%), conjunctival discharge (2%), and conjunctival congestion (2%).
Ninety-three of 216 children (43%) had no symptoms. Of the 93 asymptomatic children, 13 (14%) had ocular symptoms, while 80 (86%) didn't. Among all children, 101 (47%) had mild illness, and 115 (53%) had moderate disease. Median hospital stay was 11 days, and all patients were released from the hospital.
"Ocular disorders in children with COVID-19 are typically very mild, children recover rather quickly, and these disorder are not associated with any long-term complications," the authors wrote. "Most individuals with ocular symptoms recover spontaneously without any treatment. Therefore, we recommend only close observation for COVID-19–related ocular manifestations in children."
Possible role of testing eye secretion samples
The second study, published today, described two adults with COVID-19 and conjunctivitis in a mobile hospital for coronavirus patients. The first, a 29-year-old man, had conjunctival congestion in his right eye starting before hospitalization. He was given antiviral eye drops and isolated from other patients.
The second patient was a 51-year-old woman who developed conjunctival congestion, tearing, and watery secretions in her left eye 10 days after hospitalization. COVID-19 RNA was detected in the patient's tears. She was given antiviral eye drops and transferred to an intensive care unit for treatment of low oxygen levels.
The authors noted a previously reported case of a 30-year-old man with COVID-19 who developed conjunctivitis in both eyes 13 days after symptom onset, adding that swabbing the eyes as well as the throat of patients with possible COVID-19 could detect eye infections earlier.
"As the number of people infected with SARS-CoV-2 continues to increase, a large number of mild cases may be treated in mobile hospitals around the world," the researchers said. "Although this method might alleviate the shortage of medical resources and decrease transmission routes in the community, the ophthalmologist still may play a role in ocular screening and eye disease treatment as part of the fight during the pandemic."