Strict measures to protect mouth, nose and eyes are recommended to healthcare professionals, including ophthalmologists, to prevent COVID-19 infection. 

“Ophthalmologists should take particular care when examining patients, because of both the proximity to patients’ nose and mouth, and the potential exposure to tears which may contain the virus,” according to the authors of an editorial published in the British Journal of Ophthalmology. 

The same authors also emphasized the importance of detecting potential ocular manifestations of the infection.  Though not yet proven, viral conjunctivitis should be considered as “a possible presentation”.   

The transmission route of COVID-19 is considered to be mainly respiratory, but transmission through the ocular surface should not be excluded, they pointed out. One case of reported infection involved a healthcare worker, part of the task force active in Wuhan, who was fully gowned with protective suit and N95 respirator but did not wear anything to protect his eyes. The first symptom of COVID-19 infection was unilateral conjunctivitis, followed by a fever a few hours later.   

“Since his report, healthcare professionals in China have been urged to use eye protection when they are in close contact with patients,” the authors wrote.  

They emphasized the need, at this time of limited information, “to stay highly vigilant to recognise early manifestation of COVID-19 including consideration of viral conjunctivitis as a possible presentation”, and to adopt the recommended measures for prevention of infection,  including strict hand hygiene and protection of the exposed mucous membranes with goggles or face masks.

They also recommended that patients who present to the hospital with viral conjunctivitis should be questioned about travel history, systemic influenza-like symptoms and family history. On the other hand, patients with confirmed COVID-19 infection should be asked if they had sign and symptoms of conjunctivitis prior to respiratory and other systemic symptoms, in order to better understand the natural history of the disease.

“Research into if COVID-19 can be found in tears and conjunctival scrapings would be valuable and inform ongoing disease prevention strategies,” they concluded.  .

Sources: 

Li J-PO, Lam DSC, Chen Y, et al. Br J Ophthalmol 2020;104:297–298. Published Online First 13 February 2020, doi:10.1136/bjophthalmol-2020-315994 

Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored.  Lancet. 2020 Feb 22;395(10224):e39. doi: 10.1016/S0140-6736(20)30313-5. Epub 2020 Feb 6