Ocular Surface and Conjunctival Cytology Findings in Patients With Confirmed COVID-19

PURPOSE: To assess the effect of severe acute respiratory syndrome coronavirus-2 infection on the conjunctiva and tear film METHODS: Thirty-eight patients with confirmed COVID-19 and 31 healthy controls were included in this prospective and observational study Individuals with COVID-19 formed the patient group, and healthy individuals formed the control group Conjunctival impression cytology (CIC), TBUT, Schirmer II test, and ocular surface disease index were evaluated in all participants RESULTS: No significant difference was observed regarding the mean age and gender between the groups (P=0 786 and P=0 122, respectively) The mean TBUT and Schirmer II test results did not differ between the two groups (P=0 496 and P=0 447, respectively) The CIC results revealed decreased density and cell size of goblet cells and moderate to high enlargement, squamous changes, and increased nucleocytoplasmic ratio in nongoblet epithelial cells in the COVID-19 group compared with the control group Based on the Nelson classification in CIC samples, 60 6% of the COVID-19 group and 19 4% of the control group had changes consistent with grade 2 or above The presence of neutrophils in CIC was significantly higher in the COVID-19 group (P<0 001), whereas the presence of lymphocyte was similar between the two groups (P=0 247) CONCLUSION: This study revealed the pathological conjunctival alterations in patients with COVID-19 and demonstrated that pathological ocular surface alterations may present even at the beginning of COVID-19 without clinically significant ocular manifestation