Are Ocular Symptoms Common in Patients with COVID-19?

Background: Coronavirus disease 2019 (COVID-19) is a highly infectious disease transmitted human-to-human by the coronavirus SARS-CoV-2. The SARS-CoV-2 RNA has been found in conjunctival scrape samples in a small number of COVID-19-positive patients with conjunctivitis. We further investigated subtle ocular involvement in confirmed COVID-2019 cases by assessing subjective ocular symptoms. Methods: Fifty-six COVID-19-positive patients, discharged from hospital, participated as subjects. Medical histories were obtained from the medical record system. Ocular history and ocular symptoms data were obtained using subjective recall and structured questionnaires for before and after onset of COVID-19. Findings: Subjects classified as “severe” COVID-19 cases were more likely to have hypertension than “mild” cases (p<0·05). Thirteen subjects (23·2%) were infected in Wuhan, 30 (53·6%) were community-infected in Hangzhou, 12 (21·4%) were unknown origin, one (1·8%) was a doctor presumed infected while on duty. Three subjects reported wearing face masks when in close contact with confirmed cases. Fifteen subjects (26·8%) reported ocular symptoms in the course of COVID-19. Six subjects (10·7%) reported ocular symptoms several days before fever and respiratory symptoms onset. The differences in mean scores of OSDI and SEEQ questionnaires before and after onset of COVID-19 were significant (p<0·05). Interpretation: Ocular symptoms are associated with COVID-19 and in some cases, appear just before the onset of systemic symptoms. These subtle ocular symptoms may be indicative of a wider ocular involvement in COVID-19 than previously thought. Funding Statement: Maurice Yap is supported by an endowed professorship from the KB Woo Family. Declaration of Interests: No conflicting relationship exists for any author. Ethics Approval Statement: The study was approved by the Ethics Committee of the First-Affiliated Hospital of Zhejiang University and performed in accordance with the tenets of the Declaration of Helsinki.