COVID-19: SARS-CoV-2 isolated in ocular secretions

  • Daniela Ovadia — Agenzia Zoe
  • Univadis Medical News
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SARS-CoV-2 was isolated in the ocular secretion of a 65-year-old woman, travelling from Wuhan, China, to Italy on 23 January 2020 and admitted on 29 January 2020, one day after symptom onset. She presented with nonproductive cough, sore throat, coryza, and bilateral conjunctivitis. She had no fever until day 4, when fever (38 °C), nausea, and vomiting began. Infection with SARS-CoV-2 was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR) assay on sputum samples followed by viral M gene sequencing.

On day 3 after hospital admission, owing to the persistence of conjunctivitis, an ocular swab was collected and viral RNA was detected. Subsequent ocular samples collected with almost daily frequency resulted positive up to day 21, with declining virus concentration. Conjunctivitis greatly improved at day 15 and apparently resolved at day 20.
Five days after it became undetectable, SARS-CoV-2 RNA was detected again in the ocular swab sample collected at day 27. SARS-CoV-2 RNA was detected in ocular swabs days after it was undetectable in nasal swabs.
Ocular fluids from SARS-CoV-2-infected patients may contain infectious virus, according to the authors, and hence may be a potential source of infection. As ocular involvement of SARS-CoV-2 may occur early in the COVID-19 course, measures to prevent transmission via this route must be implemented as early as possible.

Human-to-human transmission occurs mainly through respiratory droplets, but other routes are under investigation, because SARS-CoV-2 has been detected in several body fluids. So far, few data are available on ocular samples from patients with COVID-19, although conjunctivitis has been occasionally reported among COVID-19 symptoms, similar to infections caused by other human coronaviruses.

During the SARS epidemic, eye exposure to infectious fluids was associated with an increased risk for SARS-CoV transmission to health care workers.