The Ocular Manifestations and Transmission of COVID-19; Recommendations for Prevention

Dockery, Dominique M.; Rowe, Susannah G.; Murphy, Marjorie A.; Krzystolik, Magdalena G.

Abstract Background Coronavirus disease-2019 (COVID-19), caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been linked to ocular signs and symptoms in several case reports. Research has demonstrated that SARS-CoV-2 is spread primarily through close contact via respiratory droplets, but there is the possibility for ocular transmission with the conjunctiva as a conduit as well as a source of infection. Discussion Ocular manifestations of SARS-CoV-2 include follicular conjunctivitis and have been repeatedly noted as an initial or subsequent symptom of COVID-19 positive patients. Particularly in patients with ocular manifestations, there is evidence that the virus may present in tears based on the detection of SARS-CoV-2 in conjunctival swab samples via reverse transcription polymerase chain reaction (RT-PCR). The virus may therefore be transmittable from the ocular surface to a new host via contact with the ocular mucosa, tears, or subsequent fomites. Conclusions All healthcare professionals should ask patients about ocular symptoms consistent with SARS-CoV-2, use eye protection such as goggles or face shields as part of the standard personal protective equipment (PPE) for high-risk patients in addition to wearing of masks both by the patient and provider, and should consider tears to be potentially infectious.