Implications of COVID-19 for Ophthalmologists

Danesh-Meyer, Helen V.; McGhee, Charles NJ.

PURPOSE: To describe and explain the implications of COVID-19(SARS-CoV-2) for ophthalmologists in light of the rapid developments in our understanding of the virology, transmission and ocular involvement. DESIGN: Evidence-based perspective METHODS: Review and synthesis of pertinent literature RESULTS: Retrospective studies highlight that less than 1% of patients display COVID-19 related-conjunctivitis. However, prospective studies suggest the rate is higher, approximately 6%. Viral RNA has been identified in tears and conjunctival secretions in patients with active conjunctivitis as well as asymptomatic cases. Overall, conjunctival swabs are positive in 2.5%. Samples taken earlier in the disease course are more likely to demonstrate positive virus. Viral transmission through ocular tissues has not been substantiated. Ophthalmologists are in the high-risk category for COVID-19 infection for several reasons: high volume clinics, close proximity with patients, equipment intense clinics and direct contact with patients’ conjunctival mucosal surfaces. COVID-19 is predominantly contracted through direct or airborne transmission by inhalation of respiratory droplets. Evidence that aerosol transmission occurs is increasing in particularly prolonged exposure to high concentrations in a relatively closed environment. Based on the current evidence ophthalmologists should consider measures that include social distancing, wearing masks, sterilisation techniques and managing clinic volumes. CONCLUSIONS: A major challenge to containing COVID-19 is that many infected people are asymptomatic. Droplet spread, contaminated environmental surfaces and shared medical devices are particular areas that require management by ophthalmologists. More studies are required to explore the role of the conjunctiva and ocular tissues in the transmission of disease.