Conjunctivitis most common ocular sign of COVID-19


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Colatrella N. Ophthalmic manifestations of COVID-19. Presented at: Optometry’s Meeting; June 24-26, 2021; Denver.

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DENVER – While the coronavirus has been detected on the ocular surface and in conjunctival secretions of COVID-19-positive patients, the virus is unlikely to be transmitted in this manner, according to a presentation at Optometry’s Meeting.

“A presenting symptom of COVID-19 could be red, irritated eyes,” Nicholas Colatrella, OD, said, “and follicular conjunctivitis is by far the most common ocular presenting sign.”

Other common ocular manifestations include lid margin hyperemia, crusted eyelashes and meibomian orifice abnormality.

“Viral conjunctivitis has been seen,” Colatrella said. “Patients can also present with hemorrhagic and pseudomembranous conjunctivitis.”

Nicholas Colatrella, OD

Nicholas Colatrella

A thorough exam should be done to rule out other common ocular manifestations, “but there are so many other reasons patients could have these issues,” Colatrella said.

Posterior segment manifestations may also be seen, he said, including retinal vascular occlusions.

“Crazy things may pop up,” Colatrella said, “Acute macular neuroretinopathy and paracentral acute middle maculopathy have been reported following or concurrent with COVID-19 diagnosis. It’s an acute, painless diminution of vision with faint, colorful paracentral scotomas — a migraine-like event.”

Other retinal findings may include peripheral retinal hemorrhages, macular hyperpigmentation, retinal sectoral pallor, peripapillary flame-shaped hemorrhages, hard exudates and cotton-wool spots.

“Neuro-ophthalmic manifestations are not common,” Colatrella said, “but a couple of cases of optic neuritis have been seen. Miller Fisher syndrome and cranial nerve palsy are rare. It’s most likely that the virus triggered this in patients who had it previously. A cerebrovascular accident with vision loss can result from a procoagulant state in COVID. Also, retroorbital pain could be a prominent and even presenting symptom in patients with COVID.”

Orbital cellulitis and sinusitis are possible, Colatrella said.

“It is suggested that COVID-induced upper respiratory congestion can compromise mucociliary clearance with secondary sinus obstruction and bacterial infection,” he said. “This must be treated quickly and with IV antibiotics.”

COVID-19 should be suspected when there is an unusual presentation of common ophthalmic pathology in a patient where it is not expected, Colatrella said.

“Knowing that many of these manifestations can be the presenting feature can help diagnose the infection early and limit disease transmission,” he said.

Another ophthalmic consequence of COVID-19 is children getting hand sanitizer in their eyes.

“There’s been a sevenfold increase of ER visits for kids due to this,” Colatrella said. “It debrides the epithelium right off these kids.

“Treat it like any large epithelial defect,” he continued. Possibilities include bandage contact lenses, antibiotics and amniotic membrane.

People are also experiencing mask-associated dry eye.

“Exhaled breath is blowing right back into the cornea and causing irritation,” he said. “There is really no solution.”

Other consequences include “quarantine myopia,” cessation of office visits for chronic ocular disease and increased ocular surface disease.

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