Pharmacists Be Aware: Pink Eye Might Signal COVID-19 Infection

Pink eye is a common condition and, in normal times, raises few concerns. But these times are far from normal, and pharmacists should be aware that conjunctivitis can be a presenting symptom for novel coronavirus infection. Here is more information on a Canadian case and research from China.

ALBERTA, CANADA – Pharmacists might want to suggest that patients who present with pink eye be tested for COVID-19.

That is according to a recent clinical article from University of Alberta researchers, as well as previous research from China.

The case report in the Canadian Journal of Ophthalmology discusses that, while coughing, fever and difficulty breathing are common symptoms of novel coronavirus infection, the situation involving a Canadian woman from Edmonton has led to the assumption that conjunctivitis and keratoconjunctivitis can also be primary symptoms.

Researchers describe how, in March, a 29-year-old woman showed up at the Royal Alexandra Hospital's Eye Institute of Alberta with a severe case of conjunctivitis and minimal respiratory symptoms. The patients, who said she has recently returned from Asia, showed little improvement after several days of treatment and tested positive for COVID-19.

"What is interesting in this case, and perhaps very different to how it had been recognized at that specific time, was that the main presentation of the illness was not a respiratory symptom. It was the eye," explained Carlos Solarte, MD, MPH, an assistant professor of ophthalmology. "There was no fever and no cough, so we weren't led to suspect COVID-19 at the beginning. We didn't know it could present primarily with the eye and not with the lungs."

Solarte recounts how academic studies at the outset of the pandemic identified conjunctivitis as a secondary symptom in about 10 to 15% of COVID-19 cases. Since then, he notes, scientists have learned more about how the virus can transmit through and affect the body's mucous membrane system.

"The patient in this case eventually recovered well without any issues. But several of the residents and staff who were in close contact with the patient had to be under quarantine," said Solarte. "Fortunately, none who were involved in her care also tested positive."

An article in JAMA Ophthalmology at the end of March discussed ocular manifestations and conjunctival viral prevalence in patients from Hubei province, China, with COVID-19.

That study looked at a case series including 38 patients with COVID-19, determining that 12 patients had ocular manifestations, such as epiphora, conjunctival congestion, or chemosis. Researchers suggest that those symptoms commonly occurred in patients with more severe systemic manifestations.

Reverse transcriptase–polymerase chain reaction results were positive for severe acute respiratory syndrome coronavirus 2 in 28 nasopharyngeal swabs and two conjunctival swabs, and more significant changes in blood test values appeared in patients with ocular abnormalities.

The authors caution that, although there is a low prevalence of SARS-CoV-2 in tears, it is possible to transmit via the eyes.

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