Researchers identify pink eye as possible primary symptom of COVID-19

A team of researchers at the University of Alberta believe a case of pink eye is now a reason to be tested for COVID-19.

While coughing, fever and difficulty breathing are common symptoms of the illness, a recent case study involving an Edmonton woman and published in the Canadian Journal of Ophthalmology has determined that conjunctivitis and keratoconjunctivitis can also be primary symptoms.

A separate team of researchers have found the COVID-19 virus can cause ocular complications such as conjunctivitis, though not necessarily in the early stages of the disease.

A 29-year-old woman arrived at the Royal Alexandra Hospital's Eye Institute of Alberta in March with a severe case of conjunctivitis and minimal respiratory symptoms.

After the patient had undergone several days of treatment with little improvement. After it had been determined that the woman had recently returned home from Asia, a resident ordered a COVID-19 test. The test came back positive.

Main presentation was the eye

"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," Carlos Solarte, an assistant professor of ophthalmology at the University of Alberta, said in a press release.

"There was no fever and no cough, so we were not led to suspect COVID-19 at the beginning,” he said. “We didn't know it could present primarily with the eye and not with the lungs."

According to Solarte, academic studies at the outset of the pandemic identified conjunctivitis as a secondary symptom in about 10 to 15 percent of COVID-19 cases.

Since then, scientists have gained greater knowledge of how the virus can transmit through and affect the body's mucous membrane system, of which the conjunctiva--the clear, thin membrane that covers the front surface of the eye--is an extension.

While the finding provides important new health information for the public, it also makes eye exams more complicated for ophthalmologists and staff.

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

Take precautions

Patients coming into an eye clinic with conjunctivitis and keratoconjunctivitis are now treated as potential cases of COVID-19 and extra precautions are taken by staff. Workers performing an eye exam are strongly advised to wear personal protective equipment to minimize potential exposure to the illness. Solarte added that it is important to ensure that everyone is well protected.

“Our residents are now using gloves, gowns and facial masks every time they see one of these patients," Solarte added. "We need to be really careful about protective measures to examine these patients."

As ophthalmology practices have returned to work, to support the safe reopening of care, the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Outpatient Ophthalmic Surgery Society, developed a checklist that details specifically how to approach and manage some of the key decisions in reopening more normal practice in the COVID-19 era.

According to the groups, with respect to COVID-19 testing, facilities should adhere to state and local guidance.

Decisions on reopening eye clinics to routine care and resuming elective eye surgery should be made in consideration of numerous factors, including but are not limited to evolving city and state restrictions to nonessential services, local/regional new case rates, availability of PPE and access to COVID-19 testing.