The infection evidence of SARS-COV-2 in ocular surface: a single-center cross-sectional study

  1. Xian Zhang
  2. Xuhui Chen
  3. Liwen Chen
  4. Chaohua Deng
  5. Xiaojing Zou
  6. Weiyong Liu
  7. Huimin Yu
  8. Bo Chen
  9. Xufang Sun

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Abstract

The aim of this study was to identify whether SARS-COV-2 infected in ocular surface.

Methods

Cross-sectional study of patients presenting for who received a COVID-19 diagnosis, from December 30, 2019 to February 7, 2020, at Tongji hospital, Tongji medical college, Huazhong University of Science and Technology. Demographics, temperature was recorded, blood routine test (Rt), chest Computed Tomography (CT) were took intermittently, and SARS-COV-2 real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay were arranged for the nasopharyngeal and conjunctival swab samples.

Results

A total of 102 patients (48 Male [50%] and 54 Female [50%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) confirmed by laboratory diagnosis with SARS-COV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis was identified from 72 patients with a laboratory confirmed COVID-19. However, SARS-COV-2 RNA fragments was found in ocular discharges by SARS-COV-2 RT-PCR only in one patient with conjunctivitis.

Conclusions

Although we suspect the incidence of SARS-COV-2 infection through the ocular surface is extremely low, the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-COV-2. Therefore, to lower the SARS-COV-2 nosocomial infection, the protective goggles should be wore in all the health care workers.

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  1. ScreenIT

    SciScore for 10.1101/2020.02.26.20027938: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the ethics committee of Tongji hospital and was performed in accordance with the tenets of the Declaration of Helsinki.6 Clinical specimens for 2019-nCoV diagnostic testing were obtained in accordance with CDC guidelines.
    Consent: All patients invited to participate in the study provided consent for the nasopharyngeal and conjunctival swab samples with synthetic fiber swabs.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The statistical analysis was performed using SPSS software version 22.0 (SPSS Inc, Chicago, IL).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations need to be considered. First, the conjunctival scraping test should be done as early as possible if we find ocular symptoms in a suspected one. The mean time for conjunctival sampling in our study are 18.15 days, in which exceeded the optimal detection time. Second, how to increase the positive rate. The most commonly used chest CT examination has certain limitations for the special suspected groups, such as pregnant women. In addition, we found that 2∼3 repeated tests did in suspected patients of nasopharyngeal swabs before the SARS-CoV-2 was obtained, which may be related to the false-negative result of RT-PCR. Therefore, the low viral load in the ocular surface and the lower positive rate of RT-PCR makes early diagnosis of SARS-CoV-2 a challenge. Recently, Doan21 reported that the influenza virus and rubella virus found in patients’ conjunctival sac or tears by the next generation sequencing rapidly, which provides us with a feasible direction for future study.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.02.26.20027938 on medRxiv