Ocular manifestations and clinical characteristics of 535 cases of COVID‐19 in Wuhan, China: a cross‐sectional study

  1. Liwen Chen
  2. Chaohua Deng
  3. Xuhui Chen
  4. Xian Zhang
  5. Bo Chen
  6. Huimin Yu
  7. Yuanjun Qin
  8. Ke Xiao
  9. Hong Zhang
  10. Xufang Sun

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Abstract

Purpose

To investigate the ocular manifestations and clinical characteristics of COVID‐19 patients caused by SARS‐CoV‐2 in Wuhan, China.

Methods

A total of 535 COVID‐19 patients were recruited at Mobile Cabin Hospital and Tongji Hospital. Information on demographic characteristics, exposure history, ocular symptoms, eye drop medication, eye protections, chronic eye diseases, systemic concomitant symptoms, radiologic findings and SARS‐CoV‐2 detection in nasopharyngeal swabs by real‐time PCR was collected from questionnaires and electronic medical records.

Results

Of 535 patients, 27 patients (5.0%) presented with conjunctival congestion and 4 patients had conjunctival congestion as the initial symptom. The average duration of conjunctival congestion was 5.9 ± 4.5 days (mean [SD]). The other ocular symptoms, including increased conjunctival secretion, ocular pain, photophobia, dry eye and tearing, were also found in patients with conjunctival congestion. Notably, hand–eye contact was independently correlated with conjunctival congestion in COVID‐19 patients. We also found that some COVID‐19 patients had chronic eye diseases, including conjunctivitis (33, 6.2%), xerophthalmia (24, 4.5%) and keratitis (14, 2.6%). Similar to the published studies, the most common clinical symptoms were fever, cough and fatigue. A total of 343 patients (64.1%) had positive SARS‐CoV‐2 detection in nasopharyngeal swabs.

Conclusions

Conjunctival congestion is one of the COVID‐19‐related ocular symptoms, which could occur as the initial symptoms. Frequent hand–eye contact may be the risk factor for conjunctival congestion in COVID‐19 patients. Screening of patients with conjunctival congestion by ophthalmologists is advocated during the outbreak of COVID‐19. It is essential to provide eye‐care equipment and strengthen education on eye protection.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.12.20034678: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The ethics committee of Tongji Hospital and the China Ethics Committee for Registering Clinical Trials
    Consent: Written informed consent was obtained from the patients involved.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    The present study has some limitations. First, the sample size was small and the covered population consisted mainly of patients with mild disease; this is because only patients with mild symptoms and cured patients could complete our questionnaire survey. Second, this is a descriptive study, and no correlation analysis was performed; however, we present the ocular manifestations that we observed during the SARS-CoV-2 outbreak in detail. To date, this is the most comprehensive survey with the largest sample related to the eyes. Third, no normal population was observed in our study, therefore, a normal control group should be included for comparison in future studies. In conclusion, although ophthalmology is not the main battlefield among all kinds of major infectious diseases, the significance of understanding the ocular manifestations of our present study lies in 1) helping to deepen the understanding of COVID-19–associated eye diseases; identify ocular symptoms, manifestations, and clinical outcomes; and enrich the symptom spectrum of COVID-19; 2) observing the incidence of eye diseases during COVID-19 treatment in hospital; and 3) providing a clue that patients with eye diseases are not being effectively treated during the COVID-19 outbreak. Our findings may provide useful information for the diagnosis and treatment of COVID-19 and indicate the need for effective eye protection for COVID-19 patients. Simultaneously, it also provides useful clues for the treatment of eye di...

    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 10.1111/aos.14472
  3. Version published to 10.1101/2020.03.12.20034678v1 on medRxiv