Dry eye symptoms are prevalent in moderate-severe COVID-19, while SARS-COV-2 presence is higher in mild COVID-19: Possible ocular transmission risk of COVID-19

Rina La Distia Nora; Syaffa Sadida Zahra; Mei Riasanti; Aliya Fatimah; Rani Dwi Ningtias; Fera Ibrahim; Budiman Bela; R R Diah Handayani; Andi Yasmon; Made Susiyanti; Lukman Edwar; Yulia Aziza; Ratna Sitompul

doi:10.1016/j.heliyon.2024.e28649

Dry eye symptoms are prevalent in moderate-severe COVID-19, while SARS-COV-2 presence is higher in mild COVID-19: Possible ocular transmission risk of COVID-19

Heliyon. 2024 Mar 27;10(7):e28649. doi: 10.1016/j.heliyon.2024.e28649. eCollection 2024 Apr 15.

Authors

Rina La Distia Nora^{1

2

3}, Syaffa Sadida Zahra², Mei Riasanti¹, Aliya Fatimah³, Rani Dwi Ningtias³, Fera Ibrahim^{2

4}, Budiman Bela^{2

4}, R R Diah Handayani^{2

5}, Andi Yasmon⁴, Made Susiyanti¹, Lukman Edwar¹, Yulia Aziza¹, Ratna Sitompul¹

Affiliations

¹ Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia.
² Universitas Indonesia Hospital (RSUI), Depok, West Java, Indonesia.
³ Wisma Atlet COVID-19 Emergency Hospital, North Jakarta, Jakarta, Indonesia.
⁴ Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia - Cipto Mangunkusumo, Jakarta, Indonesia.
⁵ Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia - Persahabatan Hospital, Jakarta, Indonesia.

Abstract

Purpose: To evaluate the correlation between dry eye symptoms and coronavirus disease 2019 (COVID-19) infection and to assess the real-time reverse transcription-polymerase chain reaction (RT‒PCR) of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from the conjunctival swab.

Methods: A prospective observational case series study was conducted of all suspected and confirmed COVID-19 patients from Dr. Cipto Mangunkusumo Hospital (RSCM) and the Universitas Indonesia Hospital (RSUI). On the first day of the visit (day 0), systemic clinical symptoms and naso-oropharyngeal (NO) RT‒PCR results will classify all subjects as non-, suspected, or confirmed (mild, moderate, and severe) COVID-19. In all patients, we determined the dry eye symptoms based on the Ocular Surface Disease Index (OSDI) and followed up 7(day 7) and 14 days (day 14) after the first visit. When it was technically possible, we also examined the objective dry eye measurements: tear meniscus height (TMH), noninvasive Keratograph® break-up time (NIKBUT), and ocular redness. Additionally, we took conjunctival swab samples for SARS-CoV-2 RT-PCR in all patients.

Results: The OSDI scores for 157 patients decreased across days 0, 7, and 14 (median (interquartile range): 2.3 (0-8), 0 (0-3), and 0 (0-0), p value < 0.0001 (D0 vs D14). The moderate-severe COVID-19 group had a higher OSDI score than the other groups at median D0 (15.6 vs 0-2.3), p value < 0.0001 and this pattern was consistently seen at follow-up D7 and D14. However, dry eye complaints were not correlated with the three objective dry eye measurements in mild-moderate COVID-19 patients. NO RT‒PCR results were positive in 32 (20.4%) patients, namely, 13 and 19 moderate-severe and mild COVID-19 patients, respectively. Positive RT‒PCR results were observed in 7/157 (4.5%) conjunctival swab samples from 1 in non-COVID-19 group and 6 in mild group.

Conclusion: In the early phase of infection, COVID-19 patients experience dry eye symptoms, which have no correlation with objective dry eye measurements. SARS-CoV-2 in conjunctival swab samples can be detected in patients with normal-to-mild COVID-19, which shows the risk of ocular transmission.

Keywords: COVID-19; Coronavirus; Dry eye; OSDI; SARS-CoV-2.