SCIENTISTS are still deep in the research process of uncovering all the ways in which COVID-19 can be transmitted. Now, in a new study, researchers at the University of Hong Kong have found eyes are ‘important route’ for coronavirus.
The findings are challenging the widely held assumption in the earliest stages of the health crisis that medical staff would be adequately protected with N95 masks and protective clothing, without the need for specialist glasses.
The study, which reinforces the piece of advice to the public not to touch their eyes and to wash hands regularly to avoid infection, said COVID-19 may be transmitted through the eye.
Researchers analysed data from 38 patients with COVID-19 from Hubei Province, China, and found 12 individuals had eye manifestations, including epiphora (excessive tear production), pink eye or chemosis (an eye irritation).
A new report published by JAMA Ophthalmology found preliminary data may suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), might be transmitted through the eye.
These symptoms commonly occur in patients with severe systemic manifestations of COVID-19 and are consistent with conjunctivitis, or pink eye. None of the 12 patients experienced blurred vision.
The study also found COVID-19 was present on conjunctiva swabs from 2 of 11 (18 per cent) patients tested for SARS-CoV-2 via nasal swabs.
Dr Yinka Ologunsua, a consultant ophthalmologist at LAUTECH Teaching Hospital Osogbo, Osun State, stated that it is possible for the eye to be infected with coronavirus through the conjunctiva, the mucus membrane in the eyes.
According to him, coronavirus has been documented to be present in many body fluids such as the blood, semen, saliva or tears.
Although the nose is the most common route coronavirus enters into the human body, he declared that the eye can also be infected if touched by a hand contaminated with the germ.
Nonetheless, Dr Ologunsua said the possibility of the coronavirus, which causes COVID-19 entering the eye is why the Personal Protective Equipment (PPE), also has some part of it covering the eyes and the face.
Dr Ologunsua said eye protection is only important in health workers such as ophthalmologists, Ear, Nose and Throat surgeons and dentists who in the course of assessment and treatment get close to their patients.
“For those who are involved with ordinary day to day things, it is not compulsory that they wear eye protectors like goggles. As long as you are not touching their eyes and maintain social distance, the risk is very low,” he added.
Dr Opeyemi Komolafe, a consultant ophthalmologist at the Federal Medical Centre, Owo, stated that COVID-19 is a novel disease and a lot of things are still not clear about it for now.
According to him, even if the tear fluid contains the virus, because the tear fluid stays in the eye and does not splash, the likelihood of getting it from the eye is still low, except by touching the eye.
He declared, “Red eye, for now, is not a major presenting symptom in coronavirus infection, but some people have actually said that it can happen. Some have also reported that the virus even lives longer in the conjunctival even longer than it lives in the nose.”
According to Dr Komolafe, the possibility that the germ hanging in the air can get deposited in the eye is very remote.
“That is why the issue of maintaining adequate distance, for now, becomes very important and at every point, you wash your hands.”
Dr Gboyega Ajayi, the Chief Executive Officer of Eleta Eye Institute, Ibadan, said that Dr Li Wenliang, an ophthalmologist, in Wuhan China was the first to alert the world about COVID-19.
He stated that in the course of treating the infected patients, a good number of patients were found to have red eyes called conjunctivitis.
Dr Ajayi added, “In actual fact, some COVID -19 patients with conjunctivitis were also found to have the virus in their conjunctival secretions in addition to the virus in their throats and nostrils.
“This does not come as a surprise because of the continuity between the conjunctival linings of the eye through the nose to the throat, airways and lungs.
“The conjunctiva is also exposed to the atmosphere and is an easy target of the droplets or aerosols from an infected person while talking, sneezing or coughing.
“The popular adage of the Yoruba, that whatever affects the eye will affect the nose is true. And we know that once in the nose it will get to the throat.
“It is therefore not unusual that a patient with cold, catarrh or flu has watery eyes, runny nose to develop a cough followed by breathing difficulties and death from lack of air getting into his lungs. So conjunctivitis (red eyes) could as well be a warning sign of the presence of COVID-19 infection.”
“Simply put, discharge from the eyes could be another source of transmission of the disease. And that is one of the reasons that we have been asked to wash and sanitise our hands before we touch our face.
“When you wear a mask and keep touching and pulling it up with your fingers or removing and putting it back, you are actually increasing your chances of getting infected! So your mask becomes a danger rather than a preventive barrier for Covid-19 infection.”
Dr Ajayi added that the watery discharge from the conjunctiva can be deposited on any surface touched by the infected patient and aid the spread of the infection. As such measures need to be taken at eye clinics to sanitise all instruments that in the course of treatment touch the eye.
“Both the patient and the caregiver must ensure compliance with safety measures because one is at the risk of infecting not just the other person but all other people who come in contact with them.”
Previously, the American Academy of Ophthalmology (AAO) observed that some reports suggest “the virus can cause conjunctivitis and possibly be transmitted by aerosol contact with the conjunctiva.” The AAO also reported that there is a low risk of spreading COVID-19 through tears.
The team led by Dr Michael Chan Chi-wai, which published its findings in the latest issue of The Lancet Respiratory Medicine also provided evidence that coronavirus can infect humans through the eye and airways.
They found that SARS-Cov-2, the strain of coronavirus that causes the Covid-19 disease, is much more efficient in infecting the human conjunctiva and the upper respiratory airways than SARS, with virus level some 80 to 100 times higher.
The findings from Dr Chan’s team and others challenge the widely held assumption in the earliest stages of the health crisis that medical staff would be adequately protected with N95 masks and protective clothing, without the need for specialist glasses.
Nevertheless, this wasn’t the first study to document eye-related symptoms for those with COVID-19. A study published late February in the New England Journal of Medicine reviewed data on 1,099 patients who had laboratory-confirmed COVID-19 from 552 hospitals in China.
These are not big numbers of people with possible COVID-19 conjunctivitis, implying that the rate of eye symptoms for COVID-19 is probably low. Regardless, these studies do suggest that infection of the eyes is possible.
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