The Sequelae of Bilateral Conjunctivitis as an Initial Presentation of Presumed COVID-19 Positive Female
Main Article Content
Background and Objective
Presented is a case of a 28-year-old female, who was diagnosed with presumed COVID-19 (SARS-CoV-2) and the sequelae of her bilateral conjunctivitis. Since December 2019, the presence of severe acute respiratory syndrome COVID-19 has swept worldwide, infecting over 170 million to date and counting. It has been discovered that the virus can make its way to the eyes due to an abundance of human angiotensin-converting enzyme-2 on the conjunctiva. There are limited reports accounting for bilateral keratocon-junctivitis associated with SARS-CoV-2, and even less reporting as the initial symptom and the sequelae of the ocular findings that can be associated with a COVID-19 positive patient. In this report, the signs, symptoms, management, and treatment of COVID-19 related keratoconjunctivitis will be discussed.
Presented is a case of a 28-year-old female diagnosed with presumed COVID-19 and the sequelae of her bilateral conjunctivitis.
A 28-year-old female initially presented to her local emergency room on 7/9/2020 for bilateral red eyes and loss of taste and smell. She tested positive for COVID-19 at that time via a polymerase chain reaction nasopharyngeal swab. There was no conjunctival swab or serology testing of her tears performed. Her ocular symptoms persisted for an additional 3 weeks when she finally presented to our clinic, with bilateral keratoconjunctivitis, after testing negative for the virus 14 days prior.
This case presents findings of an initial presentation of bilateral conjunctivitis secondary to presumed COVID-19. The sequelae of the patient’s ocular findings after testing negative for COVID-19 were of specific interest. This case provides a resource to help guide eye care professionals in proper questioning of those diagnosed with COVID-19 about ocular symptoms they had initially, as well as symptoms that occurred after systemic resolution of the virus infection. Furthermore, this case can help educate eye care professionals on the possible sequalae, management, and treatment of COVID-19-related keratoconjunctivitis to ensure full resolution of its effect and provide a good visual outcome for patients. We will continue to learn more about COVID-19 and its effects on the eye as well as the effect of COVID-19 vaccines on ocular manifestations of the virus.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Pettersson H MB, Hernandez S. Tracking Covid-19’s global spread: The disease has spread to every continent and case numbers continue to rise. [cited 2021 May 28]. Available from: https://www.cnn.com/interactive/2020/health/ coronavirus-maps-and-cases/
3. Willcox MDP, Walsh K, Nichols JJ, Morgan PB, Jones LW. The ocular surface, coronaviruses and COVID-19. Clin Exp Optom. 2020;103(4):418–24. http://dx.doi.org/10.1111/cxo.13088
4. Siedlecki J, Brantl V, Schworm B, Mayer WJ, Gerhardt M, Michalakis S, et al. COVID-19: Ophthalmological aspects of the SARS-CoV 2 global pandemic. Klin Monbl Augenheilkd. 2020;237(5): 675–80. http://dx.doi.org/10.1055/a-1164-9381
5. Cheema M, Aghazadeh H, Nazarali S, Ting A, Hodges J, McFarlane A, et al. Keratoconjunctivitis as the initial medical presentation of the novel corona-virus disease 2019 (COVID-19). Can J Ophthalmol. 2020;55(4):e125–9. http://dx.doi.org/10.1016/j.jcjo.2020.03.003
6. Huang Y, Yang C, Xu XF, Xu W, Liu SW. Structural and functional properties of SARS-CoV-2 spike protein: Potential antivirus drug development for COVID-19. Acta Pharmacol Sin. 2020;41(9):1141–9. http://dx.doi.org/10.1038/s41401-020-0485-4
7. Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020;92(6):589–94. http://dx.doi.org/10.1002/jmv.25725
8. Bestle D, Heindl MR, Limburg H, Lam van TV, Pilgram O, Moulton H, et al. TMPRSS2 and furin are both essential for proteolytic activation and spread of SARS-CoV-2 in human airway epithelial cells and provide promising drug targets. Life Sci Alliance. 2020;3(9):e202000786. http://dx.doi.org/10.26508/lsa.202000786
9. Guo D, Xia J, Wang Y, Zhang X, Shen Y, Tong JP. Relapsing viral keratoconjunctivitis in COVID-19: A case report. Virol J. 2020;17(1):97. http://dx.doi.org/10.1186/s12985-020-01370-6
10. Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020;104(6):748–51. http://dx.doi.org/10.1136/bjophthalmol-2020-316304
11. Bedinghaus T. An overview of epidemic keratoconjunctivitis. 2020. Available from: https:// www.ver ywellhealth.com/epidemic-keratoconjunctivitis-ekc-3421989
12. Mangalmurti N, Hunter CA. Cytokine storms: Understanding COVID-19. Immunity. 2020; 53(1):19– 25. http://dx.doi.org/10.1016/j.immuni.2020.06.017
13. Bleier BS, Ramanathan M, Jr., Lane AP. COVID-19 vaccines may not prevent nasal SARS-CoV-2 infection and asymptomatic transmission. Otolaryngol Head Neck Surg. 2021;164(2):305–7. http://dx.doi.org/10.1177/0194599820982633
14. Nyankerh CNA, Boateng AK, Appah M. Ocular complications after COVID-19 vaccination, vaccine adverse event reporting system. Vaccines (Basel). 2022;10(6):941. http://dx.doi.org/10.3390/vaccines10060941