CONJUNCTIVITIS AS A MAIN MANIFESTATION OF COVID-19: A CASE REPORT

Introduction: To describe the multiplicity of ocular manifestations of COVID-19 patients, we report a case of bilateral conjunctivitis related with SARS-CoV-2 infection without respiratory involvement in a patient with novel coronavirus disease (COVID-19).

Case Summary: A 25-year-old healthy female developed severe conjunctivitis in her right eye, followed by her left eye 4 days after fever and myalgia. The patient had no symptoms of cough, shortness of breath. On day 7, nasopharyngeal swab to identify SARS-CoV-2 by RT-PCR was positive and on day 10, after worsening of conjunctivitis, conjunctival swab specimens were found positive for SARS-CoV-2. There were no respiratory symptoms, her chest x ray and chest computed tomography (CT) did not show pneumonia.

Discussion and Conclusion: SARS-CoV-2 can cause life-threatening respiratory failure, but there are evidences representing alternative modes of transmission and others organs complications that can be also life threatening. In this case we describe a severe bilateral viral conjunctivitis in a young woman with COVID-19 infection and on day 10 after severe symptoms, conjunctival swab RT-PCR test result was positive. There are few studies that shows, presence of coronavirus in tears and conjunctival secretions is probably due to direct inoculation of SARS-CoV-2 from infected droplets, the migration by the nasolacrimal duct, or hematogenous infection of the lacrimal gland. Few studies with a positive RT-PCR test findings in conjunctival swab samples of confirmed COVID-19 patients provide objective evidence for SARS-CoV-2 ocular surface infection. However, some patients with positive conjunctival RT-PCR results with no evidence of conjunctivitis.