Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group

Maria Cristina Savastano; Gloria Gambini; Alfonso Savastano; Benedetto Falsini; Umberto De Vico; Maurizio Sanguinetti; Paola Cattani; Simona Marchetti; Anna Rita Larici; Francesco Franceschi; Angelo Santoliquido; Rossana Moroni; Andrea Cambieri; Rocco Bellantone; Francesco Landi; Giovanni Scambia; Stanislao Rizzo

doi:10.1177/1120672120976548

Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group

Eur J Ophthalmol. 2021 Nov;31(6):2886-2893. doi: 10.1177/1120672120976548. Epub 2020 Dec 23.

Authors

Maria Cristina Savastano^{1

2}, Gloria Gambini^{1

2}, Alfonso Savastano^{1

2}, Benedetto Falsini^{1

2}, Umberto De Vico^{1

2}, Maurizio Sanguinetti^{3

4}, Paola Cattani^{2

5}, Simona Marchetti^{2

5}, Anna Rita Larici^{2

6}, Francesco Franceschi^{2

7}, Angelo Santoliquido^{2

7}, Rossana Moroni⁸, Andrea Cambieri⁹, Rocco Bellantone^{2

10}, Francesco Landi^{2

11}, Giovanni Scambia^{2

12}, Stanislao Rizzo^{1

2

13}

Affiliations

¹ Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.
² Catholic University "Sacro Cuore", Rome, Italy.
³ Institute of Microbiology, Catholic University of "Sacro Cuore", Rome, Italy.
⁴ Department of Laboratory and Infectious Science, "FondazionePoliclinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
⁵ Department of Diagnostic and Laboratory Medicine, Institute of Microbiology, Catholic University of "Sacro Cuore", Rome, Lazio, Italy.
⁶ Department of Radiology, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
⁷ Emergency Medicine, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
⁸ Scientific Direction, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
⁹ Hospital Health Management, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.
¹⁰ Division of Endocrine and Metabolic Surgery, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
¹¹ Department of Geriatrics, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
¹² "Dipartimento scienze della salute della donna e del bambino e di sanità pubblica", "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Lazio, Italy.
¹³ Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy.

Abstract

Background: The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated.

Methods: Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C-NF-), (2) NPs positive and Cs negative (NFs+Cs-), (3) NPs negative and Cs positive (NFs-Cs+), and (4) NPs and Cs both positive (NFs-Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO₂), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP).

Results: A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO₂ levels are the highest in the NF-C- group (98%) and the lowest (90%) in the group NF+C+ (p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups (p = 0.019). Pulmonary impairment score increased from NFs-Cs- group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%).

Conclusions: In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity.

Trial registration: Clinicaltrials.gov registration.

Ethical committee authorization: ID number: 0013008/20.

Keywords: COVID-19; Conjunctival swab; SARS-CoV-2; eye infection; ophthalmologists; personalized medicine; precautionary measures.

MeSH terms

COVID-19* / diagnosis
Conjunctiva / virology*
Humans
Italy
SARS-CoV-2 / isolation & purification*