key: cord-025482-9iy4fxd5 authors: Zhong, Yueyang; Wang, Kai; Zhu, Yanan; Lyu, Danni; Yao, Ke title: COVID-19: Evidence of the Eye date: 2020-05-28 journal: J Infect DOI: 10.1016/j.jinf.2020.05.054 sha: doc_id: 25482 cord_uid: 9iy4fxd5 nan We read with interest of the article by Huang et al. 1 in your journal about the nonspecific and atypical manifestations of COVID-19 patients. As the initial epicenter of the outbreak, China has gained much clinical knowledge and experience in response to the disease. Based on 13 case series and 9 case reports, we would like to share five key points of the ocular manifestations of COVID-19 patients, hoping to provide a new perspective and broader view of the disease. First, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause ocular manifestations. Patients mainly present with conjunctivitis that is similar to other types of viral infection. The first large epidemiological study reported 9 cases of conjunctival congestion among 1099 patients in China 2 . Other symptoms include conjunctival secretion, epiphora, itching, foreign body sensation, and dry eye, with the prevalence ranging from 0.5% to 32% 3 . However, a recent case report observed retinal lesions of microhemorrhages and cotton wool spots among four patients, suggesting potential neurological manifestations 4 . 3 Second, the characteristics of ocular involvements are atypical. Ocular manifestations may present as the initial and the only symptoms of infection. The first case concerns a Chinese expert, who got infected in Wuhan and presented with conjunctival congestion before the onset of pneumonia 5 . Ocular involvements are more likely to present in severe COVID-19 cases, and there is no age or gender preference. To our knowledge, the youngest case was a 34-month-old boy, who had conjunctival congestion and eyelid dermatitis as the only symptoms 6 Although there is no uniform standard for conjunctival SARS-CoV-2 detection, it is speculated that conjunctival swab technique has yielded higher sensitivity over Schirmer's test. However, further studies are warranted to reach a definitive conclusion. Fifth, appropriate use of qualified personal protective equipment is necessary. No evidence has shown the protective effect of contact lenses and personal eyeglasses. Clinical workers should wear protective goggles, masks, and face shields. For The authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Rapid asymptomatic transmission of COVID-19 during the incubation period demonstrating strong infectivity in a cluster of youngsters aged 16-23 years outside Wuhan and characteristics of young patients with COVID-19: A prospective contact-tracing study Clinical Characteristics of Coronavirus Disease 2019 in China Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19 Retinal findings in patients with COVID-19 Peking University Hospital Wang Guangfa disclosed treatment status on Weibo and suspected infection without wearing goggles 2020 A child confirmed COVID-19 with only symptoms of conjunctivitis and eyelid dermatitis SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection Jia Zhi-fang. 2019-nCoV transmission through the ocular surface must not be ignored Tumpey Terrence M. Ocular tropism of respiratory viruses SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor