key: cord-311358-nrj4aysh
authors: Peng, Yuzhu; Zhou, Yi‐Hua
title: Is novel coronavirus disease (COVID‐19) transmitted through conjunctiva?
date: 2020-03-16
journal: J Med Virol
DOI: 10.1002/jmv.25753
sha: 
doc_id: 311358
cord_uid: nrj4aysh

nan

We read with interest the article of Dr Xia et al 1 Overall, only a very small proportion of the patients had conjunctival presentations, which is unknown whether the conjunctival congestion was the initial or coexisted symptom. Thus, SARS-CoV-2 is less likely to be transmitted through the conjunctiva.

In theory, the premise for transmission through conjunctiva is that SARS-CoV-2 can replicate in conjunctival epithelia. SARS-CoV-2 is assumed to use angiotensin-converting enzyme 2 (ACE2) as the cellular receptor to enter into cells as SARS-CoV. 7 Currently it is unknown whether conjunctival epithelia can express ACE2. However, oral, nasal, and nasopharyngeal epithelia do not express ACE2, 8 which can explain that most of the COVID-19 patients did not have upper respiratory symptoms. [2] [3] [4] [5] [6] Thus, whether conjunctival epithelia express ACE2 merits further study.

It has been proposed that ''2019-nCoV transmission through the ocular surface must not be ignored'' based on the nosocomial infection of some ophthalmologists and an expert who wore an N95 mask but did not wear anything to protect his eyes was infected with SARS-CoV-2. 9 However, wearing N95 mask does not mean to completely prevent the transmission. Moreover, the in-

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