Ocular Manifestations of Hospitalized Patients with COVID-19 in Northeast of Iran

ABSTRACT

Purpose

To evaluate ocular findings in patients with Coronavirus Disease 2019 (COVID-19) in the Northeast of Iran.

Methods

In a cross-sectional, observational study all consecutive patients with confirmed COVID-19 diagnosis at the central referral center of these patients in northeast of Iran were included. Ocular examinations (external and slit) were randomly performed for the patients who were admitted to the Intensive Care Unit (ICU) and six COVID wards of the hospital. Moreover, Chart records and serum chemistry results were collected.

Results

A total of 142 patients with the mean age of 62.6 ± 15 years (range: 23–96 years) and almost equal gender distribution (male: N = 77, 54.2%) were included in the study. During the initial external examination by the ophthalmologist, 44 (31%) patients were found to have conjunctival hyperemia and 22 (15.5%) patients had chemosis. Consecutive slit examination showed 41 (28.9%) conjunctival hyperemia, 22 (15.5%) chemosis, 11 (7.7%) cataract, and 9 (6.3%) diabetic retinopathy. The patients with at least one ocular manifestation had significantly higher blood urea levels at the time of admission compared to those with no obvious ocular involvement (median: 41.5, IQR: 28–66.3 vs. median: 33, IQR: 23.8–51.8, P = .023). Moreover, a significant difference was observed in the total white blood cell count, lymphocyte percent, neutrophil count, Erythrocyte Sedimentation Rate (ESR), and blood urea level between patients with positive and negative Polymerase Chain Reaction (PCR) for SARS-CoV-2 virus. None of the patients reported ocular symptoms prior to systemic involvement. The proportion of patients with at least one ocular manifestation was significantly higher in those admitted in the ICU compared to the non-ICU wards. wards. While conjunctival hyperemia was the most prevalent ocular finding in all patients, chemosis was the most common ocular manifestation in ICU admitted patients.

Conclusion

Ocular manifestation was observed in more than half of our COVID-19 patients. Hence, it seems important to involve ophthalmologist in the diagnosis and management of these patients.

KEYWORDS:

• SARS-CoV-2
• Coronavirus disease 2019
• COVID-19
• conjunctival hyperemia
• chemosis

Acknowledgments

We would like to thank Minoo Armand, Soosan Helmi, Mahdi Azhdari, Alireza Rajayi Manesh, Zahra Haghipanah, Afsaneh Sanee, and Eisa Karazma, personnel of nursing office of Imam Reza Hospital for their kind assistance with this research project. Authors also would like to thank Mr. Amir Reza Samad Zadeh, for his support with PPE for examinations. It is a pleasure for us to appreciate kindn supports  of Capt. Reza Kashani.

Authors’ contributions

All authors contributed to conception and study design. All authors agreed to be accountable for all aspects of the work. All authors made critical revision and final approval on the manuscript.

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

None of the authors has a conflicting financial or propriety interest to disclose.

Ethics approval

The study was approved by the Regional Ethic Committee at Mashhad University of Medical Sciences (IR.MUMS.REC.1399.104).

Additional information

Funding

The authors would like to acknowledge the financial support of Vice-Chancellor of Research, Mashhad University of Medical Sciences for this research project (code: 990069).