Correlation of ocular manifestations with severity of systemic disease and conjunctival SARS-CoV-2 in COVID-19 Positive patients

Abstract Background: Ocular manifestations of SARS-CoV-2 and the associated risk factors require a comprehensive analysisincludingConjunctival swab (CS) RT-PCR results irrespective of ocular involvement. Aims: To study the correlation of ocular manifestations & systemic COVID-19 status with clinical risk factors, during first & second outbreaks (FO & SO) of COVID19 pandemic in western India. CS RT-PCR results of diagnosed COVID-19 patients with positive nasopharyngeal swab (NPS) RT-PCR with or without ocular manifestations to be evaluated. Material and Methods: Prospective study conducted with confirmed COVID-19 cases with positive NPS RT-PCR during FO & SO of COVID-19 pandemic in year 2020 & 2021 in western India. Ocular manifestations & CS RT-PCR results were evaluated with systemic COVID-19 status. CS was collected within 48 hours of admission for RT-PCR analysis with repeat test within 72 hours upon increasing severity of COVID-19 stage. Result: Thirty-two (20.51%,13 FO,19 SO) patients had uniocular complaints, redness being the commonest during both the outbreaks. Out of 32 patients with ocular symptoms (OS), 87.5% had refractive error, 75% had diabetes & 53.1% had moderate COVID-19, (P=<0.0001, significant). 25% & 18.8% patients with OS had history of use of protective eye gears & covid vaccine respectively. 103 & 80 CS from 103 & 53 patients of FO & SO respectively were tested. All primary (183) & repeat (93) CS were negative for RT-PCR.Conclusion: Ocular involvement in diagnosed COVID-19 cases is variable. SARS-CoV-2 presence in conjunctival samples is inconsistent irrespective of systemic severity, probably due to intermittent shedding of virus. Keywords: COVID-19 ocular manifestations, first outbreak, second outbreak, CS RT-PCR