A 30-year-old male presented to the Emergency Department for a 3 day history of photophobia, redness and watery discharge from both of his eyes. The patient had no symptoms of fever, cough or dyspnea. His medical history was unremarkable and physical examination was normal. The patient mentioned that he is a dentist and that he wore personal protective equipment when having close contact with patients suffering from stomatological diseases, but on some particular events, he had to take off his protective eye-wear during certain interventions. In this instance, he can’t deny a possible contact with an asymptomatic case of COVID-19. The ophthalmology eye exam (Figure 1) with slit lamp examination described bilateral moderate conjunctival injection, inferior palpebral conjunctival follicles and bilateral watery discharge. Fundus examination disclosed unremarkable results. No subconjunctival haemorrhage or pseudomembranes. Macular ultrastructure or thickness assessed on optical coherence tomography were normal. No lesions on the corneal or anterior chamber. Routine fungal and bacterial cultures were also carried out and provided negative results. Oral and nasopharyngeal swab tests for SARS-CoV-2 were recommended, and came back negative. Nasal swab for influenza was also negative. Considering acute conjunctivitis, it was recommended to him to frequently clean the eyes by washing them with normal saline, to use cold compressions, topical anti-histaminics and frequent application of preservative free artificial tears. Also, a topical antibiotic was prescribed for 8 days. The patient was then discharged and recommended home isolation. After 36 hours, he was admitted to the hospital because of added complaints of cough and fever. Routine blood examination: glucose 113 mg/dL, C-reactive protein 13 mg/L, AST 43 U/L, ALT 73 U/L, LDH 313 U/L, monocytes% 14.3%, total cholesterol 223 mg/dL, triglycerides 234 mg/dL, a white blood cell count of 8.11 10^9/ Liter, neutrophils 5.76 10^9/Liter, lymphocytes 42.29%, D-dimers 487 ng/mL, creatine kinase-MB 17 U/L, fibrinogen 443 mg/dL, troponin T 7.11 ng/L, ferritin 179 ng/mL, erythrocyte sedimentation rate of 73 mm/hr, normal thrombin clotting time, creatinine clearance rate normal. Normal electrocardiogram. The computed tomography of the chest showed no signs of viral pneumonia (Figure 2). Samples for testing for SARS-CoV-2 were collected by conjunctival swab technique. The patient had positive RT-PCR results for both eye samples. Routine adenovirus tests returned negative results. To stop the evolution of COVID-19 infection, based on national protocol, the patient received the combination of lopinavir/ ritonavir (7 days), Heparin Sodium 5000 IU injection daily (7 days), cough syrup, hepatoprotectors, antacids, dexamethasone 20 mg tab daily (7 days), Azithromycin 500 mg tab daily (7 days). Other treatment was largely supportive. On day 8 of hospitalisation (day 12 of illness), the patient stated that all ocular symptoms had resolved. After hospital discharge, constant negative oropharyngeal swab tests for SARS-CoV-2 but serial conjunctival swab testing have shown that SARS-CoV-2 RNA may persist for up to 16 days, indicating a persistent replication of the 2019-nCoV.
Full text sources https://doi.org/10.31688/ABMU.2020.55.4.23
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Petru E. MUNTEAN
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