Coronavirus
Coronaviruses (CoV) are a large family of respiratory viruses whose name is due to the crown-like spikes on their surface. These viruses are common in many animal species (i.e. bats) but, in some cases, they can modify themselves and acquire the ability to infect humans and thus spread among the population. Coronaviruses are responsible for diseases that can be mild to moderate, and include common cold, but also respiratory syndromes such as MERS (Middle East Respiratory Syndrome) e SARS (Severe Acute Respiratory Syndrome).
In December 2019, in the Chinese city of Wuhan, it was isolated a new coronavirus, '2019-nCoV' now named by the World Health Organisation (WHO) SARS-CoV-2It causes severe respiratory infections, including pneumonia. Infected individuals present with fever, cough, shortness of breath and conjunctivitissymptoms that may occur between days 2 and 14 after infection.
On 22 January, Dr Guangfa Wang, a member of the Chinese National Expert Group on Pneumonia, reported that he had been infected with 2019-nCoV during an inspection in Wuhan. He was wearing an N95 mask, but was not wearing eye protection. Dr Wang, a few days before the 2019-nCoV pneumonia occurred, had complained of redness in his eyes, so it is possible that unprotected exposure of the eyes to the virus led to the infection of the doctor.
Transmission through the ocular surface
Infected droplets and body fluids can, in fact, easily contaminate the human conjunctival epithelium. It has previously been shown that severe acute respiratory syndrome from coronavirus (SARS-CoV) is mainly transmitted through direct or indirect contact of the virus with the mucous membranes of the eyes, mouth or nose. The fact that exposed mucous membranes and unprotected eyes increase the risk of SARS-CoV transmission suggests that the same thing could happen with 2019-nCoV. The respiratory tract, therefore, may not be the only transmission route for 2019-nCoV, for which the ophthalmologistsshould wear protective goggles in case they have to make a suspicious examination.
This hypothesis has also been credited by the American Academy of Ophthalmology (AAO), according to which the new outbreak of coronavirus can cause conjunctivitis and can probably be transmitted via contact of infected aerosol with the conjunctiva. Therefore, patients who go to the ophthalmologist for conjunctivitis, have respiratory symptoms and have travelled abroad, especially to China, could present with a 2019-nCoV infection.
Although conjunctivitis is not one of the most common symptoms of 2019-nCoV, the AAO has formulated a set of recommendations so that ophthalmologists act quickly and efficiently when they are the first specialists to assess any infected patients.
Some of these are:
- check whether the patient has respiratory symptoms;
- ask the patient if he/she has travelled to China or if you have friends or family members who have recently returned from that country;
- adequately protect mouth, nose and eyes in the case of a patient with suspected 2019-nCoV.
Sources:
- 2019-nCoV transmission through the ocular surface must not be ignored. Cheng-wei Lu et al. The Lancet, February 2020.
- Alert: Important coronavirus context for ophthalmologists. American Academy of Ophthalmology.
- https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Dr. Carmelo Chines
Direttore responsabile
English 
Italian