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Investigators Examine Link Between Ocular Symptoms and COVID-19 in Pediatric Patients

More than 20% of children examined in Wuhan showed various ocular manifestations.

Ocular manifestations and outcomes have been found in pediatric patients with coronavirus disease 2019 (COVID-19) infections.

However, researchers have not yet identified the relevant affecting factors and differences in ocular disease between children and adults.

A team, led by Nan Ma, MD, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Department of Ophthalmology, Huazhong University of Science & Technology, investigated ocular manifestations and clinical characteristics of pediatric patients with laboratory-confirmed COVID-19 cases.

In the cross-sectional study, the investigators examined 216 pediatric patients at the Wuhan Children’s Hospital with COVID-19 confirmed by severe acute respiratory syndrome coronavirus disease 2 nucleic acid tests of upper respiratory tract specimens between January 26 and March 18.

Of the patients, 134 were males, with a median age of 7.25 years old.

The investigators sought main outcomes of the onset of clinical symptoms and duration, ocular symptoms, and the need for medication.

Based on the exposure history, 193 children (89.4%) had a confirmed (n = 173) or suspected (n = 20) family member with COVID-19 infection.

The most common symptoms were fever (n = 81) and cough (n = 79). Of the 216 children, 93 (43.1%) had no systemic or respiratory symptoms.

The investigators also said all children with mild (n = 101) or moderate (n = 115) symptoms recovered from the virus.

In addition, 49 children (22.7%) showed various ocular manifestations, 9 of which had ocular complaints being the initial manifestations of COVID-19. The common ocular manifestations were conjunctival discharge (n = 27), eye rubbing (n = 19), and conjunctival congestion (n = 5). Children with systemic symptoms (29.3% vs 14.0%; difference, 15.3%; 95% CI, 9.8-20.7%; P = 0.008) or with cough (31.6% vs 17.5%; difference, 14.1%; 95% CI, 8.0-20.3%; P = 0.02) were more likely to develop ocular symptoms.

The ocular symptoms were generally mild and the patients ultimately recovered or improved.

“In this cross-sectional study, children hospitalized with COVID-19 in Wuhan, China, presented with a series of onset symptoms including fever, cough, and ocular manifestations, such as conjunctival discharge, eye rubbing, and conjunctival congestion,” the authors wrote. “Patients’ systemic clinical symptoms or cough were associated with ocular symptoms.”

While the common initial clinical manifestations are often fever, fatigue, and dry cough, some patients have developed conjunctivitis as an initial symptom of COVID-19.

There have also been reports of COVID-19 infections among medical staff, including ophthalmologists, presumably acquired during close contact with infected patients. A better understanding of the ocular manifestations could help facilitate more effective prevention and mitigation strategies with cases of patients with COVID-19 and ocular symptoms and potential conjunctival transmission route for SARS-CoV-2 reported.

However, previously almost all of the research involving ocular manifestations and COVID-19 was done in adults.

The study, “Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China,” was published online in JAMA Ophthalmology.