Incidence and Clinical Characteristic of Ocular Surface Manifestation: An Evaluation of Conjunctival Swab Results in Corona Virus 2019 (COVID-19) Patients in Jakarta, Indonesia

Objectives: This study aimed to investigate the spectrum of ocular characteristics and viral presence in the conjunctival swab of patients with COVID-19. Methods: Fifty-three patients were recruited from two COVID-19 referral hospitals in Jakarta (Cipto Mangunkusumo Hospital and Persahabatan Hospital) from July 2020 to March 2021. The inclusion criteria were patients who were suspected of or confirmed cases of COVID-19 with or without ocular symptoms. Demographic data, history of COVID-19 exposure, underlying medical condition, systemic symptoms, ocular symptoms, supporting laboratory results, reverse-transcriptase polymerase chain reaction (RT-PCR) of naso-oropharyngeal (NOP) swab and conjunctival swab were collected. Results: : Fifty-three patients who were suspected, probable or confirmed cases of Covid-19 were included. Forty-six out of 53 patients (86.79%) tested positive for either Covid-19 antibody rapid test or naso-oropharyngeal (NOP) swab. Forty-two patients tested positive for NOP swab. Two out of 42 patients (4.76%) who tested positive for NOP swab were also positive for conjunctival swab. Conclusions: : Establishing the relationship between Covid-19 infection, ocular symptoms, and presence of SARS-CoV-2 virus on the ocular surface proves to be challenging. Ocular symptoms did not warrant a positive conjunctival swab result due to nasolacrimal drainage that quickly clears the virus into the respiratory tract. Most importantly, a patient without ocular symptoms can have detectable presence of SARS-CoV-2 virus on the ocular surface. Hence, tear droplets transmission is possible and preventative measures should be implemented. As ocular involvement is often a systemic response rather than local viral activity, detection of the virus in conjunctival swab is low.