Abstract
Purpose: Previous studies show a great variability of SARS‐CoV‐2 RNA detection rates in tear fluids. The aim of this study was to investigate the presence of SARS‐CoV‐2 in the tear fluid of hospitalized COVID‐19 patients and to evaluate systemic and ophthalmic clinical features in a Belgian cohort. Methods: Adult patients hospitalized for COVID‐19 pneumonia confirmed by a chest computer tomography (CT) were included. Patients with a recent diagnosis or exacerbation of an ocular pathology were excluded. After completing an ocular symptom questionnaire, patients underwent a macroscopic ocular exam and a conjunctival swab. A reverse transcriptase polymerase chain reaction (RT‐PCR) was performed on the swabs to identify SARS‐CoV‐2 RNA. Clinicobiological data (C reactive protein, lymphocyte count, CT scan, risk factors and symptoms) and PCR results of both ocular and nasopharyngeal samples were collected. Results: Fifty‐eight patients were included between September 2020 and May 2021. 43 (74.1%) were male, the median age was 56 (min 32 ‐max 93). 54 (93.1%) of the nasopharyngeal swabs were positive. Two (3.45%) had a positive conjunctival PCR: one with <10 E3 copies/ml, the second highly positive with > = 10E3 ‐ < 10 E5 copies/ml. Both were males without any ocular symptoms. 13 patients (22%) presented ocular symptoms such as tearing (69.23%), redness (53.85%), burning 38% or itching 15.38%. All but one reported that the symptoms started at the beginning of their SARS‐CoV‐2 infection (92.31%). Statistical analysis by linear regression found that there was a significant statistical correlation between the presence of ocular symptoms and neurological symptoms (p = 0.021). Conclusions: It is possible to find tear fluids with a high viral load but the probability of this occurrence appears to be rather low. The presence of SARS‐CoV‐2 in tears was however not associated with the presence of symptoms in this study. Ocular symptoms may not be related to the presence of the virus itself.