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Ocular Surface and Conjunctival Cytology Findings in Patients With Confirmed COVID-19
Erdinç Bozkurt1, Serdar Özateş, Ersin Muhafız
1Department of Ophthalmology (E.B., E.M.), Faculty of Medicine, Kafkas University, Kars, Türkiye; Department of Ophthalmology (S.Ö.), Okan University, Istanbul, Türkiye; and Departments of Pathology (F.Y.), and Infectious Disease and Clinical Microbiology (O.C.), Harakani State Hospital, Kars, Türkiye.
Purpose:
To assess the effect of severe acute respiratory syndrome coronavirus-2 infection on the conjunctiva and tear film.
Methods:
Thirty-eight patients with confirmed COVID-19 and 31 healthy controls were included in this prospective and observational study. Individuals with COVID-19 formed the patient group, and healthy individuals formed the control group. Conjunctival impression cytology (CIC), TBUT, Schirmer II test, and ocular surface disease index were evaluated in all participants.
Results:
No significant difference was observed regarding the mean age and gender between the groups (P=0.786 and P=0.122, respectively). The mean TBUT and Schirmer II test results did not differ between the two groups (P=0.496 and P=0.447, respectively). The CIC results revealed decreased density and cell size of goblet cells and moderate to high enlargement, squamous changes, and increased nucleocytoplasmic ratio in nongoblet epithelial cells in the COVID-19 group compared with the control group. Based on the Nelson classification in CIC samples, 60.6% of the COVID-19 group and 19.4% of the control group had changes consistent with grade 2 or above. The presence of neutrophils in CIC was significantly higher in the COVID-19 group (P<0.001), whereas the presence of lymphocyte was similar between the two groups (P=0.247).
Conclusion:
This study revealed the pathological conjunctival alterations in patients with COVID-19 and demonstrated that pathological ocular surface alterations may present even at the beginning of COVID-19 without clinically significant ocular manifestation.
