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SARS-CoV-2 and the ocular surface: test accuracy and viral load.

Dalton de Freitas Santoro1, Flavio Eduardo Hirai1, Lucas Baldissera Tochetto1

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|September 19, 2024
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Summary

The Schirmer and conjunctival swab tests can accurately detect SARS-CoV-2 RNA on the ocular surface in COVID-19 patients. Viral load was significantly lower in ocular samples compared to nasopharyngeal swabs.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Molecular Diagnostics

Background:

  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause coronavirus disease 2019 (COVID-19).
  • Ocular surface involvement in COVID-19 is of clinical interest for diagnostic and transmission perspectives.

Purpose of the Study:

  • To evaluate SARS-CoV-2 RNA presence on the ocular surface of individuals with suspected COVID-19.
  • To determine the accuracy of ocular surface molecular testing compared to nasopharyngeal swabs.
  • To assess different tear film collection techniques for SARS-CoV-2 detection.

Main Methods:

  • 152 individuals with suspected COVID-19 underwent simultaneous nasopharyngeal and ocular surface sampling.
  • Tear film was collected using the Schirmer test filter strip and conjunctival swab/cytology.
  • Quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR) was performed on all samples.

Main Results:

  • 86 out of 152 patients (56.6%) tested positive for COVID-19 via nasopharyngeal PCR.
  • Both Schirmer (16.3%) and conjunctival swab (17.4%) tests detected SARS-CoV-2 RNA, with no significant difference between them.
  • No ocular tests were positive in patients with negative nasopharyngeal PCR results.
  • Ocular viral load (mean Ct 35.6-36.4) was significantly lower than nasopharyngeal viral load (mean Ct 18.2).

Conclusions:

  • Schirmer and conjunctival swab tests are comparably accurate for detecting SARS-CoV-2 RNA on the ocular surface.
  • Ocular surface viral load is substantially lower than in nasopharyngeal samples.
  • Ocular manifestations observed via slit lamp biomicroscopy were not linked to ocular RT-PCR positivity.