We read with interest the article by Lacorzana et al. entitled “Conjuntivitis hiperaguda en paciente joven” [“Hyperacute conjunctivitis in a young patient”].1 When faced with signs and symptoms with the characteristics reported by the authors, it is always important to rule out a gonococcal aetiology and diagnose possible ocular complications, such as the conjunctival symblepharon reported in this article.
However, at the current moment in time, we feel that is it important to point out the relationship between COVID-19 and conjunctivitis, given the ongoing pandemic.2 Although ocular signs in patients diagnosed with COVID-19 have a low prevalence,3 the importance of suspecting and diagnosing them lies in the fact that conjunctivitis may be the first sign of the disease4 and, in some cases, the only one.5
Since various studies at the start of the epidemic documented the possibility of isolating SARS-CoV-2 in patients' tears and therefore suggested its transmission by this route,6 different case series and isolated case reports of patients diagnosed with COVID-19 and conjunctivitis have been published. Cases of conjunctivitis associated with COVID-19, with a broad, highly varied clinical spectrum, have been reported both in paediatric patients7 and in adults.8
In most cases published to date, signs and symptoms of COVID-19–related conjunctivitis have been mild, bilateral and follicular, and have not usually included corneal involvement; this is consistent with other forms of conjunctivitis of viral origin, such as adenoviral conjunctivitis. Additionally, the onset of maxillary and preauricular lymphadenopathy accompanying signs and symptoms of conjunctivitis has been reported,8 this being a trait shared by viral forms of conjunctivitis. Nonetheless, more variegated cases of pseudomembranous and haemorrhagic conjunctivitis have been reported,9 meaning that there is no established characteristic pattern in relation to this specific aetiology.
A recent meta-analysis suggested that there is a relationship between conjunctivitis and severity of signs and symptoms of COVID-19,10 although the relevant data may have significant limitations, such as inclusion of patients with a clinical diagnosis of conjunctivitis but no microbiological confirmation.
Therefore, in the context of the current pandemic, we believe that it is important to consider COVID-19 among all different possible diagnoses of conjunctivitis. This means that it is important to ask all patients with suspected conjunctivitis about any systemic symptoms that might accompany their ocular signs and symptoms, and about possible epidemiological environments with suspected or confirmed cases. For now, no characteristics differentiating this type of conjunctivitis from other types have been identified, owing to which more studies are needed to determine the specific characteristics of these cases, as well as other possible implications for the disease’s prognosis.
Conflicts of interestThe authors declare that they have no conflicts of interest.
Please cite this article as: Arias-Peso B, Rendón-Fernández H. Conjuntivitis y COVID-19: la importancia de un reconocimiento precoz. Enferm Infecc Microbiol Clin. 2021;39:111.
