Investigators study COVID-19 ocular manifestations in children in China

A new study out of Wuhan, China where the novel coronavirus was first detected in late 2019 found that some children hospitalized with coronavirus disease 2019 (COVID-19) presented with series of onset symptoms that included fever, cough, and conjunctival discharge, eye rubbing, and conjunctival congestion.

The patients’ systemic clinical symptoms or cough were associated with the ocular symptoms.

A consideration for investigators was that most reported cases were adults, and little is known about ocular manifestations in children with COVID-19.

“Compared with adults, COVID-19 in children could be very different in terms of exposure history, clinical characteristics, and ocular manifestations,” they commended.

As a result, investigators conducted a retrospective clinical study on the clinical and ocular characteristics of pediatric patients hospitalized with COVID-19. Children with confirmed severe acute respiratory syndrome coronavirus disease between January 26 and March 18 were included. The main outcomes were the onset of clinical symptoms and duration, ocular symptoms, and need for medication.

The investigators found that 22.7% of the 216 children (median age, 7.25 years) included in the study had ocular manifestations, including conjunctival discharge, eye rubbing, and conjunctival congestion.

“Children with systemic symptoms or cough were more likely to develop ocular symptoms, which were mild, and recovered or improved with minimal eye drops or self-healing,” they reported. The investigators published their results in JAMA Ophthalmology.1

Almost 90% of children had a family member with confirmed or suspected COVID-19. The most common symptoms among symptomatic children were fever in 37.5% and cough in 36.6%; 43.1% had no systemic or respiratory symptoms. All children with mild (46.8%) or moderate (53.2%) symptoms recovered. Of the 22.7% with ocular symptoms, 9 had ocular complaints that were the initial manifestations of COVID-19 including conjunctival discharge (55.1%), eye rubbing (38.8%), and conjunctival congestion (10.2%). A few had ocular pain (8.2%), tearing (4.1%), and eyelid swelling (8.2%). Two patients (4.1%) had allergic conjunctivitis before the COVID-19 pandemic. Children with systemic symptoms or with cough were more likely to develop typically mild ocular symptoms. 

“These data could help guide prevention and management of ocular disorders in children with COVID-19,” the authors concluded.

REFERENCE

Ma N, Li P, Wang X, et al. Ocular manifestations and clinical characteristics of children with laboratory-confirmed COVID-19 in Wuhan, China. JAMA Ophthalmol 2020; Published online August 26, 2020. doi:10.1001/jamaophthalmol.2020.3690