COVID-19 ocular findings in children: a case series

Abstract

Children account for 1% of cases of COVID-19 in most published series, with significantly reduced risk of developing severe forms of disease or death [1–3]. Because most children present with mild forms of acute respiratory infections, interest has been focused initially on children with underlying/comorbid diseases and concentrated rare fatalities [1, 4]. In children with active COVID-19, the most common clinical manifestations are fever and cough, sometimes accompanied by fatigue, myalgia, rhinorrhoea, sneezing, sore throat, headache, dizziness, diarrhoea, vomiting, and abdominal pain [1, 2, 5]. Dyspnea is more common in adults and has been described in more than 20% of patients, although lower respiratory tract infection can also develop in children [6, 7]. Conjunctival congestion is the most common ocular manifestation described, although it is rarely mentioned in nonophthalmology-specific studies [6]. However, it is present in 1 to 5% of adults, consistent with mild follicular conjunctivitis without pseudomembrane formation [8]. Concern with COVID-19 in children began when they started to develop a wide range of manifestations from chilblains, to a severe pediatric inflammatory multisystem syndrome (PIMS) mimiquing Kawasaki disease (KD) [9–11]. Scarce literature has been published thus far regarding ocular findings in the COVID-19 pediatric population. A cross-sectional study performed in Wuhan (China) showed conjunctival discharge and conjunctival congestion as the most common manifestation, and a higher risk of developing ocular symptoms when systemic clinic was present [12]. Therefore, we aimed to share our experience in managing children with ocular involvement possibly related to COVID-19. This is a prospective, observational study performed at the Pediatric Ophthalmology Department of La Paz University Hospital (Madrid, Spain) between the 1st of April and the 1st of June 2020. The present study was approved by the Ethics Committees of La Paz University Hospital (identification number PI-4081). Informed consent was obtained from all parents and/or legal tutors of patients involved. All patients admitted with a suspected COVID-19 infection were examined by the Pediatric Ophthalmologist to rule out a possible ocular involvement of the disease. The inclusion criteria were: (1) patients admitted at the Pediatric and Infectious Diseases Department or the Pediatric Intensive Care Unit of La Paz University Hospital between the 1st of April and the 1st of June 2020; (2) children from 0 to 17 years of age, and (2) SARSCoV-2-positive PCR (polymerase chain reaction) from nasopharyngeal swabs (TaqMan 2019-nCoV Assay Kit v1 [ThermoFisher, MA, USA] and SARS-CoV-2 realtime PCR kit (Vircell)) and/or SARS-CoV-2 IgG/IgM-positive serology test (chemiluminescence immunoassay, vircell/ abbott/siemens). Presumed COVID-19 patients without a positive test result were excluded. A total of 17 patients aged between 4 and 17 years were included into this study. Table 1 shows demographic data of the patents. The mean age was 9.23 years, and 18% were female. None of them had any relevant systemic or ocular disease previously described. Half of the patients had a positive epidemiological history for COVID-19, wherein parents were the most frequent known contact. PCR from nasopharyngeal swabs was positive in 6 patients (35%), whereas 14 patients had positive IgG (82%), and 19% had both IgM and IgG positive serology tests. Systemic manifestations were the following: 35% had PIMS, 41% were diagnosed with pneumonia, 12% had chilblains and cutaneous * Celia Fernández Alcalde [email protected]