SARS-CoV-2 positivity rates in tear secretions of inpatient COVID-positive individuals in an Indian tertiary care setting.

Purpose: In the third wave of the coronavirus disease 2019 (COVID-19) pandemic, despite progressive vaccination coverage, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was rapidly spreading and the possibility for ocular transmission of COVID-19 was most relevant. This study aimed to determine the presence of SARS-CoV-2 RNA in tears as detected by real-time polymerase chain reaction (RT-PCR), among individuals who tested COVID-positive during the third wave of the COVID pandemic.

Methods: Among 90 patients admitted with mild to severe COVID-19 infection (ranging from asymptomatic to severe symptoms), separate conjunctival samples were obtained from both eyes without topical anesthesia taking precautions to avoid contamination. Inferior fornices of the eyes were swept slowly with sterile Dacron swabs for 10 s or until visibly wet. They were inoculated directly in a viral lysis buffer containing carrier RNA and transported to the Virology Laboratory for the detection of SARS-CoV-2 RNA by RT-PCR. Conjunctival swabs were declared positive based on cycle threshold values of <37.

Results: Seven of 180 conjunctival swabs were positive (3.9%). Five patients had unilateral positive and one patient had bilateral positive conjunctival swabs. Thirty-six (40%) patients had their conjunctival swabs taken on the same day of detection of the first positive nasopharyngeal swab, while the rest (54) had their conjunctival swabs taken up to 3 days later. Overall, 20 (22.2%) patients were symptomatic for COVID-19.

Conclusion: Considering the contagious nature of SARS-CoV-2 in the third wave, there is a possibility that ocular surface fluid might have been a contributing factor along with other modes of transmission of COVID-19.