Evidence-based of conjunctival COVID-19 positivity: An Italian experience: Gemelli Against COVID Group

Maria Cristina Savastano, Gloria Gambini, Alfonso Savastano, Benedetto Falsini, Umberto De Vico, Maurizio Sanguinetti, Paola Cattani, Simona Marchetti, Anna Rita Larici, Francesco Franceschi, Angelo Santoliquido, Rossana Moroni, Andrea Cambieri, Rocco Bellantone, Francesco Landi, Giovanni Scambia, Stanislao Rizzo

Research output: Contribution to journalArticlepeer-review


Background: The possible transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) by tears and conjunctiva is still debated. Methods: Main outcome was to investigate the agreement between nasopharyngeal swab (NPs) and conjunctival swabs (Cs) in patients with SARS-CoV-2 infection. We divided patients into four groups: (1) NPs and Cs both negative (C−NF−), (2) NPs positive and Cs negative (NFs+Cs−), (3) NPs negative and Cs positive (NFs−Cs+), and (4) NPs and Cs both positive (NFs−Cs+). The secondary outcomes were to correlate Cs results with systemic clinical parameters such as: oxygen saturation (SpO2), dyspnea degree (DP), radiologic pulmonary impairment based on chest radiography (XR) or computed tomography (CT), blood chemistry as D-Dimer (D-Dimer), fibrinogen, ferritin, lactate dehydrogenase (LDH), and C-reactive protein (C-RP). Results: A total of 100 conjunctival swabs in 50 patients with SARS-CoV-2 have been enrolled in this interventional clinical trials. Ocular signs (conjunctivitis) were present in five patients (10%). NPs and Cs highlighted a poor level of agreement (0.025; p = 0.404). Median SpO2 levels are the highest in the NF−C− group (98%) and the lowest (90%) in the group NF+C+ (p = 0.001). Pulmonary impairment was statistically significantly different between NFs and Cs groups (p = 0.019). Pulmonary impairment score increased from NFs−Cs− group (3.8 ± 3.9), to NFs+Cs+ group (6.7 ± 4.1). Intensive care unit patients showed higher COVID-19 Cs positivity in conjunctiva (12.5%) against hospitalized ones (5.8%). Conclusions: In patients hospitalized for SARS-CoV-2 the virus can be detected in conjunctival swab. Intensive care unit patients may reveal a higher COVID-19 presence in the conjunctiva. The most severe pulmonary impairment can be observed in NFs and Cs positivity. Trial registration: Clinicaltrials.gov registration. Ethical committee authorization: ID number: 0013008/20

Original languageEnglish
JournalEuropean Journal of Ophthalmology
Publication statusAccepted/In press - 2020


  • Conjunctival swab
  • COVID-19
  • eye infection
  • ophthalmologists
  • personalized medicine
  • precautionary measures
  • SARS-CoV-2

ASJC Scopus subject areas

  • Ophthalmology


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