Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Ophthalmology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
Front Public Health. 2020 Apr 24;8:155. doi: 10.3389/fpubh.2020.00155. eCollection 2020.
The outbreak of the current 2019 novel coronavirus (2019-nCoV, now named SARS-CoV-2) infection has become a worldwide health threat. Currently, more information is needed so as to further understand the transmission and clinical characteristics of 2019-nCoV infection and the infection control procedures required. Recently, the role of the eye in transmitting 2019-nCoV has been intensively discussed. Previous investigations of other highly infectious human CoVs, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), may provide useful information. In this review, we describe the genomics and morphology of human CoVs, the epidemiology, systemic and ophthalmic manifestations, and mechanisms of human CoV infection, and recommendations for infection control procedures. The role of the eye in the transmission of 2019-nCoV is discussed in detail. Although the conjunctiva is directly exposed to extraocular pathogens, and the mucosa of the ocular surface and upper respiratory tract are connected by the nasolacrimal duct and share the same entry receptors for some respiratory viruses, the eye is rarely involved in human CoV infection, conjunctivitis is quite rare in patients with 2019-nCoV infection, and the CoV RNA positive rate by RT-PCR test in tears and conjunctival secretions from patients with 2019-nCoV and SARS-CoV infection is also extremely low. This suggests that the eye is neither a preferred organ of human CoV infection nor a preferred gateway of entry for human CoVs for infecting the respiratory tract. However, pathogens that the ocular surface is exposed to might be transported to nasal and nasopharyngeal mucosa by constant tear rinsing through the lacrimal duct system and then cause respiratory tract infection. Considering that close doctor-patient contact is quite common in ophthalmic practice and is apt to transmit human CoVs by droplets and fomites, strict hand hygiene and proper personal protection are highly recommended for health care workers to avoid hospital-related viral transmission during ophthalmic practice.
当前 2019 年新型冠状病毒（2019-nCoV，现命名为 SARS-CoV-2）感染的爆发已成为全球健康威胁。目前，需要更多的信息来进一步了解 2019-nCoV 感染的传播和临床特征，以及所需的感染控制程序。最近，人们对眼睛在传播 2019-nCoV 中的作用进行了深入讨论。之前对其他高度传染性的人类冠状病毒（即严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV））的研究可能提供了有用的信息。在这篇综述中，我们描述了人类冠状病毒的基因组和形态、流行病学、系统和眼部表现以及人类冠状病毒感染的机制，以及感染控制程序的建议。详细讨论了眼睛在 2019-nCoV 传播中的作用。尽管结膜直接暴露于眼外病原体，且眼表和上呼吸道的黏膜通过鼻泪管相连并共享某些呼吸道病毒的相同进入受体，但眼睛很少参与人类冠状病毒感染，结膜炎在 2019-nCoV 感染患者中相当罕见，并且从 2019-nCoV 和 SARS-CoV 感染患者的泪液和结膜分泌物中通过 RT-PCR 检测到的 CoV RNA 阳性率也极低。这表明眼睛既不是人类冠状病毒感染的首选器官，也不是人类冠状病毒感染呼吸道的首选进入门户。然而，眼表暴露的病原体可能通过泪液冲洗通过泪管系统被输送到鼻和鼻咽黏膜，然后引起呼吸道感染。考虑到眼科实践中经常发生密切的医患接触，并且容易通过飞沫和污染物传播人类冠状病毒，强烈建议医护人员在眼科实践中保持严格的手卫生和适当的个人防护，以避免医院相关的病毒传播。
