Department of Ophthalmology (E.B., E.M.), Faculty of Medicine, Kafkas University, Kars, Türkiye; Department of Ophthalmology (S.Ö.), Okan University, Istanbul, Türkiye; and Departments of Pathology (F.Y.), and Infectious Disease and Clinical Microbiology (O.C.), Harakani State Hospital, Kars, Türkiye.
Eye Contact Lens. 2021 Apr 1;47(4):168-173. doi: 10.1097/ICL.0000000000000752.
To assess the effect of severe acute respiratory syndrome coronavirus-2 infection on the conjunctiva and tear film.
Thirty-eight patients with confirmed COVID-19 and 31 healthy controls were included in this prospective and observational study. Individuals with COVID-19 formed the patient group, and healthy individuals formed the control group. Conjunctival impression cytology (CIC), TBUT, Schirmer II test, and ocular surface disease index were evaluated in all participants.
No significant difference was observed regarding the mean age and gender between the groups (P=0.786 and P=0.122, respectively). The mean TBUT and Schirmer II test results did not differ between the two groups (P=0.496 and P=0.447, respectively). The CIC results revealed decreased density and cell size of goblet cells and moderate to high enlargement, squamous changes, and increased nucleocytoplasmic ratio in nongoblet epithelial cells in the COVID-19 group compared with the control group. Based on the Nelson classification in CIC samples, 60.6% of the COVID-19 group and 19.4% of the control group had changes consistent with grade 2 or above. The presence of neutrophils in CIC was significantly higher in the COVID-19 group (P<0.001), whereas the presence of lymphocyte was similar between the two groups (P=0.247).
This study revealed the pathological conjunctival alterations in patients with COVID-19 and demonstrated that pathological ocular surface alterations may present even at the beginning of COVID-19 without clinically significant ocular manifestation.
评估严重急性呼吸综合征冠状病毒 2 型感染对结膜和泪膜的影响。
本前瞻性观察研究纳入了 38 名确诊为 COVID-19 的患者和 31 名健康对照者。COVID-19 患者纳入患者组，健康个体纳入对照组。所有参与者均接受结膜印迹细胞学（CIC）、泪膜破裂时间（TBUT）、Schirmer II 试验和眼表疾病指数（OSDI）评估。
两组的平均年龄和性别无显著差异（P=0.786 和 P=0.122）。两组的平均 TBUT 和 Schirmer II 试验结果无差异（P=0.496 和 P=0.447）。CIC 结果显示，与对照组相比，COVID-19 组的杯状细胞密度和细胞大小降低，非杯状上皮细胞出现中度至重度增大、鳞状改变和核浆比增加。根据 CIC 样本中的 Nelson 分类，COVID-19 组有 60.6%、对照组有 19.4%的患者发生 2 级或更高级别的改变。COVID-19 组 CIC 中中性粒细胞的存在显著高于对照组（P<0.001），而两组之间淋巴细胞的存在无差异（P=0.247）。
本研究揭示了 COVID-19 患者的病理性结膜改变，并表明即使在 COVID-19 早期，眼部无明显临床症状时，也可能存在病理性眼表改变。
