A prospective interventional case series comprised 30 patients with confirmed severe acute respiratory syndrome‐related coronavirus 2 (SARS–CoV‐2) infection. They were treated at a hospital in Zhejiang University between January 26 to February 9, 2020. Every 2 to 3 days, tear and conjunctival secretions were collected twice with disposable sampling swabs for RT‐PCR assay.

Outcomes

The average age of patients was 54.5 years; 21 patients were men. Two samples of tear and conjunctival secretions from the only 1 patient with conjunctivitis yielded positive RT‐PCR results; sputum samples were also positive in that patient. Fifty‐eight samples from other patents were all negative. The one patient who tested positive had what the authors defined as the common-type COVID-19, and not the severe-type where patients had more advanced respiratory complications.

Limitations

There were several limitations of the study, including a small sample size and small sample concentration, which might be insufficient for RT‐PCR detection of the virus and carry the possibility of false-negative results. It was not possible to determine whether all patients with viral conjunctivitis exist with the virus in their conjunctival sac and whether the virus causes conjunctivitis. In addition, most patients in this study received antiviral treatment before sampling. Although sputum samples were tested for comparison, the effect of drug treatment on the results could not be excluded.

Clinical significance

These findings show SARS‐CoV‐2 may be detected in the tears and conjunctival secretions in COVID-19 patients with conjunctivitis. The virus was not detected in the conjunctival sac of infected patients without conjunctivitis. The possibility of eye infection and the ocular route as a potential infection source should be considered and further examined. Therefore, eye protection is recommended as part of the defense against the spread of COVID-19. Further large‐sample and more comprehensive studies are needed to evaluate the role of novel coronaviruses in the eyes.