(Reuters Health) — Acute, non-remitting conjunctivitis may be the only presenting symptom of Covid-19 infections in some instances, according to case reports on five patients in Italy.

“Conjunctivitis per se is not a very common finding among positive subjects, but when it occurs, it generally presents with or anticipates other symptoms, such as fever, general malaise, cough,” said Dr. Edoardo Trovato Battagliola, a resident physician in ophthalmology at the University of Bologna in Italy and coauthor of the case reports published in IDCases.

“The peculiarity of our five patients was that conjunctivitis remained the only symptom and sign of infection throughout their illness,” Dr. Battagliola said by email.

Dr. Battagliola and his colleague and co-author Dr. Sergio Zaccaria Scalinci report on the cases of four middle-aged men and one middle-aged woman with acute conjunctivitis and symptoms like conjunctival hyperemia, epiphora, discharge and photophobia who were referred to them after several days without symptom improvement.

The doctors confirmed the diagnosis of acute conjunctivitis and advised all five of these patients to continue symptomatic therapy and moxifloxacin eye drops for five more days.

Because they treated these patients during the current SARS-CoV-2 pandemic, they also inquired about recent travels and discovered that all five of the patients had recently traveled to Lombardy, a Covid-19 hotspot. None had fever, respiratory symptoms, or other symptoms of Covid-19.

Still, tests performed using naso-pharyngeal swabs were done for all five patients, and all five came back positive for SARS-CoV-2.

All five patients were instructed to self-quarantine until their infection cleared up and followed up by phone. Throughout the course of their infections, they consistently reported no fever, respiratory symptoms, or general malaise.

“Our patients were paucisymptomatic,” Dr. Battagliola said. “Individuals who display a few or no symptoms are lucky in the sense that their immune system is reacting well against the virus and they feel good overall,” he added. “However, they can potentially represent a greater threat to other individuals, as they are understandably less aware of their condition, but can still pass the virus on to others.”

Testing resources remain limited, and it may not be advisable to test all patients who have a similar profile to the five in these case reports until further research more clearly establishes the connection between conjunctivitis and Covid-19, the study authors conclude.

The results do underscore that more research is urgently needed, and highlight the importance of eye protection for health care professionals, they advise.

“We don’t know in what percentage of patients, conjunctivitis will be the sole or the starting symptom of SARS-COV-2,” said Dr. Saeed Shoar, a clinical research scientist at ScientificWriting Corporation in Houston, Texas, who wasn’t involved in the study.

“But as (these case reports) revealed, it can start days before the typical symptoms of COVID-19 begin,” Dr. Shoar said by email. SOURCE: https://bit.ly/2WSzYC8 IDCases, online April 24, 2020.