2019-nCoV transmission through the ocular surface must not be ignored
Authors: Cheng-wei Lu, Xiu-fen Liu, Zhi-fang Jia
Journal: The Lancet (2020)

Chaolin Huang and colleagues1Huang C Wang YM Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30183-5.)Summary Full Text Full Text PDF Scopus (33099) Google Scholar reported the epidemiology, symptoms, and treatment of patients infected by the 2019 novel coronavirus (2019-nCoV) in Wuhan, China. As ophthalmologists, we believe that transmission of 2019-nCoV through the eyes was ignored. On Jan 22, Guangfa Wang, a member of the national expert panel on pneumonia, reported that he was infected by 2019-nCoV during the inspection in Wuhan.2Dai X Peking University Hospital Wang Guangfa disclosed treatment status on Weibo and suspected infection without wearing goggles.http://www.bjnews.com.cn/news/2020/01/23/678189.htmlDate: Jan 22, 2020Date accessed: January 24, 2020Google Scholar He wore an N95 mask but did not wear anything to protect his eyes. Several days before the onset of pneumonia, Wang complained of redness of the eyes. Unprotected exposure of the eyes to 2019-nCoV in the Wuhan Fever Clinic might have allowed the virus to infect the body.2Dai X Peking University Hospital Wang Guangfa disclosed treatment status on Weibo and suspected infection without wearing goggles.http://www.bjnews.com.cn/news/2020/01/23/678189.htmlDate: Jan 22, 2020Date accessed: January 24, 2020Google Scholar Infectious droplets and body fluids can easily contaminate the human conjunctival epithelium.3Olofsson S Kumlin U Dimock K Arnberg N Avian influenza and sialic acid receptors: more than meets the eye?.Lancet Infect Dis. 2005; 5: 184-188Summary Full Text Full Text PDF PubMed Scopus (75) Google Scholar Respiratory viruses are capable of inducing ocular complications in infected patients, which then leads to respiratory infection.4Belser JA Rota PA Tumpey TM Ocular tropism of respiratory viruses.Microbiol Mol Biol Rev. 2013; 77: 144-156Crossref PubMed Scopus (245) Google Scholar Severe acute respiratory syndrome coronavirus (SARS-CoV) is predominantly transmitted through direct or indirect contact with mucous membranes in the eyes, mouth, or nose.5Peiris JS Yuen KY Osterhaus AD Stohr K The severe acute respiratory syndrome.N Engl J Med. 2003; 349: 2431-2441Crossref PubMed Scopus (1028) Google Scholar The fact that exposed mucous membranes and unprotected eyes increased the risk of SARS-CoV transmission4Belser JA Rota PA Tumpey TM Ocular tropism of respiratory viruses.Microbiol Mol Biol Rev. 2013; 77: 144-156Crossref PubMed Scopus (245) Google Scholar suggests that exposure of unprotected eyes to 2019-nCoV could cause acute respiratory infection. Thus, Huang and colleagues1Huang C Wang YM Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30183-5.)Summary Full Text Full Text PDF Scopus (33099) Google Scholar should have analysed conjunctival scrapings from both confirmed and suspected 2019-nCoV cases during the onset of symptoms. The respiratory tract is probably not the only transmission route for 2019-nCoV, and all ophthalmologists examining suspected cases should wear protective eyewear. We declare no competing interests.