{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T07:51:29Z","timestamp":1769845889603,"version":"3.49.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T00:00:00Z","timestamp":1632268800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T00:00:00Z","timestamp":1632268800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Ophthal Inflamm Infect"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can induce conjunctivitis signs and symptoms. However, limited information is available on their impact on COVID-19 disease phenotype. Quantification of ocular signs\/symptoms can provide a rapid, non-invasive proxy for predicting clinical phenotype. Moreover, the existence and entity of conjunctival viral shedding is still debated. This has relevant implications to manage disease spread.<\/jats:p>\n                <jats:p>The purpose of this study was to investigate conjunctivitis signs and symptoms and their correlation with clinical parameters, conjunctival viral shedding in patients with COVID-19.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Fifty-three patients hospitalized between February 25th and September 16th, 2020 at the San Raffaele Hospital, in Milan, Lombardy, Italy with a confirmed diagnosis of SARS-CoV-2 were evaluated. Presence of interstitial pneumonia was confirmed with computed tomography scan imaging. Ocular signs and symptoms, anosmia\/ageusia, clinical\/laboratory parameters, and reverse transcriptase\u2013polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for COVID-19 virus were analyzed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Forty-six out of 53 patients showed a positive nasopharyngeal swab for SARS-CoV-2 infection at the time of conjunctival evaluation. All the conjunctival swabs were negative. Conjunctivitis symptoms were present in 37% of patients. Physician-assessed ocular signs were detected in 28% of patients<jats:underline>.<\/jats:underline><\/jats:p>\n                <jats:p>Patients with ocular symptoms or signs tended to be older: 76.8\u2009years (62.4\u201383.3) vs 57.2\u2009years (48.1\u201374.0), <jats:italic>p<\/jats:italic>\u2009=\u20090.062 and had a longer hospitalization: 38\u2009days (18\u201349) vs. 14\u2009days (11\u201321), <jats:italic>p<\/jats:italic>\u2009=\u20090.005. Plasma levels of Interleukin-6 were higher in patients with signs or symptoms in comparison with those without them: 43.5\u2009pg\/ml (19.7\u201349.4) vs. 8\u2009pg\/ml (3.6\u201320.7), <jats:italic>p<\/jats:italic>\u2009=\u20090.02. Red cell distribution width was also significantly higher: 15 (14.3\u201316.7) vs 13.2 (12.4\u201314.4), <jats:italic>p<\/jats:italic>\u2009=\u20090.001.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We found that over a third of the patients had ocular signs or symptoms. These had higher prevalence in patients with a more severe infection. No viral shedding was detected in the conjunctiva. Our results suggest that prompt detection of conjunctivitis signs\/symptoms can serve as a helpful proxy to predict COVID-19 clinical phenotype.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12348-021-00264-0","type":"journal-article","created":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T20:02:52Z","timestamp":1632340972000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Symptoms and signs of conjunctivitis as predictors of disease course in COVID-19 syndrome"],"prefix":"10.1186","volume":"11","author":[{"given":"Martina","family":"Ranzenigo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Bruzzesi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Galli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Castagna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6474-9908","authenticated-orcid":false,"given":"Giulio","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,22]]},"reference":[{"issue":"1","key":"264_CR1","doi-asserted-by":"publisher","first-page":"103","DOI":"10.18502\/jovr.v16i1.8256","volume":"16","author":"N Nasiri","year":"2021","unstructured":"Nasiri N, Sharifi H, Bazrafshan A, Noori A, Karamouzian M, Sharifi A (2021) Ocular Manifestations of COVID-19: A Systematic Review and Meta-analysis. J Ophthalmic Vis Res 16(1):103\u2013112. https:\/\/doi.org\/10.18502\/jovr.v16i1.8256","journal-title":"J Ophthalmic Vis Res"},{"key":"264_CR2","doi-asserted-by":"crossref","unstructured":"Sen M, Honavar SG, Sharma N, Sachdev MS (2021) COVID-19 and eye: a review of ophthalmic manifestations of COVID-19. Indian J Ophthalmol 69(3):488\u2013509. https:\/\/doi.org\/10.4103\/ijo. IJO_297_21","DOI":"10.4103\/ijo.IJO_297_21"},{"key":"264_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2020.e00774","volume":"20","author":"SZ Scalinci","year":"2020","unstructured":"Scalinci SZ, Trovato BE (2020) Conjunctivitis can be the only presenting sign and symptom of COVID-19. IDCases. 20:e00774. https:\/\/doi.org\/10.1016\/j.idcr.2020.e00774","journal-title":"IDCases."},{"key":"264_CR4","doi-asserted-by":"publisher","unstructured":"Chen L, Deng C, Chen X, et al. (2020) Ocular manifestations and clinical characteristics of 535 cases of COVID-19 in Wuhan, China: a cross-sectional study. Acta Ophthalmol;98(8). doi:https:\/\/doi.org\/10.1111\/aos.14472","DOI":"10.1111\/aos.14472"},{"key":"264_CR5","doi-asserted-by":"publisher","unstructured":"De Cobelli F, Palumbo D, Ciceri F et al (2021) Pulmonary vascular thrombosis in COVID-19 pneumonia. J Cardiothorac Vasc Anesth Published online January 13. https:\/\/doi.org\/10.1053\/j.jvca.2021.01.011","DOI":"10.1053\/j.jvca.2021.01.011"},{"key":"264_CR6","doi-asserted-by":"publisher","unstructured":"Mancini N, Clementi N, Ferrarese R, Ambrosi A, Tonelli M, Zangrillo A, Landoni G, Clementi M (2021) Very high SARS-CoV-2 load at the emergency department presentation strongly predicts the risk of admission to the intensive care unit and death. Clin Chem Lab Med Published online January 21(6):e247\u2013e250. https:\/\/doi.org\/10.1515\/cclm-2020-1709","DOI":"10.1515\/cclm-2020-1709"},{"issue":"16","key":"264_CR7","doi-asserted-by":"publisher","first-page":"2252","DOI":"10.1093\/cid\/ciaa619","volume":"71","author":"MR Tom","year":"2020","unstructured":"Tom MR, Mina MJ (2020) To interpret the SARS-CoV-2 test, consider the cycle threshold value. Clin Infect Dis 71(16):2252\u20132254. https:\/\/doi.org\/10.1093\/cid\/ciaa619","journal-title":"Clin Infect Dis"},{"key":"264_CR8","doi-asserted-by":"publisher","unstructured":"World Medical Association Declaration of Helsinki (2013) JAMA. 310(20):2191. doi:https:\/\/doi.org\/10.1001\/jama.2013.281053","DOI":"10.1001\/jama.2013.281053"},{"issue":"2","key":"264_CR9","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1080\/00031305.1998.10480550","volume":"52","author":"A Agresti","year":"1998","unstructured":"Agresti A, Coull BA (1998) Approximate is better than \u201cexact\u201d for interval estimation of binomial proportions. Am Stat 52(2):119\u2013126. https:\/\/doi.org\/10.1080\/00031305.1998.10480550","journal-title":"Am Stat"},{"issue":"1","key":"264_CR10","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s10875-020-00899-z","volume":"41","author":"W Udomsinprasert","year":"2021","unstructured":"Udomsinprasert W, Jittikoon J, Sangroongruangsri S, Chaikledkaew U (2021) Circulating levels of Interleukin-6 and Interleukin-10, but not tumor necrosis factor-alpha, as potential biomarkers of severity and mortality for COVID-19: systematic review with Meta-analysis. J Clin Immunol 41(1):11\u201322. https:\/\/doi.org\/10.1007\/s10875-020-00899-z","journal-title":"J Clin Immunol"},{"issue":"4","key":"264_CR11","doi-asserted-by":"publisher","first-page":"e253","DOI":"10.1016\/S2665-9913(21)00012-6","volume":"3","author":"G Cavalli","year":"2021","unstructured":"Cavalli G, Larcher A, Tomelleri A, Campochiaro C, Della-Torre E, de Luca G, Farina N, Boffini N, Ruggeri A, Poli A, Scarpellini P, Rovere-Querini P, Tresoldi M, Salonia A, Montorsi F, Landoni G, Castagna A, Ciceri F, Zangrillo A, Dagna L (2021) Interleukin-1 and interleukin-6 inhibition compared with standard management in patients with COVID-19 and hyperinflammation: a cohort study. Lancet Rheumatol 3(4):e253\u2013e261. https:\/\/doi.org\/10.1016\/S2665-9913(21)00012-6","journal-title":"Lancet Rheumatol"},{"key":"264_CR12","doi-asserted-by":"publisher","unstructured":"Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, Wu K (2020) Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province. China JAMA Ophthalmol 138(5):575\u2013578. https:\/\/doi.org\/10.1001\/jamaophthalmol.2020.1291","DOI":"10.1001\/jamaophthalmol.2020.1291"},{"issue":"7","key":"264_CR13","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/j.ophtha.2020.03.026","volume":"127","author":"IYJ Seah","year":"2020","unstructured":"Seah IYJ, Anderson DE, Kang AEZ, Wang L, Rao P, Young BE, Lye DC, Agrawal R (2020) Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients. Ophthalmology. 127(7):977\u2013979. https:\/\/doi.org\/10.1016\/j.ophtha.2020.03.026","journal-title":"Ophthalmology."},{"key":"264_CR14","doi-asserted-by":"publisher","unstructured":"Azzolini C, Donati S, Premi E, Baj A, Siracusa C, Genoni A, Grossi PA, Azzi L, Sessa F, Dentali F, Severgnini P, Minoja G, Cabrini L, Chiaravalli M, Veronesi G, Carcano G, Maffioli LS, Tagliabue A (2021) SARS-CoV-2 on ocular surfaces in a cohort of patients with COVID-19 from the Lombardy region. Italy JAMA Ophthalmol Published online March 4. https:\/\/doi.org\/10.1001\/jamaophthalmol.2020.5464","DOI":"10.1001\/jamaophthalmol.2020.5464"}],"container-title":["Journal of Ophthalmic Inflammation and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-021-00264-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12348-021-00264-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-021-00264-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T20:04:11Z","timestamp":1632341051000},"score":1,"resource":{"primary":{"URL":"https:\/\/joii-journal.springeropen.com\/articles\/10.1186\/s12348-021-00264-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,22]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["264"],"URL":"https:\/\/doi.org\/10.1186\/s12348-021-00264-0","relation":{},"ISSN":["1869-5760"],"issn-type":[{"value":"1869-5760","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,22]]},"assertion":[{"value":"24 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki8 and the evaluated patients are part of the COVID-19 institutional clinical-biological cohort (Covid-BioB registered on the  website: ), whose study protocol was approved by the Hospital Ethics Committee (protocol number 34\/int\/2020). Informed consent was obtained according to the Ethic Committee guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Does not apply.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"35"}}