Ocular manifestation, eye protection, and COVID-19

Dear Editor,

We found that the report on “Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong” is very interesting [1]. Lai et al. noted that “In order to minimise transmission of COVID-19, ophthalmologists should work closely with local infection control teams to implement infection control measures that are appropriate for their own clinical settings [1].” In fact, Li et al. pointed out the possibility of ocular manifestation in COVID-19 and the importance of eyewear [2]. We would like to share ideas and experience from Thailand, the second country in Southeast that the new infection-19 has been occurred for 3 months [3]. At present (March 6, 2020), there are accumulated 48 COVID-19 patients. From these 48 cases, the complete physical examination including the eye examination, which includes direct ophthalmoscopy and further corneal scraping in suspicious conjunctivitis case, to detect ocular manifestation was done in each case, and there is no report on ocular problem. Nevertheless, it should note that the ocular manifestation is usually overlooked by Thai practitioners. The local infection control guidelines provided by local medical professor team state for only fever and respiratory manifestation (local guideline by the Department of Medical Services, Ministry of Public Health is available online at https://www.dms.moph.go.th/backend//Content/Content_File/Practice_guidelines/Attach/25630213145852PM_2019-nCoV_flow_HosManage_Feb5.pdf). It is no doubt that the case with initial presentation of eye problem is easily missed. In addition, there has never recommendation for eyewear use in medical practice. Practitioner usually wears facemask and exposes eyes to the patient. Modification of the present infection control guidelines to include the eye protective device during medical practice is suggested. It is necessary to educate the practitioner for recognizing possible ocular manifestation of COVID-19.