RELATIONSHIP BETWEEN OCULAR FINDINGS AND LABORATORY DATA IN PATIENTS WITH HOSPITALIZED COVID-19 PATIENTS (preprint)

Purpose: To investigate the relationship between laboratory blood parameters and ocular findings in hospitalized moderate or severe COVID-19 patients. Methods Ophthalmologic examination of 215 patients who were hospitalized with the diagnosis of COVID-19 was performed in their beds and their ocular findings were noted. Blood parameters were compared in patients with and without conjunctivitis like symptoms. Results Conjunctivitis like inflammatory findings were detected in 15 (7.44%) of 215 moderate or severe COVID-19 patients. There was no difference between the patients with and without ocular findings in terms of laboratory findings such as WBCs, neutrophil counts, lymphocyte counts, NLR, LDH, procalcitonin, D-dimer, CRP, and ferritin. Conclusion There was a significant relationship between COVID-19 and an acute conjunctival inflammatory response. Blood parameters that determined progression in patients with COVID-19 were not significant in terms of ocular findings.

COVID-19 pandemic from an ophthalmology point of view.

Coronavirus disease 2019 (COVID-19) is caused by a highly contagious RNA virus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ophthalmologists are at high-risk due to their proximity and short working distance at the time of slit-lamp examination. Eye care professionals can be caught unaware because conjunctivitis may be one of the first signs of COVID-19 at presentation, even precluding the emergence of additional symptoms such as dry cough and anosmia. Breath and eye shields as well as N95 masks, should be worn while examining patients with fever, breathlessness, or any history of international travel or travel from any hotspot besides maintaining hand hygiene. All elective surgeries need to be deferred. Adults or children with sudden-onset painful or painless visual loss, or sudden-onset squint, or sudden-onset floaters or severe lid oedema need a referral for urgent care. Patients should be told to discontinue contact lens wear if they have any symptoms of COVID-19. Cornea retrieval should be avoided in confirmed cases and suspects, and long-term preservation medium for storage of corneas should be encouraged. Retinal screening is unnecessary for coronavirus patients taking chloroquine or hydroxychloroquine as the probability of toxic damage to the retina is less due to short-duration of drug therapy. Tele-ophthalmology and artificial intelligence should be preferred for increasing doctor-patient interaction.

Case Series: Unbiased Deep Sequencing Analysis of Acute Infectious Conjunctivitis in an Ambulatory Eye Center in Berkeley, California.

SIGNIFICANCE: Acute infectious conjunctivitis poses significant challenges to eye care providers. It can be highly transmissible, and because etiology is often presumed, correct treatment and management can be difficult. This study uses unbiased deep sequencing to identify causative pathogens of infectious conjunctivitis, potentially allowing for improved approaches to diagnosis and management. PURPOSES: This study aimed to identify associated pathogens of acute infectious conjunctivitis in a single ambulatory eye care center. CASE REPORTS: This study included patients who presented to the University of California Berkeley eye center with signs and symptoms suggestive of infectious conjunctivitis. From December 2021 to July 2021, samples were collected from seven subjects (ages ranging from 18 to 38). Deep sequencing identified associated pathogens in five of seven samples, including human adenovirus D, Haemophilus influenzae , Chlamydia trachomatis , and human coronavirus 229E. CONCLUSIONS: Unbiased deep sequencing identified some unexpected pathogens in subjects with acute infectious conjunctivitis. Human adenovirus D was recovered from only one patient in this series. Although all samples were obtained during the COVID-19 pandemic, only one case of human coronavirus 229E and no SARS-CoV-2 were identified.

Report of a case of perforating nodular scleritis developed after hospitalisation for COVID-19 pneumonia (preprint)

Introduction: Conjunctivitis, keratoconjunctivitis, and episcleritis are known ocular surface manifestations of coronavirus disease. Case presentation: A 56-year-old male patient experienced red eye two days after being released from the COVID department. Two weeks later developed nodular scleritis. Ultrasound biomicroscopy raised the possibility of a foreign body or helminth; however, this was not confirmed during the surgical exploration. From an intraoperatively obtained sample, methicillin-resistant Staphylococcus aureus grew, while coronavirus could not be detected. Systemic work-up yielded negative results except for the Quantiferon gold test, but as histology showed granulation tissue, not granulomatous inflammation, it was unlikely that Mycobacterium pneumoniae had a role in ocular inflammation. After targeted local antibiotic therapy, the inflammation resolved slowly over the next five months. Conclusions: Thorough systematic workup, surgical exploration, and sample collection were necessary to determine the exact etiology, where only an indirect connection came to light with the COVID infection itself. To the best of our knowledge, there have been no previously published attempts to detect SARS-CoV-2 in scleral inflammatory tissue.

Profile of Eye-Related Emergency Department Visits in Ontario – A Canadian Perspective (preprint)

Background: Understanding the epidemiology of ophthalmic presentations to emergency departments can help guide resource allocation, medical education programs, and optimize the patient experience. The purpose of this investigation was to summarize and assess the urgency of ophthalmic presentations in emergency departments (EDs) in Ontario, Canada over a 5-year period.  Methods: This was a multicentered retrospective review of all patient presentations to EDs in Ontario between January 1st, 2012, to December 31st, 2017. Presentations were included if patients had an ophthalmic related ICD-10 code as their primary problem prompting ED presentation. Patients under the age of 18 were excluded from this investigation. Results: A total of 774,057 patients patient presentations were included across the pediatric (149,679 patients) and adult (624,378 patients) cohorts. The mean (SD) age at presentation was 47.4 (17.9) years, and 6.54 (5.20) in the adult and pediatric cohorts respectively. Of the total presentations, 256,776 (33.1%) were due to a trauma related presentation. Problems pertaining to Cornea and External disease were the most common reason for presentation (51.0% of cases). Of all presentations, 34.1% were classified as either ‘emergent’ or ‘likely emergent’; the remaining presentations were either ‘non-emergent’ (39.5%) or the urgency ‘could not be determined’ (26.4%). The three most frequent presentations were due to conjunctivitis (121,175 cases or 15.7%), ocular foreign bodies (104,322 cases or 13.5%), and corneal / conjunctival abrasions (94,554 cases of 12.2%). Conclusions: This investigation summarizes all ophthalmic presentations to EDs in Ontario, Canada over a 5-year period. The results of this investigation can help guide ophthalmic related knowledge translation. Additionally, these results highlight that in Canadian EDs, a significant proportion of ophthalmic presentations are nonurgent; systems level efforts to improve access for eye-related complaints to healthcare professionals outside of the ED can help facilitate improved resource allocation. As we emerge from the COVID-19 pandemic, optimising the structure of patient care access is crucial to help alleviate the pressure from overburdened EDs while effectively meeting patient healthcare needs.

Misdiagnosis of multisystem inflammatory syndrome in children: A diagnostic challenge.

AIMS: As the COVID-19 pandemic continues, multisystem inflammatory syndrome in children (MIS-C) maintains its importance in the differential diagnosis of common febrile diseases. MIS-C should be promptly diagnosed because corticosteroid and/or intravenous immunoglobulin treatment can prevent severe clinical outcomes. In this study, we aimed to evaluate clinical presentation, diagnostic parameters and management of MIS-C and compare its clinical features to those of common febrile disease. METHODS: This study was conducted at a tertiary-level university hospital between December 2020 and October 2022. One hundred and six children who were initially considered to have MIS-C disease were included in the study. During the follow-up period in the hospital, when the clinical and laboratory findings were re-evaluated, 38 out of 106 children were diagnosed differently. The clinical and laboratory findings of 68 children followed up with the diagnosis of MIS-C and 38 children who were initially misdiagnosed as MIS-C but with different final diagnoses were retrospectively compared. RESULTS: We identified 68 patients with MIS-C and 38 patients misdiagnosed as MIS-C during the study period. Infectious causes (71%), predominantly bacterial origin, were the most frequently confused conditions with MIS-C. Patients with MIS-C were older and had a more severe clinical course with high rates of respiratory distress, shock, and paediatric intensive care unit admission. While rash and conjunctivitis were more common among patients with MIS-C, cough, abdominal pain and diarrhoea were observed more frequently in patients misdiagnosed as MIS-C. Lower absolute lymphocyte counts, platelet counts and higher C-reactive protein and fibrinogen levels, pathological findings on echocardiography were the distinctive laboratory parameters for MIS-C. Multivariate analysis showed that older age, presence of conjunctivitis, high level of serum CRP and lower platelets were the most discriminative predictors for the diagnosis of MIS-C. CONCLUSION: There are still no specific findings to diagnose MIS-C, which therefore can be confused with different clinical conditions. Further data are needed to assist the clinician in the differential diagnosis of MIS-C and the diagnostic criteria should be updated over time.

Central retinal artery occlusion with cilioretinal artery sparing secondary to COVID-19: Additional ocular complication.

We describe a 68-year-old female patient with unilateral central retinal artery occlusion (CRAO) with cilioretinal artery sparing post-coronavirus disease 2019 (COVID-19) infection. The patient presented with acute vision loss in the left eye 11 days after discharge from a severe COVID-19 infection, with altered D-dimer, C-reactive protein, and fibrinogen levels. The best-corrected visual acuity (BCVA) in the left eye was 20/400; fundoscopic examination revealed diffuse pallor retina with a patent arterial branch from the optic disk to the fovea, confirmed by fluorescein angiography. CRAO with a cilioretinal artery sparing post-COVID-19 may be considered an additional ocular manifestation of the post-acute COVID-19 syndrome spectrum.

Zoonotic potential of guinea pigs: Outbreak of cryptosporidiosis combined with chlamydiosis in a breeding guinea pig herd.

INTRODUCTION: In a guinea pig herd with 26 breeding animals, several individuals of all age categories died (16/26) after three animals had been newly introduced from another herd. Furthermore, the population suffered of apathy, anorexia, severe weight loss and conjunctivitis, as well as abortions and stillbirths. At the same time, the owner experienced a SARS-CoV-2 infection with pneumonia, which was confirmed by taking a PCR test. Chlamydia caviae was detected from the conjunctiva and vagina/uterus in one juvenile animal together with an intestinal Cryptosporidium wrairi infection. Oocysts were found histologically in the small intestine, which was confirmed by PCR. C. wairi is a parasite adapted to guinea pigs with zoonotic potential, which causes diarrhoea with frequent deaths in larger guinea pig herds. C. caviae is also a zoonotic pathogen and often the cause of conjunctivitis, pneumonia and abortions in guinea pigs and can lead to upper respiratory tract disease, conjunctivitis but also severe pneumonia in humans. The increased death cases and the clinical signs could be traced back to an infection with Cryptosporidium wrairi, complicated by a co-infection of C. caviae. We suspect that the abortions were caused by C. caviae, but since the population was treated with various antibiotics effective against chlamydial infections, it was no longer possible to verify this by PCR testing. Unfortunately, more animals succumbed and finally only two animals of the originally 26 were left. With this case report, we would like to point out to veterinarians that guinea pigs can be an important source of zoonotic infections for various pathogens, especially since they are popular pets and often come into close contact with children where hygiene might not always be strictly followed.

INTRODUCTION: Dans un groupe de cobayes de 26 animaux reproducteurs, plusieurs individus de toutes les catégories d'âge sont morts (16/26) après l'introduction de trois animaux provenant d'un autre groupe. En outre, la population a souffert d'apathie, d'anorexie, de perte de poids sévère et de conjonctivite ainsi que d'avortements et de mortinatalité. La présence de Chlamydia caviae a pu être détectée dans la conjonctive et le vagin/utérus d'un animal juvénile, ainsi qu'une infection intestinale à Cryptosporidium wrairi. Des oocystes ont été trouvés histologiquement dans l'intestin grêle, ce qui a été confirmé par PCR. C. wairi est un parasite adapté aux cobayes avec un potentiel zoonotique, qui provoque des diarrhées avec des morts fréquentes dans les grands groupes de cobayes. C. caviae est également un agent pathogène zoonotique et est souvent à l'origine de conjonctivites, de pneumonies et d'avortements chez les cobayes ; il peut entraîner des maladies des voies respiratoires supérieures, des conjonctivites mais aussi des pneumonies graves chez l'homme. L'augmentation des cas de décès et les signes cliniques pourraient être attribués à une infection par Cryptosporidium wrairi, compliquée par une co-infection par C. caviae. Nous soupçonnons que les avortements ont été causés par C. caviae, mais comme la population a été traitée avec divers antibiotiques efficaces contre les infections à chlamydia, il n'était plus possible de le vérifier par des tests PCR. Malheureusement, d'autres animaux ont succombé et il ne restait finalement que deux animaux sur les 26 d'origine. Avec ce rapport de cas, nous aimerions attirer l'attention des vétérinaires sur le fait que les cochons d'Inde peuvent être une source importante d'infections zoonotiques pour divers pathogènes, d'autant plus qu'il s'agit d'animaux de compagnie populaires qui sont souvent en contact étroit avec des enfants avec lesquels l'hygiène n'est pas toujours strictement respectée.

Assessment of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during COVID-19 pandemic.

Purpose: : To determine the presence of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during the COVID-19 pandemic. Methods: This observational, cross-sectional study was conducted in clinically diagnosed patients with conjunctivitis attending the outpatient services of our institute from July 2021 to December 2021. The tear samples were collected from patients using Schirmer's strips or capillary tubes to detect the presence of SARS-CoV-2 by real-time PCR assay. COVID-19 vaccination and infection status, visual acuity, and clinical features were documented in all cases. Results: A total of 111 patients with symptoms of conjunctivitis were included during the study period. The mean age was 41.1 ± 13.1 years, and the mean duration of symptoms was 7.1 ± 4.4 days, with 74% males. Conjunctival congestion was mild in 69 (62.1%) patients, moderate in 30 (27%) patients, and severe in 12 (10.8%) patients. All except four had superficial punctate keratitis (SPK). Five (4.3%) patients were positive for SARS-CoV-2 RNA in their tear samples. All had mild-moderate conjunctival congestions with variable papiliofollicular reaction and SPKs, superficial hemorrhages were seen in three and pseudomembrane in one patient. They were followed up with telemedicine and three of them developed mild COVID-19-related symptoms and recovered after in-home quarantine. None of them had a previous history of COVID-19 infection and all had received COVID-19 vaccination within 2 weeks to 2 months. Conclusion: SARS-CoV-2 transmission through ocular secretion of conjunctivitis patients cannot be ignored and appropriate COVID-19-preventive behavior should be followed in ocular settings.

Severe Acute Respiratory Syndrome Coronavirus 2-Associated Blepharoconjunctivitis and Erythema Multiforme-Like Rash in a Young Man.

PURPOSE: The aim of this study was to describe the diagnosis and management of bilateral blepharoconjunctivitis and erythema multiforme (EM)-like illness in an otherwise healthy young man who tested positive for severe acute respiratory syndrome coronavirus (SARS-CoV)-2. METHODS: This is a case report of a 27 year-old man with a positive result for SARS-CoV-2 testing who presented with fever, eye redness, oral ulcerations, cough, sore throat, and progressive rash suspicious for EM-like illness. RESULTS: A SARS-CoV-2-positive patient presented to the emergency room with a progressing skin rash, bilateral conjunctivitis, and oropharyngeal mucosal ulcers. On initial ophthalmic examination, visual acuity was 20/25 both eyes (OU), and slit lamp examination demonstrated erythema and ulceration of the eyelid margins with fluorescein uptake at the mucocutaneous junction OU. The patient was admitted for observation and supportive treatment. During and after his hospital stay, he was treated with systemic and topical steroids, topical cyclosporine ophthalmic drops, erythromycin ophthalmic ointment, and artificial tears. At his 1-week follow-up visit after hospital discharge, the patient had complete resolution of his skin findings and improvement of his ocular and oral mucosal findings. Laboratory workup and imaging studies searching for other potential autoimmune and infectious etiologies showed negative results. CONCLUSIONS: Topical antiinflammatory drops, artificial tears, erythromycin ointment, and systemic steroids were an effective treatment for this bilateral blepharoconjunctivitis and EM-like presentation of SARS-CoV-2.

Outpatient human coronavirus associated conjunctivitis in India.

BACKGROUND: Viral conjunctivitis (pink eye) can be highly contagious and is of public health importance. There remains significant debate whether SARS-CoV-2 can present as a primary conjunctivitis. The aim of this study was to identify pathogens associated with outpatient infectious conjunctivitis during the COVID-19 Delta surge. METHODS: This prospective study was conducted in the spring and summer months of 2021. 106 patients with acute conjunctivitis who presented to the Aravind Eye Center in Madurai, India were included. One anterior nasal swab and one conjunctival swab of each eye were obtained for each enrolled patient. Samples were subsequently processed for unbiased metagenomic RNA deep sequencing (RNA-seq). Outcomes included clinical findings and codetection of other pathogens with SARS-CoV-2 in patients with conjunctivitis. RESULTS: Among the 13 patients identified with human coronavirus RNA fragments in their swabs, 6 patients had SARS-CoV-2 infection, 5 patients had coinfections of SARS-CoV-2 and human adenovirus (HAdV), 1 patient had a coinfection with human coronavirus OC43 and HAdV, and 1 patient had a coinfection of Vittaforma corneae and SARS-CoV-2. 30% had bilateral disease and symptoms on presentation. Petechial hemorrhage was noted in 33% of patients with SARS-CoV-2 infection. No patients with SARS-CoV-2 or SARS-CoV-2 and HAdV infections had subepithelial infiltrates on presentation. All patients denied systemic symptoms. CONCLUSIONS: Among the patients presented with conjunctivitis associated with human coronavirus infection, over 50% of the patients had co-infections with other circulating pathogens, suggesting the public-health importance of broad pathogen testing and surveillance in the outpatient conjunctivitis population.

Deep sequencing analysis of clinical samples from patients with acute infectious conjunctivitis during the COVID-19 delta surge in Madurai, India.

BACKGROUND: Seasonal outbreaks of infectious conjunctivitis remain a public health issue. Determination of outbreak etiologies in the context of a worldwide pandemic may provide useful information to guide public health strategies. The aim of this study was to identify pathogens associated with outpatient infectious conjunctivitis during the COVID-19 Delta surge. METHODS: This prospective study was conducted from April 2021 to September 2021. All outpatients presenting to the Aravind Eye Center (Madurai, India) with signs and symptoms consistent with acute infectious conjunctivitis were eligible. Three swabs were obtained from each participant: one from each conjunctiva and one from the anterior nares. Samples were processed for metagenomic RNA deep sequencing (RNA-seq). RESULTS: Samples from 106 study participants were sequenced. The most common presenting symptoms were tearing (86%) and itching (71%). Preauricular lymphadenopathy was present in 38% of participants. 20% of participants had close contacts with similar symptoms. Systemic symptoms such as coughing, runny nose, vomiting or diarrhea were uncommonly reported. 60% of all participants used some medicated eye drops upon enrollment. 75% of study participants demonstrated infection with human adenovirus D (HAdV-D). 11% of conjunctivitis was associated with SARS-CoV-2. 15% had no definitive pathogen detected. 8% of all participants had codetection of more than one pathogen on RNA-seq. CONCLUSIONS: During the COVID-19 Delta surge in India, HAdV-D was the most common pathogen associated with infectious conjunctivitis. SARS-CoV-2 was the second most common associated pathogen. Seasonal surveillance may be necessary for the determination of emerging and reemerging pathogens responsible for infectious conjunctivitis.

Acquired Brown syndrome following COVID-19 infection in a child.

Coronavirus disease 2019 (COVID-19) is a highly virulent multisystem disease caused by the SARS-CoV-2 virus. Symptoms of COVID-19 infection commonly include fever, malaise, cough, and shortness of breath. Numerous manifestations affecting nearly every organ system have been described. Ophthalmic manifestations, though rare, have been reported, including, most commonly, conjunctivitis in both adults and children, which often occurs as part of a multisystem inflammatory syndrome in children. However, pediatric ocular findings of COVID-19 are poorly understood. We present a case of acquired Brown syndrome in a child following COVID-19 infection.

A Google Trends Approach to Identify Distinct Diurnal and Day-of-Week Web-Based Search Patterns Related to Conjunctivitis and Other Common Eye Conditions: Infodemiology Study.

BACKGROUND: Studies suggest diurnal patterns of occurrence of some eye conditions. Leveraging new information sources such as web-based search data to learn more about such patterns could improve the understanding of patients' eye-related conditions and well-being, better inform timing of clinical and remote eye care, and improve precision when targeting web-based public health campaigns toward underserved populations. OBJECTIVE: To investigate our hypothesis that the public is likely to consistently search about different ophthalmologic conditions at different hours of the day or days of week, we conducted an observational study using search data for terms related to ophthalmologic conditions such as conjunctivitis. We assessed whether search volumes reflected diurnal or day-of-week patterns and if those patterns were distinct from each other. METHODS: We designed a study to analyze and compare hourly search data for eye-related and control search terms, using time series regression models with trend and periodicity terms to remove outliers and then estimate diurnal effects. We planned a Google Trends setting, extracting data from 10 US states for the entire year of 2018. The exposure was internet search, and the participants were populations who searched through Google's search engine using our chosen study terms. Our main outcome measures included cyclical hourly and day-of-week web-based search patterns. For statistical analyses, we considered P<.001 to be statistically significant. RESULTS: Distinct diurnal (P<.001 for all search terms) and day-of-week search patterns for eye-related terms were observed but with differing peak time periods and cyclic strengths. Some diurnal patterns represented those reported from prior clinical studies. Of the eye-related terms, "pink eye" showed the largest diurnal amplitude-to-mean ratios. Stronger signal was restricted to and peaked in mornings, and amplitude was higher on weekdays. By contrast, "dry eyes" had a higher amplitude diurnal pattern on weekends, with stronger signal occurring over a broader evening-to-morning period and peaking in early morning. CONCLUSIONS: The frequency of web-based searches for various eye conditions can show cyclic patterns according to time of the day or week. Further studies to understand the reasons for these variations may help supplement the current clinical understanding of ophthalmologic symptom presentation and improve the timeliness of patient messaging and care interventions.

Anxiety in adults with allergic rhinitis during the coronavirus disease 2019 pandemic: A Canadian perspective.

BACKGROUND: Despite the symptom overlap between allergic rhinitis (AR) and coronavirus disease 2019 (COVID-19), pandemic-time anxiety in people with AR remains an area of limited study. OBJECTIVE: To assess the AR-anxiety relationship in the unique context of the COVID-19 pandemic from a Canadian perspective. METHODS: The COVID-19 Associated Anxiety in patients with Asthma and AR Experiencing Symptoms survey was distributed on the "Qualtrics XM" platform, with 835 adult participants responding to the first iteration from April to August 2020. Anxiety was assessed on the Generalized Anxiety Disorder Assessment-7 (GAD-7), and AR burden of disease was assessed on the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). All analyses were conducted using IBM SPSS Statistics 27. RESULTS: High levels of anxiety were found, with 28.0% of the AR group and 27.5% of the control group meeting the diagnostic criteria for generalized anxiety disorder. After controlling for covariates, AR status had no significant predictive effect on GAD-7 in a hierarchal multiple regression model (ΔR² = .00, P = .69). In the AR subgroup, there were significant positive correlations between anxiety and burden of disease for the total RQLQ score and all 7 domain scores (P < .001 for all), with the non-nose or eye symptom domain having the strongest correlation (r = .63). After controlling for covariates, total RQLQ score had a predictive effect on GAD-7 in a hierarchal multiple regression model (ΔR² = .049, P < .001). CONCLUSION: High levels of anxiety exist during the COVID-19 pandemic regardless of AR status, indicating the importance of early anxiety screening in all patients. This study also highlights the importance of non-nose or eye symptoms in AR management.

Investigation and analysis of occupational physical injuries among healthcare staffs during allopatric medical aid for the fight against COVID-19.

BACKGROUND: Occupational health impairment of medical personnel manifested as a prominent problem in COVID-19. The aim of this study is to investigate the occupational physical injuries of front-line medical staffs in Hubei province during the fight against COVID-19. MATERIAL AND METHODS: questionnaire survey was conducted among 476 medical staffs from 3 regions of Hubei Province, including general characteristics and the physical discomfort/damage suffered in the isolation wards during working hours. RESULTS: A total of 457 valid questionnaires were collected. The common physical discomfort/damage included skin injuries (22.76%), conjunctivitis (15.10%), falls (9.19%), intolerant unwell symptoms (8.53%) and sharp injuries (6.13%). Logistic regression analysis showed that: lack of protective work experience (OR = 2.049, 95% CI: 1.071-3.921), continuous working for 4 h (OR = 3.771, 95% CI: 1.858-7.654), and working >4 h (OR = 7.076, 95% CI: 3.197-15.663) were high-risk factors for skin injuries. Working continuously for 4 h (OR = 3.248, 95% CI: 1.484-7.110) and working >4 h (OR = 3.096, 95% CI: 1.232-7.772) were high-risk factors for conjunctivitis. Lack of protective work experience was a high risk factor for falls (OR = 5.508, 95% CI: 1.299-23.354). The high risk factors for intolerant unwell symptoms were continuous working for 4 h (OR = 5.372, 95% CI: 1.239-23.301) and working >4 h (OR = 8.608, 95% CI: 1.843-40.217). Working in a COVID-19 critical care unit (OR = 3.249, 95% CI: 1.344-7.854) and implementation of nursing (OR = 9.766, 95% CI: 1.307-72.984) were high risk factors for sharp injuries. CONCLUSIONS: Occupational physical injuries are universal in the COVID-19 ward. Those who take up nursing, work in a critical care ward, with no experience in an isolation ward for infectious diseases, and work continuously for ≥4 h on the same day should get more attention. Med Pr. 2022;73(3):209-18.

Clinical course, diagnosis, and management of bilateral COVID-19 associated conjunctivitis: A case study.

We present a rare case of COVID-19 associated conjunctivitis where patient presented with redness, foreign body sensation, watering, and pain. Symptoms started while patient was COVID-19 positive. On examination, severe conjunctival congestion was present along with follicles. Visual acuity was 6/6 in both eyes. The patient was started on topical antibiotics and showed improvement but again presented with aggravated symptoms. Conjunctival swab was sent for culture and sensitivity, which was negative for any organisms. The patient was then started on oral and topical steroid, which showed improvement. Even though COVID-19 associated conjunctivitis is self-limiting, here it showed a progressive course and resolved only after steroid.

Epidemiological Investigation and Risk Factor Analysis of Acute Hemorrhagic Conjunctivitis in Huangshi Port District, Huangshi City.

Objective: This study is aimed at investigating the epidemiology and risk factors of acute hemorrhagic conjunctivitis (pinkeye) in Huangshi Port District of Huangshi City. Methods: A total of 593 cases of acute hemorrhagic conjunctivitis from January 2019 to December 2021 were selected as the observation group. The epidemiological characteristics (age of onset, season, occupation, clinical manifestations, and etiological characteristics) were analyzed. A total of 425 healthy subjects (nonacute hemorrhagic conjunctivitis) were selected as the control group. The general data of the two groups were compared, and the risk factors affecting the occurrence of acute hemorrhagic conjunctivitis were analyzed by logistic regression. Results: The onset age of acute hemorrhagic conjunctivitis was mainly concentrated in 0-20-year-old and 60-year-old age groups, and the onset season was mainly concentrated in April to August, with the highest incidence in May. The proportions of middle school students and workers in patients with acute hemorrhagic conjunctivitis were higher than those of other occupations (both P < 0.05). Ocular conjunctival congestion, tingling, and foreign body sensation were the main clinical manifestations of patients with acute hemorrhagic conjunctivitis. Among the 593 conjunctival swab samples collected in this study, the positive rates of HEV70 and CVA24v were higher than those of adenovirus nucleic acid (both P < 0.05). The proportion of people aged ≤40 years old, male, working outdoors, using potable water equipment, contact history of patients with acute conjunctivitis, history of chemical substances entering eyes, combined with immune system diseases, and public toilet utilization rate ≥ 1 times/d in the observation group was higher than that in the control group (all P < 0.05), and the proportion of people washing hands before eating and after toilet was lower than that in the control group (P < 0.05). Multiple logistic regression analysis showed that working place outdoors, use of potable water equipment, contact history of patients with acute conjunctivitis (all P < 0.05), and use of public toilets ≥ once a day were risk factors for the occurrence of acute hemorrhagic conjunctivitis, and washing hands before eating and after toilet was a protective factor (P < 0.05). Conclusion: The onset age of acute hemorrhagic conjunctivitis was mainly concentrated in 0-20-year-old and 60-year-old age; the onset season was mainly concentrated in summer and autumn; adenovirus is the main pathogenic bacteria; ocular conjunctivitis congestion, tingling, and foreign body sensation were the main clinical manifestations; working place outdoors, use of potable water equipment, contact history of patients with acute conjunctivitis (all P < 0.05), and use of public toilets ≥ once a day were risk factors for the occurrence of acute hemorrhagic conjunctivitis, while washing hands before eating and after toilet was a protective factor.

A qualitative evaluation of pediatric conjunctivitis medical decision making and opportunities to improve care.

BACKGROUND: Acute infectious conjunctivitis is a common childhood illness, and the role of antibiotic treatment remains unclear. The purpose of this study was to describe the decision-making process providers use when managing infectious conjunctivitis, to identify factors that reduce unnecessary antibiotic prescribing, and to evaluate how the COVID-19 pandemic influenced prescribing behavior. METHODS: We conducted semi-structured interviews with 20 providers caring for children in primary care, urgent cares, and emergency departments in Denver, Colorado. Interviews were evaluated for major themes using deductive and inductive content analysis methods. RESULTS: Significant drivers for deciding to treat infectious conjunctivitis with antibiotics included patient's clinical presentation, family expectations, antibiotic stewardship concerns, etiological diagnostic uncertainty, and school/daycare policies. High variability existed in approaches used to distinguish viral from bacterial conjunctivitis. No providers were aware of pediatric treatment guidelines or standardized recommendations for return to school or daycare. Providers reported higher antibiotic prescribing during the COVID-19 pandemic. Factors identified that could reduce unnecessary antibiotic prescribing included family education, a reliable diagnostic test to decrease diagnostic uncertainty, pediatric clinical guidelines, and standardizing exclusion policies for school/daycare. CONCLUSIONS: Management of pediatric infectious conjunctivitis is inconsistent. Creation of guidelines for the evaluation and management of infectious conjunctivitis in children could help reduce unnecessary prescribing and the burden for families and the health care system. In addition, updated guidelines for school/daycare exclusion may be important to establish streamlined and evidence-based exclusion practices.