1/ @choo_ek's tweet made me giggle last night (there has been evidence of this, although small)!

THEN PAPER COMES OUT TODAY:
#SARSCoV2 Nucleocapsid Protein in the Ocular Tissues of a Patient Previously Infected With #COVID19 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2771320

HT @EricTopol @equibotanica https://twitter.com/choo_ek/status/1314015333733154818

2/ Study out of #China

N of 1 BUT EYES and #LongCovid! So I'm already interested. It's a weird one:

64yo lady develops diarrhea on 1/22, then a cough 1/26, finally gets hospitalized 1/31 mild fever 100F, O2 sat 98%, CRP 1.25, WBC 7270, throat swab positive for #SARSCoV2 RT-PCR

3/ - CT chest --> ground-glass opacity in lower bilateral lobes
- Dx with #COVID19
- Admitted to the hospital for antiviral and antibacterial Tx, & supplemental oxygen
- Symptoms fully resolved By day 18
- Throat swab RT-PCR tests on 2/18 and 2/20, both negative

BUT THEN!!!

4/ -02/28/2020: she began experiencing persistent LEFT
eye pain and visual acuity loss.

- 03/02/2020: the same symptoms developed in her RIGHT eye

- 03/08/2020: admitted to the ophthalmology clinic. Visual acuity was light perception bilaterally, IOP
50mmHg in both eyes

5/ Slitlamp examination showed bilaterally:
- Conjunctival hyperemia
- Corneal edema
- Dilated (5-mm diameter) and fixed pupils
- Flat anterior chambers
- Lens opacity
- Fundus unclear because of the corneal edema

Dx w/ acute angle-closure glaucoma &
cataract @DGlaucomflecken

6/ IOP could not be lowered by Rx, so:
- 03/14/2020: phacoemulsification surgery performed on LEFT eye
- 03/15/2020: phacoemulsification surgery performed on RIGHT eye

(2 months after initial sx!)

Tissue samples of the anterior lens capsular were collected during surgery

7/ After phacoemulsification surgery, intraocular pressure (IOP) was STILL uncontrollable in her right eye. So she then:

04/10/2020: Underwent trabeculectomy surgery

Samples of the conjunctiva, trabecular, and iris were collected during this surgery

8/ Control samples collected on same day from 61yo gentleman with glaucoma also undergoing trabeculectomy surgery.

Control had negative RT-PCR throat swabs x2,
a negative chest CT & negative blood test results

Fasting serum samples collected for #SARSCoV2 IgM, IgG, & NP antigen

9/ Nucleocapsid protein (NP) antigen of #SARSCoV2 was detected on the conjunctiva, trabecular, and iris specimens using immunochemistry (IHC) or immunofluorescence (IF), while ACE2 receptor protein on the conjunctiva was detected using IHC. #COVID19 #LongCovid @DGlaucomflecken

10/ So #SARSCoV2 may exist intracellularly in the inner ocular tissues as well as on the ocular surface.

AND based on these results, the EYE is also one
of the target organs for the viral infection in addition to the lungs.

The route the virus enters the eye is still unclear.

11/ Authors propose #SARSCoV2 could enter the inner eye tissues in 2 ways:

1. Via the ACE2 receptor on the surface of the
conjunctiva (needs to be confirmed w/ further studies)

2. Systemically to end organs as a result of the primary respiratory infection (hematologic) #COVID19

12/ LIMITATIONS:
- Patient under study was not in the acute period
of infection.
- Transmission route was short of definite evidence

CONCLUSIONS:
Viral antigen detected in the eye of the patient 2 months after infection should prompt future investigations to determine:

13/
1. Whether the viral NP antigens that remain in the eye over time cause damage to the ocular structure or function

2. Represent the presence of active viral residues in organs (not only the eyes)

3. Are still infectious

#LongCovid #COVID19

14/ The eye is an immuno-priveleged site. A truly fascinating organ. I wrote about it back in April d/t literature on its involvement in other viruses.

THREAD 3: Eyes, ENT, Neuro, and #SARSCoV2 https://twitter.com/ErinSandersNP/status/1249790563991400450?s=20

15/ The American Academy of Opthalmology has also curated a list of studies on the eye and #COVID19, although it is very limited: https://www.aao.org/headline/covid-19-background-primer-ophthalmologists

16/ Several studies have already found #SARSCoV2 RNA in the eyes of both living and deceased patients. Like the brain, the incidence of viral organ involvement of the eyes is not zero & certainly merits further investigation. #COVID19 #LongCovid https://twitter.com/ErinSandersNP/status/1299158891595476996?s=20

17/ Also just have to share this AMAZING illustration of the blood supply to the brain around the optic nerve recently posted by @ysaralee! https://twitter.com/ysaralee/status/1313188932834619392

18/ Notably, the ophthalmic artery connects directly to the internal carotid artery (sitting under optic nerve), which is interesting to consider given potential for hematogenous route/spread.