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Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China

Educational Objective
To understand the ocular manifestations and clinical characteristics of children with COVID-19
1 Credit CME
Key Points

Question  What are the ocular manifestations and outcomes in children with confirmed coronavirus disease 2019 (COVID-19) and what factors contributed to ocular symptoms during the course of disease in children?

Findings  In this cross-sectional study of 216 children hospitalized with COVID-19 in Wuhan, China, 49 (22.7%) had ocular manifestations, including conjunctival discharge, eye rubbing, and conjunctival congestion. Children with systemic symptoms or cough were more likely to develop ocular symptoms, which were mild, and recovered or improved with minimal eye drops or self-healing.

Meaning  These data could help guide prevention and management of ocular disorders in children with COVID-19.


Importance  Ocular manifestations and outcomes in children with confirmed coronavirus disease 2019 (COVID-19), relevant affecting factors, and differences in ocular disease between children and adults have yet to be fully understood.

Objective  To investigate ocular manifestations and clinical characteristics of children with laboratory-confirmed COVID-19.

Design, Setting, and Participants  This cross-sectional study was conducted at Wuhan Children’s Hospital in Wuhan, China. Children with COVID-19 confirmed by severe acute respiratory syndrome coronavirus disease 2 nucleic acid tests of upper respiratory tract specimens between January 26 and March 18, 2020, were included.

Main Outcomes and Measures  Onset clinical symptoms and duration, ocular symptoms, and needs for medication.

Results  A total of 216 pediatric patients were included, among whom 134 (62%) were boys, with a median (interquartile range) age of 7.25 (2.6-11.6) years. Based on the exposure history, 193 children (89.4%) had a confirmed (173 [80.1%]) or suspected (20 [9.3%]) family member with COVID-19 infection. The most common symptoms among symptomatic children were fever (81 [37.5%]) and cough (79 [36.6%]). Of 216 children, 93 (43.1%) had no systemic or respiratory symptoms. All children with mild (101 [46.8%]) or moderate (115 [53.2%]) symptoms recovered without reported death. Forty-nine children (22.7%) showed various ocular manifestations, of which 9 had ocular complaints being the initial manifestations of COVID-19. The common ocular manifestations were conjunctival discharge (27 [55.1%]), eye rubbing (19 [38.8%]), and conjunctival congestion (5 [10.2%]). Children with systemic symptoms (29.3% vs 14.0%; difference, 15.3%; 95% CI, 9.8%-20.7%; P = .008) or with cough (31.6% vs 17.5%; difference, 14.1%; 95% CI, 8.0%-20.3%; P = .02) were more likely to develop ocular symptoms. Ocular symptoms were typically mild, and children recovered or improved.

Conclusions and Relevance  In this cross-sectional study, children hospitalized with COVID-19 in Wuhan, China, presented with a series of onset symptoms including fever, cough, and ocular manifestations, such as conjunctival discharge, eye rubbing, and conjunctival congestion. Patients’ systemic clinical symptoms or cough were associated with ocular symptoms. Ocular symptoms recovered or improved eventually.

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Article Information

Corresponding Author: Shilian Li, MD, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science & Technology, 100 Hongkong Rd, Wuhan 430016, China (lianshili163@163.com); Fagang Jiang, MD, PhD, Tongji Medical College, Union Hospital, Huazhong University of Science & Technology, 1277 Liberation Ave, Wuhan 430022, China (13554100999@163.com).

Accepted for Publication: August 10, 2020.

Published Online: August 26, 2020. doi:10.1001/jamaophthalmol.2020.3690

Author Contributions: Drs Jiang and S. Li had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Ma, P. Li, Wang, and Yu contributed equally to the manuscript as joint first authors.

Concept and design: Ma, P. Li, Wang, S. Li, Jiang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ma, P. Li, Wang.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ma, P. Li, Wang, Yu.

Obtained funding: Wang.

Administrative, technical, or material support: Tan, Chen, S. Li.

Supervision: Jiang.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by the National Natural Science Foundation of China (81900912).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Yun Xiang, PhD (Department of Laboratory Medicine, Wuhan Children’s Hospital, Wuhan, China), for providing COVID-19 testing data in the manuscript. We also thank Chuanyi M. Lu, MD, PhD (University of California, San Francisco), for the valuable English language editing. Neither individuals received compensation for their work.

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