Children develop ocular manifestations with COVID-19


Some 23 percent of children hospitalized with COVID-19 in Wuhan, China, had ocular manifestations

Due to several reported cases, it is understood that patients with COVID-19 and ocular symptoms are at an increased risk of transmitting SARS-CoV-2 through a conjunctival route.1-3 However, virtually all currently reported cases of conjunctival transmission have occurred in adults, and little is known about the ocular manifestations of COVID-19 in children.

When compared with adults, exposure history, clinical characteristics, and ocular manifestations in children with COVID-19 could present very differently.4-9


A cross-sectional study was conducted at Wuhan Children’s Hospital in Wuhan, China, to investigate ocular manifestations and clinical characteristics of children with laboratory-confirmed COVID-19 between January 26 and March 18, 2020.

A total of 216 pediatric patients were studied, among whom 134 (62 percent) were boys, with a median age of 7.25 (3 to 12) years. Some 90 percent of participants had family members with suspected or confirmed COVID-19 infections, and some 43 percent of COVID-19–positive children were asymptomatic before laboratory confirmation.


The common initial symptoms that were reported include fever and cough, which is consistent with those observed in adult patients.10 Differing from adults, all infected children subjects had mild or moderate symptoms. This finding is consistent with previous studies which determined that children show milder cases and a better prognosis than adults infected with COVID-19.11-13

The most common ocular manifestations were conjunctival discharge (55 percent), eye rubbing (39 percent), and conjunctival congestion (10 percent).

Children with systemic symptoms or with cough were more likely to develop ocular symptoms, which were typically mild. All children recovered or improved.

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1. Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020 Feb 22;395(10224):e39.

2. Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, Xin N, Huang Z, Liu L, Zhang G, Wang J. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol. 2020 Jun;104(6):748-751.

3. Zhang X, Chen X, Chen L, Deng C. The evidence of SARS-CoV-2 infection on ocular surface. Ocul Surf. 2020;18(3):360–362.

4. Ma H, Hu J, Tian J, Zhou X, Li H, Laws MT, Wesemann LD, Zhu B, Chen W, Ramos R, Xia J, Shao J. A single-center, retrospective study of COVID-19 features in children: a descriptive investigation. BMC Med. 2020 May 6;18(1):123.

5. Lu X, Xiang Y, Du H, Wing-Kin Wong G. SARS-CoV-2 infection in children - Understanding the immune responses and controlling the pandemic. Pediatr Allergy Immunol. 2020 Apr 24.

6. Sun D, Chen X, Li H, Lu XX, Xiao H, Zhang FR, Liu ZS. SARS-CoV-2 infection in infants under 1 year of age in Wuhan City, China. World J Pediatr. 2020 Jun;16(3):260-266.

7. Li H, Chen K, Liu M, Xu H, Xu Q. The profile of peripheral blood lymphocyte subsets and serum cytokines in children with 2019 novel coronavirus pneumonia. J Infect. Published online April 20, 2020.

8. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020 Jun;20(6):689-696.

9. Su L, Ma X, Yu H, Zhang Z, Bian P, Han Y, Sun J, Liu Y, Yang C, Geng J, Zhang Z, Gai Z. The different clinical characteristics of corona virus disease cases between children and their families in China - the character of children with COVID-19. Emerg Microbes Infect. 2020 Dec;9(1):707-713.

10. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720.

11. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-1095.

12. Chang T-H, Wu J-L, Chang L-Y. Clinical characteristics and diagnostic challenges of pediatric COVID-19: a systematic review and meta-analysis. J Formos Med Assoc. 2020;119(5):982-989.

13. Castagnoli R, Votto M, Licari A, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. Published online April 22, 2020.

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