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The severe acute respiratory syndrome coronavirus in tears
  1. S-C Loon1,
  2. S C B Teoh1,
  3. L L E Oon3,
  4. S-Y Se-Thoe3,
  5. A-E Ling3,
  6. Y-S Leo4,
  7. H-N Leong2
  1. 1The Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Republic of Singapore
  2. 2Department of Infectious Disease, Singapore General Hospital, Outram Road, Singapore 169608
  3. 3Department of Pathology, Virology Section, Blk 8, Singapore General Hospital, Outram Road, Singapore 169608
  4. 4Centre for Communicable Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
  1. Correspondence to: Dr S-C Loon Department of Ophthalmology, 5 Lower Kent Ridge Road, Main building Level 3, National University Hospital, Singapore 119074; ploonscyahoo.com

Abstract

Background: Severe acute respiratory syndrome (SARS) is a new infectious disease that caused a global outbreak in 2003. Research has shown that it is caused by a novel coronavirus. A series of cases is reported where polymerase chain reaction (PCR) testing on tears had demonstrated the presence of the virus. Detection of ocular infection from tears using the PCR technique has been widely used by ophthalmologists to diagnose infections for other viruses.

Methods: This is a case series report from cases classified as probable or suspect SARS cases. Tear samples were collected from 36 consecutive patients who were suspected of having SARS in Singapore over a period of 12 days (7–18 April 2003), and analysed by PCR using protocols developed by the WHO network of laboratories.

Results: Three patients with probable SARS (one female and two male patients) had positive results from their tear samples. Tear samples were used to confirm SARS in the female patient, who was positive only from her tears. The positive specimens were found in cases sampled early in their course of infection.

Conclusions: This is the first case series reported with the detection of the SARS coronavirus from tears, and has important implications for the practice of ophthalmology and medicine. The ability to detect and isolate the virus in the early phase of the disease may be an important diagnostic tool for future patients and tear sampling is both simple and easily repeatable. Many healthcare workers are in close proximity to the eyes of patients and this may be a source of spread among healthcare workers and inoculating patients. Ophthalmic practices may need to change as more stringent barrier methods, appropriate quarantine, and isolation measures are vital when managing patients with SARS.

  • PCR, polymerase chain reaction
  • SARS, severe acute respiratory syndrome
  • severe acute respiratory syndrome
  • SARS
  • virus
  • tears
  • polymerase chain reaction
  • PCR, polymerase chain reaction
  • SARS, severe acute respiratory syndrome
  • severe acute respiratory syndrome
  • SARS
  • virus
  • tears
  • polymerase chain reaction

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