Is orbital wall fracture associated with SARS-CoV-2 ocular surface contamination in asymptomatic COVID-19 patients?

• Published in: International ophthalmology 2023-04, Vol.43 (4), p.1369-1374
• Main Authors: Pitak-Arnnop, Poramate, Tangmanee, Chatpong, Meningaud, Jean-Paul, Neff, Andreas
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Asymptomatic; Bivariate analysis; Carrier State; Case-Control Studies; Confidence intervals; Contamination; Coronaviruses; COVID-19; Disease transmission; Female; Fractures; Humans; Lacrimal Apparatus - virology; Lacrimal gland and Nasolacrimal duct; Male; Medicine; Medicine & Public Health; Middle Aged; Nasolacrimal Duct - virology; Ophthalmology; Orbital Fractures - complications; Orbital Fractures - diagnosis; Original Paper; Paranasal sinus; Paranasal Sinuses; Prospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sinuses; Statistical analysis
• ISSN: 1573-2630; 0165-5701; 1573-2630
• DOI: 10.1007/s10792-022-02535-8

Objectives To assess the relationship between orbital wall fractures connecting to  paranasal sinuses (OWF-PNS) and SARS-CoV-2 ocular surface contamination (SARS-CoV-2-OSC) in asymptomatic COVID-19 patients. Methods This was a prospective case–control study enrolling two asymptomatic COVID-19 patient cohorts with vs. without OWF-PNS in the case–control ratio of 1:4. All subjects were treated in a German level 1 trauma center during a one-year interval. The main predictor variable was the presence of OWF-PNS (case/control); cases with preoperative conjunctival positivity of SARS-CoV-2 were excluded to rule out the possibility of viral dissemination via the lacrimal gland and/or the nasolacrimal system. The main outcome variable was laboratory-confirmed SARS-CoV-2-OSC (yes/no). Descriptive and bivariate statistics were computed with a statistically significant P  ≤ 0.05. Results The samples comprised 11 cases and 44 controls (overall: 27.3% females; mean age, 52.7 ± 20.3 years [range, 19–85]). There was a significant association between OWF-PNS and SARS-CoV-2-OSC ( P  = 0.0001; odds ratio = 20.8; 95% confidence interval = 4.11–105.2; R -squared = 0.38; accuracy = 85.5%), regardless of orbital fracture location (orbital floor vs. medial wall versus both; P  = 1.0). Conclusions Asymptomatic COVID-19 patients with OWF-PNS are associated with a considerable and almost 21-fold increase in the risk of SARS-CoV-2-OSC, in comparison with those without facial fracture. This could suggest that OWF-PNS is the viral source, requiring particular attention during manipulation of ocular/orbital tissue to prevent viral transmission.