Importance Since February 2020, coronavirus disease 2019 (COVID-19) has spread rapidly all over the world, with an epidemiological cluster in Lombardy, Italy. The viral communicability may be mediated by various body fluids, but insufficient information is available on the presence of the virus in human tears.

Objectives To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears collected from patients with COVID-19 by means of real-time reverse transcriptase–polymerase chain reaction (rRT-PCR) assay and to assess the association of virus presence with concomitant clinical conditions.

Design, Setting, and Participants Cross-sectional study conducted between April 9 and May 5, 2020. The setting was intensive care units at Azienda Socio-Sanitaria Territoriale (ASST) Sette-Laghi Hospital, University of Insubria, in Varese, Lombardy, Italy. A conjunctival swab was performed in 91 patients hospitalized for COVID-19, which was clinically diagnosed by rRT-PCR assay on nasopharyngeal swabs and by radiological imaging. Conjunctival swabs from 17 additional healthy volunteer participants with no symptoms of COVID-19 were examined to evaluate the availability and applicability of the conjunctival swab test.

Exposure SARS-CoV-2 detection by means of rRT-PCR assay performed on the collected samples obtained by conjunctival swabs.

Main Outcomes and Measures Conjunctival swab and nasopharyngeal swab results are reported, as well as demographic and clinical data.

Results A total of 108 participants (mean [SD] age, 58.7 [14.2] years; 55 female and 53 male) were tested for SARS-CoV-2 using rRT-PCR assay, including 91 patients hospitalized with COVID-19 and 17 were healthy volunteers. SARS-CoV-2 was found on the ocular surface in 52 of 91 patients with COVID-19 (57.1%; 95% CI, 46.3%-67.5%), with a wide variability in the mean viral load from both eyes. Among a subset of 41 patients, concordance of 63.0% (95% CI, 41.0%-81.0%) was found between positive conjunctival and nasopharyngeal swab test results when performed within 2 days of each other. In 17 of these patients, nasopharyngeal swab results were negative for SARS-CoV-2. In 10 of these 17 patients, conjunctival swab results were positive for the virus.

Conclusions and Relevance In this study, SARS-CoV-2 RNA was found on the ocular surface in a large part of this cohort of patients with COVID-19, although the infectivity of this material could not be determined. Because patients may have positive test results with a conjunctival swab and negative results with a nasopharyngeal swab, use of the slightly invasive conjunctival swab may be considered as a supplementary diagnostic test.

重要性 自 2020 年 2 月以来，2019 年冠状病毒病 (COVID-19) 在世界各地迅速传播，其中意大利伦巴第大区出现流行病学聚集性疫情。病毒的传播性可能是通过各种体液介导的，但关于人类眼泪中是否存在病毒的信息不足。

目的 通过实时逆转录聚合酶链式反应 (rRT-PCR) 检测，调查从 COVID-19 患者收集的泪液中严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的检出率，并评估病毒存在与伴随临床状况的关联。

设计、背景和参与者 横断面研究于 2020 年 4 月 9 日至 5 月 5 日期间进行。研究背景为意大利伦巴第瓦雷泽因苏布里亚大学 Azienda Socio-Sanitaria Territoriale (ASST) Sette-Laghi 医院的重症监护病房。对 91 名因 COVID-19 住院的患者进行了结膜拭子检查，通过鼻咽拭子的 rRT-PCR 检测和放射成像进行临床诊断。对另外 17 名没有 COVID-19 症状的健康志愿者参与者的结膜拭子进行了检查，以评估结膜拭子测试的可用性和适用性。

通过 rRT-PCR 检测结膜拭子采集的样本进行暴露SARS-CoV-2 检测。

主要结果和措施 报告结膜拭子和鼻咽拭子结果，以及人口和临床数据。

结果 使用 rRT-PCR 检测共有 108 名参与者（平均 [SD] 年龄，58.7 [14.2] 岁；55 名女性和 53 名男性）接受了 SARS-CoV-2 检测，其中包括 91 名因 COVID-19 住院的患者和 17 名因新冠肺炎住院的患者。健康的志愿者。在 91 名 COVID-19 患者中，有 52 名患者的眼表发现了 SARS-CoV-2（57.1%；95% CI，46.3%-67.5%），双眼平均病毒载量存在很大差异。在 41 名患者的子集中，在 2 天内进行的结膜和鼻咽拭子检测阳性结果之间的一致性为 63.0%（95% CI，41.0%-81.0%）。其中 17 名患者的鼻咽拭子结果显示 SARS-CoV-2 呈阴性。在这 17 名患者中，有 10 名患者的结膜拭子结果呈病毒阳性。

结论和相关性 在这项研究中，在这组 COVID-19 患者的大部分患者的眼表上发现了 SARS-CoV-2 RNA，尽管无法确定这种物质的感染性。由于患者的结膜拭子检测结果可能呈阳性，而鼻咽拭子检测结果可能呈阴性，因此可以考虑使用微创结膜拭子检测作为补充诊断检测。