Impact of COVID-19 pandemic and lockdown on eye emergencies

Alicia Poyser, Sundeep S Deol, Lina Osman, Helen J Kuht, Tharsica Sivagnanasithiyar, Roslyn Manrique, Linda O Okafor, Ian DeSilva, David Sharpe, Vijay Savant, Usman Sarodia, Nagini Sarvananthan, Ray Chaudhuri, Somnath Banerjee, Joyce Burns, Mervyn G Thomas, Alicia Poyser, Sundeep S Deol, Lina Osman, Helen J Kuht, Tharsica Sivagnanasithiyar, Roslyn Manrique, Linda O Okafor, Ian DeSilva, David Sharpe, Vijay Savant, Usman Sarodia, Nagini Sarvananthan, Ray Chaudhuri, Somnath Banerjee, Joyce Burns, Mervyn G Thomas

Abstract

Background: To characterise and compare ocular pathologies presenting to an emergency eye department (EED) during the COVID-19 pandemic in 2020 against an equivalent period in 2019.

Methods: Electronic patient records of 852 patients in 2020 and 1818 patients in 2019, attending the EED at a tertiary eye centre (University Hospitals of Leicester, UK) were analysed. Data was extracted over a 31-day period during: (study period 1 (SP1)) COVID-19 pandemic lockdown in UK (24th March 2020-23rd April 2020) and (study period 2 (SP2)) the equivalent 2019 period (24th March 2019-23rd April 2019).

Results: A 53% reduction in EED attendance was noted during lockdown. The top three pathologies accounting for >30% of the caseload were trauma-related, keratitis and uveitis in SP1 in comparison to conjunctivitis, trauma-related and blepharitis in SP2. The overall number of retinal tears and retinal detachments (RD) were lower in SP1, the proportion of macula-off RD's (84.6%) was significantly (p = 0.0099) higher in SP1 (vs 42.9% in SP2).

Conclusion: COVID-19 pandemic related lockdown has had a significant impact on the range of presenting conditions to the EED. Measures to stop spread of COVID-19 such as awareness of hand hygiene practices, social distancing measures and school closures could have an indirect role in reducing spread of infective conjunctivitis. The higher proportion of macula-off RD and lower number of retinal tears raises possibility of delayed presentation in these cases. Going forward, we anticipate additional pressures on EED and other subspecialty services due to complications and associated morbidity from delayed presentations.

Keywords: COVID-19; emergency; lockdown; pandemic; retinal detachment.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Timeline of events preceding and during COVID-19 related pandemic lockdown in the UK. Bar chart shows number of patients presenting to the eye emergency department (EED) at in 2020 and an equivalent period in 2019. The study period represents a 31-day lockdown period. Predictable drop in EED is seen during weekends and public holidays (e.g. Good Friday) in 2019. In 2020, we observe a decline in EED attendance as government escalates social distancing measures and imposes nationwide lockdown.
Figure 2.
Figure 2.
(a) Bar chart of eye emergency department during 31-day study period with average number of attendances per day during COVID-19 related pandemic lockdown, (b) compared to the equivalent period in 2019, (c) age and gender distribution for the same period during 2020, and (d) 2019 are also shown.
Figure 3.
Figure 3.
(a) Top 10 diagnoses presenting to the emergency eye department during COVID-19 related pandemic lockdown in 2020, (b) compared to equivalent period in 2019, (c) among vitreoretinal pathologies a reduced number of cases were seen for posterior vitreous detachments (PVD), (d) retinal tears, (e) and retinal detachment during lockdown. The proportion of macula off retinal detachments was significantly higher during lockdown (e), (f) reduced numbers of conjunctivitis, (g) optic disc (OD) abnormalities, (h) and keratitis was seen during 2020. The proportion of conjunctivitis (proportion of total caseload) was significantly reduced between 2020 and 2019 (f), (i) the number of contact lens (CL) related keratits was reduced in 2020, however as a proportion (of total keratitis caseload) this was not significantly different between 2020 and 2019. Reduced number of cases of ocular trauma were seen in 2020 compared to 2019, (j) this included orbital fracture, (k) chemical eye injury (CEI), (l) foreign body (FB) and (m) corneal abrasion (CA). Bar charts with mean and standard deviation of ages of patients with orbital fracture are shown (j). The proportions in relation to total trauma caseload are shown (k, l, m). RD: retinal detachment; NAD: no abnormality detected.

References

    1. WHO. Rolling updates on coronavirus disease (COVID-19), (accessed 10 May 2020).
    1. WHO. Coronavirus disease (COVID-19) dashboard, (accessed 02 August 2020).
    1. UK Government. Number of coronavirus (COVID-19) cases and risk in the UK, (accessed 10 May 2020).
    1. UK Government. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19, (accessed 10 May 2020).
    1. Royal College of Ophthalmology. RCOphth: COVID-19 clinical guidance and national information, (accessed 10 May 2020).
    1. Strata Decision Technology. National patient and procedure volume tracker, (accessed 13 May 2020).
    1. Attzs M, Lakhani B. Redeployment: a new paradigm for ophthalmology professionals. Eye 2020; 34(7): 1239–1240.
    1. De Filippo O, D’Ascenzo F, Angelini F, et al.. Reduced rate of hospital admissions for ACS during covid-19 outbreak in northern italy. N Engl J Med 2020; 383(1): 88–89.
    1. Thornton J. Covid-19: A&E visits in england fall by 25% in week after lockdown. BMJ 2020; 369: m1401.
    1. Pellegrini M, Roda M, Di Geronimo N, et al.. Changing trends of ocular trauma in the time of COVID-19 pandemic. Eye (Lond) 2020; 34(7): 1248–1250.
    1. Tan K, Moran BJ, Solomon MJ. Avoiding collateral mortality in a pandemic — time to change our mindset in surgical oncology. Nat Rev Clin Oncol 2020; 17(7): 383–385.
    1. Betsch C, Wieler LH, Habersaat K, et al.. Monitoring behavioural insights related to COVID-19. Lancet 2020; 395(10232): 1255–1256.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe