COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus. It is particularly dangerous to people with pre-existing conditions and those with weakened immune systems. (Learn More)

COVID-19 can be transmitted through droplets in the air, which can land on the eyes. (Learn More) It is not yet known if COVID-19 has a direct effect on vision, but it is expected that the virus can cause conditions like conjunctivitis. Symptoms of conjunctivitis include pain and temporary loss of vision. (Learn More)

What Is Coronavirus?

The family of viruses known as coronaviruses affect animals almost exclusively (primarily bats, cats, and cattle), but some strains of coronavirus can be passed on to people.

COVID-19, one of these viruses, can cause mild respiratory problems in some humans while leading to more serious and life-threatening conditions (such as pneumonia, bronchitis, and kidney failure) in others. People who are older or immunocompromised are most severely affected by the virus. COVID-19 is the seventh documented form of coronavirus.

COVID-19 is fully known as coronavirus disease 2019. It is the disease caused by the severe acute respiratory syndrome coronavirus (also known as SARS-CoV-2).

According to the World Health Organization, the basic symptoms of COVID-19 mimic those of the flu. Patients will usually be fatigued, experience a cough, and run a temperature. Some patients might feel pain in their bones and joints. Some might have diarrhea. The symptoms usually start out quite mild and then gradually build up.

There is a small subset of the population that will become infected by COVID-19 but won’t develop any symptoms or experience any malaise. However, they might still unknowingly pass on COVID-19 to other people, including those in poor health or who have weakened immune systems.

As many as 80 percent of the people who get COVID-19 will recover without needing significant treatment. Statistically, however, one in six people who become infected will go on to develop serious symptoms, such as extremely shallow and labored breathing. People over the age of 60 and people with underlying medical conditions may develop a serious illness or have their pre-existing condition exacerbated by COVID-19.

 

man rubbing eyes

Does Coronavirus Affect the Eyes or Vision?

In March 2020, researchers writing in the Ocular Immunology and Inflammation journal said that, to their understanding, “there have been anecdotal reports of ocular infection” stemming from transmission of COVID-19.

While there has not yet been significant study of the effects of COVID-19 in the eyes and vision of human patients, other forms of coronavirus “have been known to cause various ocular infections in animals.” Cats, rats, and mice that were infected with coronavirus developed optic neuritis, retinitis, anterior uveitis, and conjunctivitis. The researchers writing the article suggested that the longer COVID-19 goes without treatment, the more likely it is that patients will develop infection of the eye tissue as a result of the virus.

While much remains unknown about the full extent of COVID-19, ophthalmologists are very concerned about how the disease might affect the eyes and vision. Based on the animal studies that showed how non-human-transmitted forms of coronavirus affected various subjects, there is an expectation that if COVID-19 were to cause vision problems in humans, these issues would lead to the development of other conditions.

 

Conjunctivitis & Coronavirus

One such condition is conjunctivitis, which is inflammation of the conjunctiva (the thin sheet of tissue) of the eyeball. Conjunctivitis is normally caused by irritants, bacteria, and viruses, so COVID-19 might be a factor in its development.

The infection can make the eye look infected and red, so it is informally known as pink eye. Patients experience a burning sensation in the affected eye, often making it painful to keep the eye open.

The virus also inflames the tiny oil glands near the base of the eyelashes, causing a liquid discharge that can harden into crust (a condition known as blepharitis). For this reason, many patients with conjunctivitis will wake up to their eyelashes being “crusted over,” trapping the eyelids closed. The crust can be broken up and washed away with warm water.

Conjunctivitis caused by a viral infection can lead to upper respiratory infections in patients, triggering colds and flu-like symptoms. This might be a sign of the presence of COVID-19. A 2020 study published in the New England Journal of Medicine on the “clinical characteristics of coronavirus disease” across hospitals in China found the typical red, infected eyes of conjunctivitis (or more specifically, “conjunctival congestion”) in 0.8 percent of patients with confirmed COVID-19 infections.

healthy vs conjunctivitis

Transmission Through the Eyes

Similarly, the Journal of Medical Virology published a report that concluded that the SARS-CoV-2 coronavirus might possibly be detected in the conjunctival secretions (tears) of patients who have novel coronavirus pneumonia. Researchers found that COVID-19 was not detected in patients who had novel coronavirus pneumonia but did not have conjunctivitis. Even though this study of 30 patients hospitalized for COVID-19 found only one patient diagnosed with conjunctivitis, the researchers were still concerned that “the possibility of eye infection” was significant enough to warrant protection when treating patients.

The concern is based on the story of a respiratory specialist named Wang Guangfa, who was not wearing any kind of protective eyewear when he came into contact with COVID-19 patients in China. Wang’s left eye became inflamed after his exposure to the patients. He developed a fever and an accumulation of mucus in his nose and throat, subsequently becoming a confirmed COVID-19 case himself.

Ophthalmologists writing in The Lancet concluded that “unprotected exposure of the eyes to [COVID-19] ... might have allowed the virus to infect the body.” They further declared that, as eye specialists, it was their professional belief that “transmission of [COVID-19] through the eyes was ignored.”

Protecting the Eyes From COVID-19

Doctors are encouraging COVID-19 patients and other vulnerable people to protect their eyes during the outbreak. Virus particles can be sprayed through the act of sneezing, coughing, or even talking into another person’s face.

Usually, the droplets are unwittingly inhaled through the mouth or nose, but they can also affect the eyes, possibly causing conjunctivitis (among other eye conditions) and also transmitting the disease itself. The infection can also be passed by touching a surface that has the virus on it (like a doorknob or smartphone screen) and then touching the eyes.

For this reason, government and public health officials are urging ophthalmologists not to see patients during the COVID-19 outbreak, except in cases of urgent or emergency care. As the Ophthalmology Times writes, “ophthalmologists can be at risk each time they see a patient who may be exhibiting symptoms of the disease.”

Limiting contact between doctors and patients will slow the spread of the virus. Additionally, it will help to conserve supplies of masks, face shields, and other personal protective equipment (PPE), so hospitals and triage centers will have access to them first.

How to Get Help for Your Eyes

Despite the new guidelines for patient treatment during the pandemic, if a patient is experiencing pain in their eyes or loss of vision, they should call their ophthalmologist for guidance. Changes in vision or macular degeneration (an eye disease that develops in people over age 60, who are also at increased risk for contracting COVID-19) are also good reasons to call a doctor or ophthalmologist.

Even if your doctor encourages you to come in for an examination, the intake process will likely be very different as a way of reducing the transmission of the SARS-CoV-2 virus. For example, your clinic may ask you to wait in your car to limit the number of people who are inside the facility at any given time. If possible, doctors may be equipped with a plastic breath shield while they examine your eyes, and they may wear their own eye protection as well.

You might even be asked not to speak during the exam, to reduce the risk of exposing your doctor to any droplets containing the COVID-19 virus, if that is what you have that is causing disruptions to your vision or distress to your eyes. The conversation itself might take place under social distancing guidelines, where you and your doctor will sit six feet apart from each other.

If possible, your doctor’s practice might conduct the examination via telemedicine, over a consumer-based or telehealth video conferencing app. This will allow for you to get “looked at” even if you have to self-quarantine. Specific offices have different policies on this, so contact your ophthalmologist or optometrist to learn how they are handling office visits during the pandemic.

Eye Care During the COVID-19 Outbreak

The American Academy of Ophthalmology suggests that people can help their eye health, and the eye health of others, by following some simple steps during the COVID-19 outbreak.

  • Choose eyeglasses. If you wear contact lenses, use your glasses instead. This will reduce the number of times you have to touch your eyes, helping to reduce the risk of infection.
  • Stock up on critical eye medicine prescriptions. Supplies can be limited during the quarantine, and if you have to self-isolate, you will not be able to pick up a prescription. Patients with insurance that allows them to get more than a month’s supply of vital eye medicine should get as much as they can. Some insurance companies will allow patients to get up to three months’ worth of medication in an emergency. Patients should also request a refill as soon as their supplies run low.
  • Wash your hands. Regular hand washing (for at least 20 seconds at a time) is incredibly important. If you don’t have access to soap and water, use hand sanitizer that is at least 60 percent alcohol.
  • Avoid touching or rubbing your eyes. This is especially important if you are already sick or you have been near someone who has been coughing or sneezing. This can be very difficult since studies show the average person touches their face 23 times per hour.If you must touch your eyes, use a tissue instead of your fingers. Then, dispose of the tissue.

    If you need to administer eye medicine or eye drops, you should first wash your hands with soap and hot water for 20 seconds. Then, wash your hands again after administering the medication.

  • Take additional precautions. Stay six feet away from other people; avoid large crowds; and sneeze into your elbow or a tissue. Regularly clean your house and disinfect frequently used surfaces. Steer clear of people who might be sick.

All these measures will reduce the possibility of transmitting COVID-19 and help to protect your eyes and vision during this outbreak.

 

References

About the Coronaviridae Family. (March 2020). Virus Pathogen Resource.

Q&A on Coronaviruses (COVID-19). (March 2020). World Health Organization.

Can the Coronavirus Disease 2019 (COVID-19) Affect the Eyes? A Review of Coronaviruses and Ocular Implications in Humans and Animals. (March 2020). Ocular Immunology and Inflammation.

Conjunctivitis (Pink-eye). (March 2020). WebMD.

What Is Blepharitis? (April 2019). American Academy of Ophthalmology.

Clinical Characteristics of Coronavirus Disease 2019 in China. (March 2020). New England Journal of Medicine.

Evaluation Of Coronavirus in Tears and Conjunctival Secretions of Patients With SARS‐CoV‐2 Infection. (February 2020). Journal of Medical Virology.

2019-nCoV Transmission Through the Ocular Surface Must Not Be Ignored. (February 2020). The Lancet.

You Could Be Spreading The Coronavirus Without Realising You’ve Got It. (March 2020). New Scientist.

Ophthalmologists at Ground Level of COVID-19 Fight. (March 2020). Ophthalmology Times.

Why Is It So Hard to Stop Touching My Face? (March 2020). USA Today.

Face Touching: A Frequent Habit That Has Implications for Hand Hygiene. (February 2015). American Journal of Infection Control.

Age-Related Macular Degeneration. (October 2019). WebMD.

Coronavirus Could Accelerate Moves Toward “Telemedicine.” (March 2020). Los Angeles Times.

Coronavirus And Eyes: Experts Recommend Wearing Glasses Instead of Contacts to Prevent COVID-19 Spread. (March 2020). 6 ABC Action News.