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The SARS-CoV-2 virus can cause a presentation of conjunctivitis complete with swelling, discharge, and redness, which are the symptoms of a number of other viral infections and irritants to the eye. (Learn More) Doctors have stressed that there is no known connection between SARS-2-CoV and conjunctivitis, but since COVID-19 can be transmitted through the eyes, patients who have conjunctivitis could be at risk for infection. (Learn More)
One point of agreement is that people’s eyes should be protected at all times, especially during the COVID-19 outbreak. To that point, patients with contact lenses are advised to switch to wearing eyeglasses. Hands must be washed frequently and properly to minimize contaminated contact with the eyes. (Learn More)
The Coronavirus-Conjunctivitis Connection
With the rise and spread of COVID-19, doctors and health care workers are noticing a number of symptoms that the SARS-CoV-2 virus causes in patients. One such symptom is an irritation of the eye that causes redness, swelling, and a pus-like discharge, very similar to the effects of conjunctivitis.
The SARS-CoV-2 coronavirus and conjunctivitis are caused by two different viruses, but as the American Academy of Ophthalmology reported, coronavirus can cause “mild follicular conjunctivitis [that is] otherwise indistinguishable” from other viruses. Between 1 percent and 3 percent of patients with COVID-19 might also be affected by conjunctivitis, which is transmitted by droplets in the air coming into contact with the conjunctiva (the mucous membrane that protects and covers the eye).
A Yale Medicine ophthalmologist explained that viral illnesses usually affect the eyes and vision, and the characteristic redness and swelling that people associate with conjunctivitis can also be caused by many other viruses. In that 1 percent to 3 percent of patients, COVID-19 can affect the conjunctiva, causing symptoms that mimic those of conjunctivitis.
AAO also quoted a nurse from the nursing home in Washington state that was the site of the outbreak of COVID-19 in the United States, who said in an interview that elderly patients who became ill with COVID-19 were first noted to have “visibly red eyes.”
Doctors and ophthalmologists are quick to note that not all red eyes mean conjunctivitis, and not all cases of conjunctivitis mean COVID-19. That was echoed by a spokesperson for the American Academy of Ophthalmology, who clarified in a statement to Today that “there is not enough data currently to suggest [redness around the eyes] is a symptom of COVID-19.”
Is Conjunctivitis a Symptom of COVID-19?
Any inflammation around the eyes, a condition known as blepharitis, can be due to a number of different causes. Some of them are temporary and benign, and some could lead to pain and loss of vision. As of March 2020, no eye symptom is not considered by the Centers for Disease Control and Prevention to be an indicator of COVID-19.
However, the situation is rapidly changing. The high rate of transmission of SARS-CoV-2 means that eye care, proper sanitation procedures, and an understanding of how viruses are spread are part of the conversations that ophthalmologists, doctors, and public health officials are having with patients.
If a person develops redness around their eyes, the only way of knowing which virus caused that symptom is to swab the conjunctiva and test the specimen. This test is not often conducted because such symptoms usually abate on their own or with over-the-counter medication.
Treatment for conjunctivitis is mostly based on alleviating its symptoms. Applying cold or warm compresses over the course of a day can help with the swelling. Dabbing a wet cloth on the eyelids can remove the discharge and prevent it from forming a crust on the eyelashes.
People who wear contact lenses should switch to eyeglasses until the conjunctivitis passes. Likewise, wearing contact lenses is also discouraged to reduce the risk of transmitting SARS-CoV-2 through the eyes. Disposable contact lenses should be thrown away during this time. Hard lenses should be disinfected overnight. Eyeglasses should be washed regularly.
Medical News Today further explains that certain lifestyle changes will also shorten the length of the conjunctivitis infection. People should work hard to avoid touching their eyes. Doing so worsens the symptoms of pink eye and can spread the infection. Frequent handwashing is recommended.
Eye drops can help to flush discharge and other irritants out of the eyes. They can also soothe irritation and inflammation. If there is less discomfort, patients are less tempted to rub their eyes.
Viral conjunctivitis cannot be treated by antibiotics, so antibiotic eye drops will not be of any help. In most cases, symptoms will abate two weeks after they develop. If the swelling, redness, and discharge in the eyes are traced to the herpes simplex virus, then antiviral medications might be prescribed.
If the conjunctivitis is due to allergic conjunctivitis, an ophthalmologist can prescribe anti-allergy eyedrops, containing antihistamines and mast cell stabilizers. These will help control allergic reactions and reduce inflammation.
Protecting the Eyes From COVID-19
Coincidentally, the COVID-19 outbreak emerged right around allergy season. This is when many hundreds of people experience allergic conjunctivitis, which develops due to a reaction to pollen.
At a time when the virulence and transmission of COVID-19 are as high as they are, and no treatment for the disease has yet been developed, people with symptoms of conjunctivitis are advised to self-isolate themselves, as their immune systems are likely already weakened. However, a patient with the symptoms of conjunctivitis, who is also experiencing a fever and respiratory problems, should definitely call their physician and describe their situation. Those three factors — red eyes, shortness of breath, and running a temperature — are all signs of COVID-19 (fever, cough and breathing problems more so than red eyes).
It is important to stay at home until otherwise directed. Many hospitals are overwhelmed during this outbreak. Also, being in close proximity to other sick people might pass on the virus to them, or it might make patients sick if they didn’t already have the virus themselves.
The American Academy of Ophthalmology warned eye doctors and emergency medical personnel alike that the potential link to conjunctivitis-like symptoms increases the chances that ophthalmologists might be the first health care providers who evaluate patients with possible COVID-19 infections.
One of the concerns at this time is that COVID-19 can spread through eye droplets, which possibly includes the secretions the eye produces as the result of a conjunctivitis infection. If a person has COVID-19, tears and discharge from the eyes can possibly transmit the virus. This is why not touching your face or eyes, and regularly and thoroughly washing your hands when you do, is vital.
The Coronavirus-Conjunctivitis Overlap
Because so little is still known about COVID-19, researchers are hesitant to declare a definite link between that disease, the virus that causes it (SARS-CoV-2), and conjunctivitis. Quoted in Newsweek, a doctor granted that red eyes and conjunctivitis “could certainly be a symptom” of COVID-19.
Other doctors echoed the caution, with the associate professor of pediatrics at the University of Colorado Anschutz Medical Campus emphasizing that since only a maximum of 3 percent of COVID-19 patients present with symptoms similar to those of conjunctivitis, conclusions should not be drawn from cases in the minority.
What adds to the confusion is that the earliest reports of COVID-19 infections (from Wuhan, China) did indicate that patients with confirmed cases “also had conjunctival congestion” similar to cases of viral conjunctivitis. This was exacerbated by doctors in Wuhan not having sufficient eye protection while treating infected patients. As the situation became clearer, those reports were updated to reflect that this happened only in a minority of patients, but the association had already been made.
Reducing COVID-19 Transmission Risks
For these reasons, doctors have suggested that people who need corrective lenses use eyeglasses instead of contact lenses. This is so the risk of transmitting COVID-19 through the conjunctiva is reduced.
A doctor with AAO suggested that avoiding contact lenses during the COVID-19 outbreak can prevent contaminated fingers from coming in contact with the eye. Additionally, wearing glasses can offer a small amount of protection from infected droplets in the air reaching the eyes. A doctor speaking to the Huffington Post said, “Glasses can provide barrier protection against splashes or droplets,” theoretically shielding the eyes from airborne droplets with the SARS-CoV-2 virus.
If it is absolutely necessary to use contact lenses, people should wash their hands with soap and hot water for 20 seconds before touching their eyes. Eyeglasses should also be cleaned regularly (hot water and soap will suffice), as should smartphone and tablet screens and all surfaces that are frequently touched.
Ultimately, the best way to protect yourself against COVID-19 is to avoid touching your face, wash your hands frequently, and follow area guidelines for social distancing. If you wear contacts, switch to eyeglasses for the time being.
If you do experience symptoms of pink eye, consult your eye doctor. While many offices are only open for eye emergencies, most are conducting telemedicine appointments on an as-needed basis.
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Pink Eye May Be A Rare Symptom of Coronavirus, Doctors Say. (March 2020). Today.
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Is It Allergies or Coronavirus? Here Is How To Tell And How To Deal. (March 2020). The Huffington Post.
What Is Allergic Conjunctivitis? (January 2018). Medical News Today.
Symptoms. (February 2020). Centers for Disease Control and Prevention.
COVID-19: Low Risk of Coronavirus Spreading Through Tears. (March 2020). Science Daily.
Chinese Expert Who Came Down With Wuhan Coronavirus After Saying It Was Controllable Thinks He Was Infected Through His Eyes. (January 2020). South China Morning Post
Local Optometrist Discusses Contact Lens Care During Coronavirus Pandemic. (March 2020). News Watch 12.
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