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Interviewed by Eric Weintraub, Additional Expertise Contributions by Dr Brian Toy
Much remains unknown about the ever-evolving coronavirus disease 2019 (COVID-19). However, more information has become available over the past 1.5 years regarding the effects of COVID-19 on one of the most sensitive parts of our bodies: the eyes. To provide an update, Dr. Annie Nguyen, Assistant Professor of Clinical Ophthalmology and Deputy Director of Corneal and refractive surgery fellowship at the USC Roski Eye Institute, answers frequently asked questions about how vulnerable our eyes are to the novel coronavirus.
If COVID-19 droplets land in your eye, are you susceptible to infection?
Evidence for ocular transmission has not been well studied. However, the mucous membranes, which line many body cavities and organs, including the respiratory tract, are most susceptible to the new coronavirus and viruses in general. The surface of the eye and the inner eyelids are also lined with a mucous membrane called the conjunctiva. Therefore, if infected droplets land in your eye, you may be susceptible to infection. Published reports suggest that SARS-CoV-2 can possibly be transmitted by aerosol contact with the conjunctiva.
The mode of transmission of COVID-19 is still believed to be primarily through person-to-person respiratory droplets. However, the virus can also live on surfaces for up to a few days; therefore, touching an infected surface and then touching your eyes, nose, or mouth without washing your hands can lead to infection, but this risk is generally considered low.
Can cleaning the eyes with water or over-the-counter eye drops reduce the risk of infection?
The ocular surface has its own protective mechanisms, including antimicrobial proteins and natural lubrication. Therefore, routine eye cleaning or rinsing with water is not necessary and may in fact remove some of the natural protective barriers from the ocular surface, leading to an increased risk of infection.
If your eyes become sore or red, using over-the-counter artificial tears can help relieve your symptoms. If symptoms persist, you should contact your ophthalmologist.
Is it true that contact carriers have a higher risk of COVID-19 infection?
With good hygiene, there is no evidence that wearing contact lenses increases your risk of infection for COVID-19. However, contact lens wearers touch their eyes more often than the average person. If you tend to touch or rub your eyes, it may be best to switch to glasses temporarily, given the risk of transmission by friction without good hand hygiene. Plus, glasses minimize the risk of irritation from wearing contact lenses and serve as a barrier that forces you to pause before touching your eyes.
While not this best protection, goggles can also serve as partial protection against respiratory droplets. If you continue to wear contact lenses, be sure to strictly adhere to contact lens hygiene and wash your hands. If you develop any redness or irritation, please stop wearing contact lenses and contact your eye doctor.
Is it true that pink eye is an early sign of COVID-19? What are the other eye signs and symptoms?
Yes, conjunctivitis, or conjunctivitis, has been reported as a possible sign of infection with COVID-19. It is still unclear exactly what percentage of COVID-19 patients have ocular manifestations, and different sources are reporting different numbers. Although some studies have reported that up to a third of patients hospitalized with COVID-19 have eye abnormalities, more studies are still needed. Of course, conjunctivitis causes unrelated to COVID-19 continue to persist.
Since the start of the pandemic, besides conjunctivitis, COVID-19 has been reported to be associated with other eye problems, including episcleritis, uveitis, inflammation of the tear glands, changes in the retina and optic nerve and ocular motility problems. Although rare, some of these problems can cause vision loss.
Can COVID-19 cause temporary or permanent damage to your eyes (possibly from lack of oxygen)?
If a patient were in respiratory distress long enough, a theoretically poor perfusion and oxygen deprivation could lead to possible damage to metabolically active tissues, such as the optic nerve or the retina. In this case, the eye damage would be caused by a decrease in oxygen, rather than by the virus itself. Perhaps the most devastating visual complication of a serious COVID-19 infection is the acute stroke affecting the parts of the brain that control vision.
Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 has been reported, which can lead to increased intracranial pressure and loss of vision.
Corneal nerve damage has been linked to a “long COVID,” debilitating symptoms that persist for more than four weeks after recovery from the acute illness.
Does the Delta variant affect the eyes differently?
The Delta variant was found to be more contagious. Overall, symptoms are similar to those seen with the original coronavirus strain and other variants; however, coughing and loss of taste are less common, and fever, runny nose, headache, and sore throat are more common. Like other variants of the coronavirus, delta can cause some eye problems, but we’re not sure at this time.
Can COVID-19 be transmitted through tear droplets and is it something to be concerned about?
The potential for transmission through ocular secretions is currently unknown, and it is still unclear how SARS-CoV-2 accumulates in ocular secretions. Transmission through infected eye tissue or fluid has been controversial. A new coronavirus has been detected in tear samples in a small number of cases. Given the presence of viral particles, it is therefore possible to transmit COVID-19, although the risk is likely low. However, the infectivity or clinical significance is not known and further studies are needed at this time.
What precautions should you take if you are taking immunosuppressive drugs?
Immunocompromised patients may be more vulnerable to infection with COVID-19, so it is important to adhere to physical distancing measures to minimize the risks. Please discuss a potential change in your medication regimen with your doctor (uveitis specialist or rheumatologist). In most cases of patients who are not sick, the risk of vision loss due to uncontrolled eye inflammation is greater than the possible increased risk of contracting COVID-19.
How can I protect myself from COVID-19?
More than a year and a half after the start of the pandemic, there is now more information available on how to protect yourself against COVID-19. Masking, hand hygiene and physical distancing remain effective tools to reduce the rate of transmission. Importantly, vaccination with one of the three COVID-19 vaccines currently available and used in the United States – Pfizer, Moderna and Johnson & Johnson – has been shown to significantly reduce your risk of contracting COVID-19 and reduce the severity of symptoms if you get a breakthrough infection. As of August 23, 2021, the FDA granted full approval for the Pfizer vaccine. Please continue to monitor the recommendations of the CDC and your healthcare provider as they evolve.
Dr Nguyen closed the interview by reminding us that the COVID-19 situation is constantly changing and that we are learning more about the virus every day. Please contact your GP if you experience symptoms of COVID-19. If you have eye irritation or pain, or have difficulty seeing, please contact an eye care professional.
Dr Nguyen based much of the information in this interview on what she learned from the following sources:
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