Coronavirus and the Eyes

Researchers continue to discover new ways that SARS-CoV-2, the virus that causes COVID-19, affects the body as a whole. While COVID-19 is primarily a respiratory illness, even the eyes are not spared from its effects.

“Most people realize that the coronavirus can cause fever and cough, but we are learning that it can also affect a number of other organ systems, including the eyes,” elaborates Jonathan A. Staman, MD, a board-certified, fellowship-trained retina specialist at Florida Retina Institute.

“Eye manifestations are more commonly seen in patients with more severe systemic disease,” the doctor continues. “Some case reports suggest that up to 30 percent of patients affected by COVID-19 have eye symptoms. Other studies have found eye involvement to be much less frequent and present in only 1 to 3 percent of those infected.”

COVID-19 has been linked to the development of an infectious eye condition called conjunctivitis, also known as pink eye. Conjunctivitis is inflammation of the clear surface of the eye, or conjunctiva, which can result in red, inflamed, swollen eyes.

“While COVID-19 can cause pink eye, it is very important to remember that most pink eye is not due to the coronavirus,” Dr. Staman stresses. “Allergies and other viruses are much more common causes. COVID-19 becomes more of a concern if the patient additionally has systemic symptoms such as fever, cough, shortness of breath, fatigue, or loss of smell or taste, on top of the red, teary, irritated eyes seen with pink eye.

“Because your typical viral pink eye is highly contagious and can be transmitted by tears, patients with pink eye should try not to touch their eyes. If they do, they should wash their hands right away,” Dr. Staman notes.

Conjunctivitis will usually go away on its own within a week or two, but if symptoms are severe or last longer than that, affected people should see their general eye doctor to make sure they don’t have a more serious eye problem.

In The Air Tonight

COVID-19 is typically spread through respiratory droplets that are released into the air when an infected person talks, coughs or sneezes.

“People can become infected with COVID-19 if these droplets are inhaled or also if they land on a surface that they touch with their hands then proceed to touch their mouth, nose or eyes,” Dr. Staman explains. “This is why everyone is being asked to clean their hands frequently and try to avoid touching their nose, mouth and eyes.

“Not only can the infection be spread to the eyes through hand-to-eye contact, but it can also potentially work in reverse. Since the virus has been found in tears, people who rub their eyes and then touch a public surface can potentially transmit the virus to others. Fortunately, the viral prevalence in tears is very low, so this would be an uncommon way for the virus to spread.”

The eyes have also been identified as a potential target for coronavirus in part due to the fact that the eyes have ACE-2 receptors that can be used by the virus to bind to cells.

“These receptors are also found in the respiratory tract and are believed to be a gateway for the virus to enter the body,” Dr. Staman elaborates. “Still, there remains only limited evidence of systemic transmission via the eyes, and this mode of transmission remains much less likely than that via the respiratory tract.”

It is not well understood why some people with COVID-19 suffer mild disease while others are more severely affected. Individuals older than 60 and people with compromised immune systems are typically affected more severely.

“While COVID-19 can cause pink eye, it is very important to remember that most pink eye is not due to the coronavirus. Allergies and other viruses are much more common causes.” – Dr. Staman

“The current estimates are that over a third of coronavirus patients are asymptomatic, and 40 percent of disease transmission occurs before someone feels sick,” Dr. Staman notes. “This reinforces the importance of wearing masks when people are in public and unable to socially distance.

“Whether you are symptomatic or not, by wearing a mask you help protect everyone around you from being exposed to your germs.”

Researchers continue to search for answers to the COVID-19 mystery. In the meantime, Dr. Staman has a suggestion for lowering the risk of eye infection for contact lens wearers.

“Given that we want to minimize how often people touch their eyes, I recommend that most contact lens wearers consider switching to glasses for a while,” the doctor relates. “This will keep patients from touching their eyes while putting in or taking out their contacts. Wearing glasses can also act as a reminder to not touch their eyes.

“Glasses can also serve as a partial barrier to potentially protect the eyes from the aerosolized infectious respiratory droplets.”

Timely Treatment

Most medical practitioners postponed non-urgent medical visits for several weeks during the early COVID-19 pandemic. Most medical offices have now reopened, but the process for office visits may look somewhat different as providers incorporate recommended safety protocols.

“Our practice and many others have incorporated strict disinfection and hygiene precautions so that we can continue to treat patients in a manner that is safe for them and for our staff,” Dr. Staman underscores.

“At Florida Retina Institute, we treat many urgent conditions such as retinal tears, retinal detachments and conditions such as diabetic retinopathy and wet macular degeneration that require timely treatment. Postponing this type of care could leave patients with permanent vision loss and we are not going to let that happen. We always remain available for these patients.”

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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Jonathan A. Staman, MD

      Jonathan A. Staman, MD, is board certified by the American Board of Ophthalmology. He earned a bachelor of arts degree in the Honors Program at Emory University in Atlanta, GA, and a Doctor of Medicine degree from the University of South F... Read More