Education & Resources

Viral Eye Infections - Do I Have COVID-19?

Jaclyn Munson
April 27, 2020

Dear Patients,

Fort Collins Family Eye Care and it’s team of providers is your resource for preventing, diagnosing, and managing viral eye infections. For many years, eye care providers have been faithful to promptly diagnose and order isolation for patients who experience a viral eye infection. Certain known contagions, such as Adenovirus, or layman’s ‘pink eye’, spreads rapidly in the tear film and specifically from the surface of the eye. You may have historically experienced a smaller scale, preventative “self - quarantine” in the academic, housing, or daycare setting.

New information and studies are being released regarding the behavior and susceptibility for transmission of COVID-19 from the eye. At this time, your risk is low to contract or transfer this virus via the tear film, contact lenses, or other eye structures.

Steadfast in Prevention,

Dr. Jaclyn Munson

Viral Eye Infections - Do I Have COVID-19?

A red eye is a dangerous, and oftentimes frightening, condition to experience. Oftentimes, red eyes are painful and cause vision changes, whether permanent or temporary. The blanket term “pink eye” warrants complete analysis and root cause solution investigation. It is critical to distinguish early and often a viral condition vs. other serious eye diseases. Here are the most common possibilities to rule out with your eye care team:

  • Ocular Surface Disease
  • Eye Strain, Eye Fatigue, Headache
  • Bacterial Infection
  • Viral Infection
  • Foreign Body or Wound
  • Contact Lens related problem
  • Allergic Reaction to chemicals or the environment
  • Traumatic eitiology
  • Acute onset angle closure or glaucoma
  • Progressing, complication from retinopathies

For current event conversations, the question is: are your eyes at risk of carrying or being exposed to COVID-19? If you are infected with this novel virus, how might your eyes give a signal? How do I know what eye allergies are versus COVID-19?

Does it spread through aqueous tears?

SARS-CoV-2 has been known to be spread through droplets, but a new study coming out of Singapore suggests that viral shedding through tears is unlikely. Seventeen COVID-19 patients were monitored from initial symptoms to recovery at various intervals via nasopharyngeal and tear swabs. None of them exhibited ocular symptoms except for one who developed conjunctival injection and chemosis during their hospital stay. The virus was not detected in any of the tear samples.

Another study was conducted in China, with thirty participants with SARS-CoV-2 with pneumonia (among which 9 were severe). The study only had one participant with conjunctivitis whose swab was positive (collected in the early stage). All other patients showed negative results. The patient with conjunctivitis was categorized as viral with conjunctival congestion and aqueous secretion. This patient did not have other symptoms (severe fever, respiratory issues) when the sample was collected. This study emphasized that routine disinfection of instruments can help prevent spread of the disease, but recommends that optometrists/ophthalmologists wear goggles as a necessary protective measure.

Both studies have limitations with sample size and participants with conjunctivitis.

The American Optometric Association (AOA) has deemed contact lens wear as safe during this pandemic, with proper hand washing, drying, and lens care. Let’s continue to take necessary precautions with disinfection of lanes and equipment, along with making sure we wear protective gear to prevent the spread of this virus.

Do the eyes give a hint?

The AOA Health Policy Institute (HPI) notes in its statement, "Doctors of Optometry and COVID-19," that though viral conjunctival infection is usually caused by adenovirus, COVID-19 may cause ocular signs and symptoms, including photophobia, irritation, conjunctival injection and watery discharge. These are predominately self-limited but may require supportive care, the statement adds.

Additionally, JAMA Ophthalmology report from Hubei Province, China—once epicenter of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic—provides a snapshot of the ocular manifestations in patients with COVID-19. Although small-scale, the study reported one-third of patients had ocular manifestations consistent with conjunctivitis, including conjunctival hyperemia, chemosis, epiphora or increased secretions. The study also suggested a low prevalence of SARS-CoV-2 in these patients' tears.

While there is conflicting literature as to the virus' expression in tears, the AOA advises doctors of optometry that in addition to respiratory transmission, SARS-CoV-2 may be found in the tears and conjunctiva of COVID-19 positive patients.

Although the Times piece suggests eye pain searches may be unrelated to seasonal allergies, Hay fever symptoms, including conjunctivitis, do share many of the same signs as COVID-19 or influenza—enough similarities that media reports nationwide delineate the conditions. As pollinators ramp up in the warmer weather, so too will the usual allergic conjunctivitis cases and, conceivably, worries over COVID-19 infection.

Sections of this article have been reviewed by the AOA COVID-19 Evidence-based Optometry Response subcommittee.

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