Recent studies show that 3% of COVID-19 patients have ocular complications. 

However, the true number actually varies between studies when calculated by a meta-analysis of six studies comprising 854 COVID-19 patients.

An article on the topic of Covid-19 and the eyes was published in the Clinical and Experimental Ophthalmology journal in June, 2020. 

According to this article, scientists in Turkey examined 93 patients that had been hospitalized with Covid-19. Out of the 93 patients, 20 of these patients (21.5%) presented with at least one of the following ocular symptoms:

• Hyperemia (red eye): 20 patients (21.5%)
• Photophobia (light intolerance): 15 patients (16.1%)
• Itchiness: 13 patients (15.7%)
• Epiphora (watery eyes): 9 patients (9.7%)
• Follicular conjunctivitis (severe conjunctiva swelling): 8 patients (8.6%)
• Burning sensation: 7 patients (8.4%)
• Increased discharge (green or yellow): 6 patients (6.5%)
• Gritty feeling (feels like sand in the eye): 5 patients (6.0%)
• Blurred vision: 4 patients (4.8%)
• Chemosis (swelling of conjunctiva): 3 patients (3.2%)
• Episcleritis (inflammation of eye sclera): 2 patients (2.2%)

The article noted that the primary risk factors for Covid-19 ocular problems included high fever (which served as a biomarker of systemic inflammation) and older age.

If you have experienced any of these symptoms contact an eye doctor near you.

Another study cited in the article noted ocular symptoms in 12 (31.6%) out of 38 patients with COVID-19.

A third study conducted in Mexico, found that none of 114 COVID-19 patients that participated in the study had any ocular symptoms.

The retina and optic nerve connection

In the May edition of the Ocular Immunology and Inflammation journal, an article stated that researchers in Germany detected COVID-19 genetic material in the retina of three out of 12 deceased patients. Moreover, prior research has also found the expression of ACE2 (the main receptor SARS-CoV-2 uses to infect cells) in the human retina.

The retina is the back part of the eye where the optic nerve sits. Any information the retina receives from the eyes is relayed to the brain via the optic nerve.

In the May edition of The Lancet, a published research study also shed light on this topic. Using a noninvasive, eye imaging technique called optical coherence tomography (OCT), researchers at the Paulista Institute of Studies and Research in Ophthalmology in Brazil detected damage to the retina and optic nerve in all 12 COVID-19 patients tested.

However, interestingly, these patients experienced no visual impairments.

Later in July, another study was published in the Journal of Medical Virology in which Ophthalmologists at the Hospital Clinico Universitario in San Carlos,Spain performed an OCT scan for five patients with COVID-19. According to the results, increased optic nerve inflammation was noted in all five patients, as compared to the state of their optic nerves prior to COVID-19 exposure.

Similar to the previous study, none of these patients experienced visual impairments. This seems to imply that the optic nerve inflammation they experienced may not have been severe enough to damage the nerve completely.

Important note: The most common early signs of COVID-19 are fever, cough, and shortness of breath — none of which are ocular symptoms.

If you notice any COVID-19 symptoms, seek appropriate medical attention as soon as possible.

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Here are the answers to the six most commonly asked questions:

Q: If COVID-19 droplets land in your eye, can you get infected?

A: The evidence of ocular transmission of the COVID virus has not been well studied.

However, mucous membranes, which line many body cavities and organs including the respiratory tract, are most susceptible to the coronavirus and viruses in general.

The surface of the eye and inner eyelids are also lined by a mucous membrane called the conjunctiva.

Therefore, if COVID infected droplets land in your eye, you may be susceptible to infection— but this only happens in very rare cases.

The primary method of COVID-19 transmission is still believed to be through respiratory droplets from person-to-person. However, the virus can also live on surfaces for up to a few days. Therefore, touching an infected surface, then touching your eyes, nose or mouth without washing your hands may lead to infection.

Q: Does cleaning your eyes with water or over the counter eye drops decrease your risk of COVID-19 infection?

A: The ocular surface of the eyes has its own protective mechanisms, including antimicrobial proteins and natural lubrication in the tears. 

Therefore, routine cleaning or flushing of the eyes with water is not necessary and may actually strip away some of the ocular surface’s natural protective barriers, leading to an increased risk of infection.

If your eyes become irritated or red, using over-the-counter artificial tears may help alleviate your symptoms, but most likely will not reduce the chances of possible infection.

If symptoms are persistent, you should contact an eye care provider near you.

SEE RELATED: COVID-19 and the Eyes: What Do the Numbers Say?

Q: Do contact lens wearers have a higher risk of COVID-19 infection?

A: As long as you practice proper hygiene, there is no evidence that suggests that wearing contact lenses increases your risk of COVID-19. 

However, contact lens wearers do touch their eyes more often than the average person. If you have a tendency to touch or rub your eyes, it may be best to switch to glasses temporarily, given the risk of transmission from rubbing your eyes without proper hand hygiene.

Wearing eyeglasses minimizes the risk of irritation from contact lens wear and also serves as a barrier that forces you to pause before touching your eyes.

Glasses can also serve as a partial shield from respiratory droplets.

If you do continue contact lens wear, make sure you carefully adhere to contact lens hygiene and wash your hands before inserting and removing your lenses. If you develop redness or irritation, discontinue contact lens wear and contact an eye doctor.

Q: Is it true that pink eyes are an early sign of COVID-19?

A: Pink eye (conjunctivitis) has been reported to be a possible sign of infection from COVID-19, but the evidence is not clear yet.

It is still uncertain exactly what percentage of patients with COVID-19 have conjunctivitis as different sources are reporting varying numbers.

Although a recent study in JAMA Ophthalmology reported up to one-third of patients hospitalized with COVID-19 had ocular abnormalities, additional studies are still needed.

Q: Can COVID-19 cause temporary or permanent damage to your eyes?

A: Although conjunctivitis has been linked to COVID-19, at this point, permanent eye damage from COVID-19 has not been reported. 

If a patient has difficulty breathing long enough, theoretically, poor oxygen flow could lead to possible damage to the optic nerve or retina—but this has yet to be reported in COVID-19 related cases. In this instance, eye damage would be caused by decreased oxygen, rather than the virus itself.

Q: Can COVID-19 be transmitted through tear droplets?

A: Reports of transmission through infected ocular tissue or fluid have been controversial. The novel coronavirus has been detected in tear samples, though only in a small number of cases. 

Given the presence of viral particles in your tears, it is possible to transmit COVID-19 through tear droplets, although the risk is very low and additional studies on this are required.

It is important to state that the COVID-19 situation is always evolving and more information about the virus is uncovered every day.

Contact your primary care physician if you are experiencing symptoms of COVID-19.

LEARN MORE: Guide to Eye Conditions

If you have irritation or pain in the eye or difficulty seeing, please reach out to an eye care provider.

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Washing your hands with warm water and soap for 30 seconds can help stop the spread of viruses.

However, soap and water is not always available, especially in the places where you need them most (think: subway stations, stores, cabs, and even the local park).  We are constantly touching things and spreading germs from contaminated surfaces.

Did you know that touching your face, specifically your eyes, nose, and mouth without washing your hands first is the number one way to catch a virus?

Well, thank goodness, there is one solution that can help to rectify this problem. Small bottles of alcohol-based hand sanitizer have become widely popular, especially these days when COVID-19 threatens us at every corner.

Doctors recommend walking around with a hand sanitizer with an alcohol concentration of between 60-95%, in your pocket, purse, backpack or briefcase so that it is easily accessible when you need it most.

The alcohol in the hand sanitizer can help to kill germs and protect you when soap and water is not available.

If hand sanitizer got in your eye, contact an eye doctor near you.

However, it is crucial to understand how to use hand sanitizer appropriately and make sure your children know how to use it as well. 

In recent months, there has been an increase in reports of eye emergencies associated with hand sanitizer, specifically alcohol-based hand sanitizer accidentally getting squirt or rubbed into the eyes.

This can be quite dangerous if not handled correctly, and even lead to vision loss.

If an alcohol-based hand sanitizer gets into your eye, you will feel stinging and burning upon contact. While your first instinct may be to rub your eyes, try to avoid this at all costs, as this can actually make the problem worse.

If the cornea (the clear front covering of your eye) or the conjunctiva (the mucous membrane that covers the white part of your eye) becomes damaged by the alcohol, you may experience severe pain and/or light sensitivity.

Signs to look out for

• Burning
• Stinging
• Redness
• Eye pain
• Blurred vision
• Light sensitivity
• Vision loss

What should you do?

Wash your eye thoroughly with warm water for at least 10 minutes. Some eye doctors recommend placing your head under a gentle stream of running water in your bathroom or kitchen sink, so the water can run continuously into your eye and just as easily drain out.

While you are doing so, be sure to keep your other eye tightly closed to avoid contaminated water from seeping into your unaffected eye.

If your eyes continue to feel a burning or stinging sensation or experience any vision changes or vision loss, contact an eye doctor immediately, as this is considered an eye emergency and must be treated promptly.

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Based on data so far, doctors believe that up to 3% of people who test positive for COVID-19 will also get conjunctivitis. 

Conjunctivitis can occur when a virus infects the conjunctiva tissue, which covers the white part of your eye and inside of your eyelids.

Symptoms to look out for:

• Pain
• Redness
• Itchy eyes
• Watery eyes
• Yellow or green discharge
• Crust surrounding eyelid margins

How does COVID-19 spread to the eyes? 

The coronavirus is primarily transmitted through infected droplets from a cough or sneeze. These particles most often enter the body through the nose or mouth, but can also enter through the eyes.

It’s also possible to catch the virus by touching a countertop, doorknob, or any other contaminated surface, and then touching your face or rubbing your eyes.

Whether you have tested positive for COVID-19 or are trying to protect yourself from catching the virus, the following advice will help you and others to stay safe:

Avoid touching your face, especially your mouth, nose, and eyes at all times.

When to see an eye doctor

If you have conjunctivitis, it doesn’t necessarily mean you have COVID-19. 

If you are experiencing any eye pain or any of the other symptoms that may signal an eye infection, it is always recommended to seek medical care.

If you receive regular eye injections or have a preexisting ocular condition such as macular degeneration or diabetic retinopathy and notice any of the following symptoms, contact your doctor immediately.

• Loss of vision
• Flashes
• Blank spots in your visual field
• Headaches
• Nausea with or without vomiting

 If you have a fever, cough, or shortness of breath and have tested positive for COVID-19, or have been in contact with someone who has COVID-19, call your doctor’s office to find out what you can do to treat your eye infection at this time. 

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The Vision Development Team

Coping with COVID-19 may be affecting your vision

The American Optometric Association (AOA) defines Computer Vision Syndrome (CVS) as, “a group of eye and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use.”

Many screens have glare, bright light, or poor contrast, which can make the eyes tired and dry after an extended period of use.

Individuals with uncorrected vision or poor functional vision skills have to work harder to see and process the visual information presented on the screens.

The frequent, long episodes of exposure to computers, cell phones, laptops, computers, iPads, or other digital screens may be to blame for symptoms such as:

• Disrupted sleep patterns
• Headaches
• Eyestrain
• Fatigue
• Neck, back, and/or shoulder pain.

Contact an eye doctor near you if you experience any of these symptoms after prolonged use of a digital device, you may be suffering from CVS.

SEE RELATED: Headaches and Vision Therapy: Top 5 Q&A

COVID-19 and CVS

Prior to the COVID-19 pandemic, the number of people diagnosed with CVS was already on the rise.

Now, in the pandemic’s wake, the number of people reporting symptoms of CVS has grown exponentially.

The increase in CVS may be related to the online solutions we are currently using to ensure that  children can continue to learn and adults can continue to  work. Unfortunately, the increase in time spent in front of the screen may pose unexpected health risks.

Fortunately, your optometrist can help keep you working and learning safely in our new digital world.  Your eye doctor may prescribe stress-reducing lenses to reduce your visual strain, or suggest blue-blocking lenses that block or absorb the blue light waves produced by electronic screens.

Vision skills and CVS

Additionally, optometrists who test functional vision skills can look for other factors that may be exacerbating symptoms— such as, problems with visual coordination or visual perception.

Poor vision skills can contribute to eyestrain.  

If your eye doctor identifies poor focusing, tracking, or convergence skills, or visual perceptual challenges, they may prescribe a course of vision training, also known as vision therapy.

Vision training for CVS

Vision training, along with stress-reducing lenses, and or blue-blocking glasses for computer use, may just be what you need to relieve symptoms from CVS and restore comfortable vision.

LEARN MORE:  Guide to Eye Conditions

If you, or someone you love complains of headaches, eyestrain, dry eyes, or vision changes after prolonged screen time, schedule an appointment with an optometrist.

Your optometrist has their eyes on your ocular health.

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