A lot of on-going research is still being done about the new onset of coronavirus and whether it can still be truly transmitted through the eyes. We will cover some facts and questions about how COVID-19 can affect your eyes and your relationship with your eye doctor.
(1) Can tears transmit coronavirus?
The most recent study done by the National University Hospital in Singapore concludes that it is unlikely that COVID-19 can be transmitted through the tears. However, there are anecdotal reports around the community that possible tear transmission can occur - so caution should be taken.
(2) Can COVID be transmitted to the eyes through other mechanisms?
While tears are low risk for transmission for COVID, the latest report from the CDC states that it is possible for COVID to be spread from person to person through airborne “respiratory droplets” which are produced when someone coughs or sneezes, similar to how the flu is spread. These droplets can land in the mouth or noses of nearby people and can possibly be inhaled into the lungs. Lastly, these droplets can also be spread when you touch your face and eyes with unwashed hands.
(3) What can I do to protect my eyes?
Again, while tears are unlikely to transmit COVID, remember that there are still two main ways that COVID (as well as other viruses) can get into the eyes via mucus membranes and cause conjunctivitis such as:
(1) Coughing/Sneezing: COVID can still get into the eyes via aerosol transfer, so if you are standing within six feet of any affected person, they can sneeze and release droplets toward your face and eyes. If you are not wearing any protective eyewear, then risk of transmission is high.
Solution: For any personnel required to be in close contact with any possibly infected individual, protective eyewear like face shield or eye goggles is definitely a must. For the typical population, 6 feet of social distance is more than adequate
(2) Touching the eyes: COVID-19 can also be transmitted from hand to eyes. So if you touch a contaminated grocery cart, and then proceed to touch your eyes, you are at higher risk.
Solution: Avoid touching your eyes and face while constantly washing hands
(4) Can the coronavirus give you conjunctivitis (“Pink eye”)?
While infected droplets (or mucus) can end up in another person’s mouth, nose & lungs, the latest study by American Academy of Ophthalmology (AAO) indicates that coronavirus might enter through the conjunctiva (clear part covering the white part) of the eyes and spread throughout the body via blood vessels within the eyeball. This can result in conjunctivitis (“pink eye”) - but more specifically viral conjunctivitis.
It is recognized that any upper respiratory tract infection may result in viral conjunctivitis as a secondary complication, and this is also the case with COVID-19. However, it is unlikely that a person would present with viral conjunctivitis secondary to COVID-19 without any other symptoms such as fever or a continuous cough.
Recent studies show that only 1-3% of affected COVID-19 people displayed symptoms of conjunctivitis. So fairly low risk.
(5) What are symptoms of viral conjunctivitis?
As mentioned above, any possible, low-risk COVID-19 related viral conjunctivitis will be treated as a typical viral conjunctivitis prior to the pandemic.
Viruses are actually the most common cause of conjunctivitis and usually affect both eyes. Symptoms normally last 5 to 12 days and include:
-Redness in the conjunctiva (white part of the eyes)
-Sandy/gritty feelings in the eyeball
-Watery or slightly thick whitish draining
(6) How do you treat viral conjunctivitis?
If you suspect that you have any kind of conjunctivitis, contact your eye doctor for an in-person or virtual consult in order to confirm the viral diagnosis. This is because conjunctivitis can be caused from an array of sources such as dry eyes, bacteria, allergies and more seriously, iritis (severe inflammation of the eye).
While there is still on-going research on how to treat possible COVID-related conjunctivitis, the standard of care is to treat it similarly to how we would treat any typical viral conjunctivitis.
Viral conjunctivitis are usually self-limiting and will resolve on itself within 5-12 days. Your doctor might recommend some treatment to reduce your symptoms:
-It is highly contagious so practice good hygiene by washing your hands often and avoid cross contamination
-Over-The-Counter Artificial tears and cold compresses help to relieve symptoms
-Discontinue all contact lens wear during the acute phase
-Topical antihistamines or steroid eye drops may be used to relieve redness or discomfort
-Antiviral eye drops might be prescribed depending on the severity of the viral infection
-Antibacterial eye drops are not effective for viral conditions
(7) Are there other ocular or retina symptoms associated with COVID-19 exposure?
A recent but small study of 12 adults with COVID-19 show that there might be mild changes in the blood vessels of the retina also known as “hypertensive retinopathy” related to COVID-19, but without any loss in vision.
This is still on-going research. In addition, there have been anecdotal reports of optic neuritis (inflammation of the optic nerve, which can lead to permanent vision loss) from around other eye care providers but no confirmed studies.
(8) What if I wear contact lenses?
Proper hygiene care of your contact lens is especially important during this viral pandemic, in order to maintain optimal ocular health and prevent transmission:
Wash your hands with soap/water for at least 20 seconds and then dry them with a lint-free towel prior to handling your contact lenses. If soap and water are not available, using a hand sanitizer (with at least 60% alcohol) is acceptable
Disinfect your contacts properly with the recommended cleaning solution as recommended by your optometrist. Do not use saline solution or OTC rewetting drops to disinfect your contact lenses.
Dispose of your daily disposable contacts each evening, or dispose of your 2-weeks or monthly lenses as instructed. Over-extending your contact lenses will increase risk of infection.
Discontinue lens wear if you are feeling sick with cold or flu-like symptoms and wear your back-up glasses as needed.
(9) Can my glasses get infected?
The latest studies show that new coronavirus can remain on hard surfaces for hours to days, and therefore can transfer to your face, then to your glasses. Therefore, glasses should be cleaned more regularly (daily if possible) with a mild dishwashing liquid soap (non-lotion) and lukewarm water.
Gently rub each lens and all part of the frame with your fingertips for a few seconds. Then dry off with a clean, cotton lint-free towel (ideally those used to clean fine glassware). Finally, remove any streaks/smudges with a clean lint-free microfiber cloth.
Here are some tips to avoid damaging the anti reflective coating of your lens or paint finish of the frame.
Avoid using your shirt or other cloth type, paper towels, tissues or toilet paper especially when the lens is dry to prevent scratching.
Do not use household glass-cleaner since these products have ingredients that can damage the lens and coating.
Avoid alcohol wipes and other disinfection methods such as Lysol wipes since they can damage the AR coating of the lens and frame paint.
Please note that a solution of warm water and hydrogen peroxide at 0.5% concentration is recommended for optimal disinfection of frame, but we are aware that these disinfection products are not widely available to consumers.
In conclusion, there is a lot of new and ongoing eye research in relation to COVID and we expect more evidence to come out as new studies get completed. In the meantime, keep practicing proper eye health hygiene and if there are any concerns, please don’t hesitate to reach out to us!
-Dr. Aaron Neufeld
Dr. Aaron Neufeld is the Chief Optometrist at Los Altos Optometric Group and primary author and editor of The EYE Digest.
To contact him with questions or make an appointment call: (650) 948-3700 or send him an email: firstname.lastname@example.org