COVID-19 and Your Vision

rub eye covid-19The U.S. Centers for Disease Control and Prevention tells us to avoid touching our eyes, nose, mouth, or anywhere on the face with unwashed hands. This should help prevent us from contracting Coronavirus 19 (COVID-19).

Learn about important updates as scientists learn more about how COVID impacts the eyes.

Jump to Updates: December, 2020

How are our eyes involved with the transmission of COVID-19?

The primary way COVID-19 appears to be transmitted between people is via the water droplets propelled into the air when an infected person coughs or sneezes. A secondary method of transmission happens when the droplets hit a surface, and an uninfected person touches the surface and then touches their eyes or face.

Viruses enter the body through mucous membranes such as the eyes, nose, and mouth. Once the virus has entered the body, it invades the infected person’s cells and begins to replicate. The person can be contagious for days before having any symptoms.

How the Body Fights Viruses

The body responds over time. First, it identifies the virus. Then, the body creates specific antibodies to resist the replication of the virus and destroy it. For most people, the body identifies the virus and attacks it before getting seriously ill. These people recover and can go back to their regular activities. About 25% have no symptoms, which makes this virus even more dangerous for others. Asymptomatic people can be contagious without knowing it.

For some, COVID-19 is severe, and a small percentage will die from it. These numbers are of critical concern if a vast number of people are exposed to COVID 19. This virus is called “novel” because it is new to the body, so there is no existing antibody memory to identify it quickly. The body needs more time to produce the right antibodies.

Pink Eye and COVID-19

According to a March 31 2020 study in JAMA Ophthalmology, a third of COVID-19 patients also suffered “pink eye” (viral conjunctivitis).1 The symptoms included redness, swelling, increased tears or other secretions. The study speculated that the virus has infected the eyes of these patients and that their tears will carry the virus. So, if one of these patients touches their eye and then another person or surface, they can unwittingly transmit the virus.

Similar viruses in the coronavirus family, known as CoVs, have caused a number of sight-threatening ocular infections in animals. These include not only conjunctivitis, but uveitis, retinitis, and optic neuritis.

Learn to Not Touch Your Face

Once we pay attention to not touching our face it may be surprising to realize what a built-in habit it is.  We have an itchy cheek, hair is tickling our face, or we rest our chin on our hands while thinking about work.  It is not easy to undo that habit.  (Actually, one of the side benefits of wearing glasses and/or a face mask is that it interrupts the automatic hand-to-face gesture).

So, it is most important to avoid touching your eyes or anywhere on your face. If you must touch them, wash your hands for 20 seconds, then wash again after touching your face. Favor wearing glasses over contact lenses during the coronavirus outbreak. Pink eye is irresistibly itchy. If you touch your eyes, wash your hands immediately so you do not accidentally transmit it to others.

If you have pink eye, cough, fever, tiredness, or difficulty breathing, consult a doctor.

Update, December 15, 2020

Now that a vaccine is near be sure to redouble your attention to avoiding getting COVID-19 by wearing your mask properly, avoiding touching your face, and washing your hands.

Scientists are publishing reports of relatively uncommon but extremely serious side-effects that emphasize the risk of COVID-19 to your precious vision. There have been earlier reports of the virus attacking the nervous system, as in Guillain-Barre syndrome in which your immune system attacks your nerves, and loss of the sense of smell.

It appears that the COVID-19 virus binds directly to the cornea rather than reaching the eyes through other routes, such as through the nose or fine blood vessels in the eyes.2 For that reason social distancing is essential.

Scientists have reported not only loss of smell and taste, but loss of peripherial vision in one eye,3 retinal hemorrhages (bleeding in the retina), acute macular neuroretinopathy (a rare disease characterized by vision distortions in part of the visual field), and paracentral acute middle maculopathy (progressive macular deterioration),4 and loss of retinal ganglion cell axons (the major nerve cells in the retina that output to the optic nerve).5

A study of 54 COVID patients and 133 COVID-free patients found that covid-19 can affect the retinal blood vessels, and seriousness is directly correlated with COVID severity.  Of the COVID patients 9.25% had haemorrhages, 27.7% had dilated veins and arteries in the eye (evidenced as pink eye), 7.4% had cotton wool spots (an abnormal finding looking like fluffy white patches on the retina, and indicative of nerve damage), 12.9% had twisted blood vessels.6

These examples are a firm reminder that we need not let down our attention to the details of COVID-19 prevention.

Up Next: Can boosting your immunity increase your resistance to viruses?

  1. Wu P, Duan F, Luo C, Liu Q, Qu X, et al. (2020). Characteristics of Ocular Findings of Patients with Coronavirus Disease 2019 (Covid-19) in Hubei Province, China. JAMA Ophthalmol. Mar 31.
  2. Willcox MD, Walsh K, Nichols JJ, Morgan PB, Jones LW. (2020). The ocular surface, coronaviruses and COVID-19. Clin Exp Optom. Jul;103(4):418-424.
  3. Selvaraj V, Sacchetti D, Finn A, Dapaah-Afriyie K. (2020). Acute Vision Loss in a Patient with Covid-19. R I Med J (2013). Jun 10;103(6):37-38.
  4. Gascon P, Briantais A, Bertrand E, Ramtohul P, Comet A, et al. (2020). Covid-19-Associated Retinopathy: A Case Report. Ocul Immunol Inflamm. Nov 16;28(8):1293-1297.
  5. Burgos-Blasco B, Guemes-Villahoz N, Donate-Lopez J, Vidal-Villegas B, Garcia-Feijoo J. (2020). Optic nerve analysis in COVID-19 patients. J Med Virol. Jul 19;10:1002/jmv.26290.
  6. Invernizzi A, Torre A, Parruli S, Zicarelli F, Schiuma M, et al. (2020). Retinal findings in patients with COVID-19: Results from the SERPICO-19 study. Lancet. Oct 1;27:100550.