Eye problems that could be related to COVID

Are you experiencing sore eyes — or itchy eyes or a sensitivity to light — and worry that your symptoms might be a sign of COVID-19? The novel coronavirus may cause eye problems in some patients, but they usually aren’t the first sign you’re sick.

The most common symptoms of COVID-19, including cough, fatigue, fever, headache, muscle aches and loss of taste or smell, are not eye-related. Doctors still are learning about how the coronavirus affects the eyes. One study on COVID and eye problems in 83 patients published in BMJ Open Ophthalmology found three common eye issues: 

• Itchy eyes – 17% of COVID-19 patients in the study reported this symptom
• Sensitivity to light – 18% of COVID-19 patients in the study reported this symptom
• Sore eyes – 16% of COVID-19 patients in the study reported this symptom

Eye-related symptoms of coronavirus can include burning eyes, itchy eyes, red eyes, sore eyes, puffy eyes, swollen eyelids and watery eyes. Such symptoms tend to be more common in patients with severe COVID-19 cases. 

It’s important to note that an eye issue in a person with coronavirus could actually be caused by something other than the virus. Many COVID-19 eye symptoms resemble allergies and other common conditions. Some coronavirus patients just happen to have unrelated eye issues, so don’t immediately assume you have COVID-19 if your eyes hurt, burn or itch. 

Coronavirus may lead to conjunctivitis (pink eye) in about 1% to 3% of adults, according to the American Academy of Ophthalmology (AAO). Conjunctivitis is inflammation or an infection of the conjunctiva, a thin membrane that covers the whites of the eyes (sclera) and the inside of the eyelids.

Symptoms of viral conjunctivitis such as that caused by the coronavirus may include:

• Burning eyes
• Itchy eyes
• Sore eyes
• Red eyes
• Watery eyes
• Photophobia (light sensitivity)

Like any viral conjunctivitis, a COVID eye infection should be considered very contagious. Viral conjunctivitis can be spread by coughing, sneezing and touching your eyes.

Because COVID can spread through the eyes, some experts recommend wearing eye protection such as COVID goggles or face shields to protect your eyes from saliva droplets that may contain the virus. Someone who gets exposed to coronavirus through the eyes and later tests positive for COVID-19 may or may not develop conjunctivitis.

Increased eye secretion has been identified in some studies as a possible COVID-19 symptom. Commonly described as "goopy" or runny eyes, eye discharge is made up of mucus, oil and skin cells. Eye discharge found in your eye when you wake up is commonly known as "sleep."

Some eye discharge is normal — in fact, it plays an important part in eye health because it removes debris and helps to keep the eye healthy. But excess eye discharge, or yellowish discharge, can be a sign of conjunctivitis and many types of eye infections.

Eye swelling may be a symptom of conjunctivitis or a sign of chemosis. One small study of 38 patients found that some patients with COVID-19 also had chemosis. Chemosis is the swelling of the conjunctiva, the thin membrane that covers the front of the eye and the insides of the eyelids.

Symptoms of conjunctival chemosis include red eyes, itchy eyes, watery eyes, puffy eyes, swollen eyelids and feeling like you have something in your eye (foreign body sensation). Some patients also have a red or pink "blister" on the white of the eye.

Doctors are still learning about COVID-19 and eye problems, so it’s too early to know whether coronavirus actually can cause chemosis.

The same small study mentioned above found that some coronavirus patients experience overly watery eyes (epiphora ), but wasn’t able to definitively conclude they are a symptom of coronavirus.

If you have epiphora, tears may overflow from your eyes and run down your cheeks. Watery eyes can be caused by a variety of conditions, including bacterial keratitis, corneal ulcers, eye infections, glaucoma and macular degeneration. Excessive tears also are a common symptom of allergies.

Antihistamines, cool compresses, changing contact lenses and taking a break from staring at screens may help resolve watery eyes, but see an eye doctor if the problem persists.

Eye twitching was not identified as an ocular symptom of COVID-19 in a meta-analysis of 12 studies on COVID-19 eye symptoms. However, COVID-19 may cause neurological symptoms in some patients. A case report described one patient who had neurological manifestations of COVID-19 and experienced facial spasms that included eye twitching.

An eye twitch is an uncontrollable spasm of the eyelid that usually lasts a few minutes but can last longer. Eye twitching (myokymia)may have a variety of possible causes, including allergies, caffeine, dry eyes, stress or nutrition problems. In many cases, it goes away on its own. Patients with persistent eye twitching should see an eye doctor.

Some studies have found that COVID-positive patients report certain eye problems at close to the same rate that patients without coronavirus do. In some cases, COVID-negative patients actually had a higher rate of certain eye problems than those with the virus.

This means that some reported eye problems may not be related to coronavirus at all.

In other words, it could just be a coincidence that someone has COVID-19 and an eye issue at the same time. This may be the case with eye flashes and floaters, two common eye issues that have been reported by some coronavirus patients.

If you have eye symptoms that may be related to COVID-19, call your eye doctor and describe your symptoms before making an appointment. Let them know over the phone if:

• You may have been exposed to coronavirus

• You’re experiencing coronavirus symptoms

• You’re waiting for coronavirus test results

• You have tested positive for COVID-19

If your eye problem isn’t an emergency, you might need to wait to visit an eye doctor. If you’re cleared to go to the eye doctor during the pandemic, remember to wear a mask. And know that your eye doctor may take extra precautions, such as checking your temperature before you can enter the building and using a special plastic breath shield when examining your eyes.

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