Coronavirus (COVID-19) may cause pink eye or conjunctivitis: But it’s rare

Dr Muralidhar Ramappa, Consultant, Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad provides insights into how COVID-19 could cause conjunctivitis and precautionary measures one needs to take to protect themselves

What one needs to know

● Conjunctivitis may be the first symptom of corona infection

● Patients with corona conjunctivitis are contagious

● Transconjunctival aerosol infection is a known mode of disease transmission

● Asymptomatic patients with corona or patients in incubation can transmit the disease

● Close contact during ophthalmic procedures has the risk of patient-to-ophthalmologist disease transmission.

Several reports suggest that coronavirus can cause pink eye or conjunctivitis and possibly be transmitted by aerosol contact with the conjunctiva. “If you see someone with a pink eye, don’t panic. It doesn’t mean that a person is infected with the coronavirus. Conjunctivitis can be seen in 1-3 per cent of cases with the coronavirus infection. The virus can spread by touching discharge or tears from an infected person’s eyes.”

Coronavirus seems to spread through small respiratory droplets produced when an infected person coughs or sneezes, although it could also spread if people touch an object contaminated with the virus and then touch their mouth, nose or eyes. Therefore, patients who go to the ophthalmologist for conjunctivitis and have respiratory symptoms, besides patients who have recently travelled to areas with active outbreak (China, Iran, Italy, Japan and South Korea) or have relatives who have recently returned, could be a possible suspect. Those affected experience symptoms such as fever, cough, shortness of breath or conjunctivitis, which can appear between two and 14 days after being exposed to the virus. It is important to remember that according to The Lancet journal, patients can transmit the virus even before experiencing symptoms.

What is red eye or conjunctivitis?

Conjunctivitis is an inflammation of the conjunctiva of the eye. The conjunctiva is the membrane that lines the inside of the eyelids and covers the front part of the eyeball. Conjunctivitis is also known as ‘pink eye’ because the eye looks pink or red. There are several causes and it is a very common condition that is not generally severe, although it can be unpleasant. Common symptoms are redness, eye-watering and others, depending on the aetiology (morning sticky eyes in infectious cases, enlarged lymph nodes in the viral cases, itchiness in allergic cases, etc.), lasting for one to three weeks.

Limiting eye exposure can help. Here’s why:

When a sick person coughs or talks, virus particles can spray from their mouth or nose into another person’s face. You’re most likely to inhale these droplets through your mouth or nose, but they can also enter through your eyes. People who have coronavirus can also spread the illness through their tears. Touching tears or a surface where tears have landed can be another portal to infection. You can also become infected by touching something that has the virus on it — like a table or doorknob — and then touching your eyes.

Can coronavirus spread through the eyes?

Authorities say guarding your eyes — as well as your hands and mouth — can slow the spread of coronavirus. Here’s why the eyes are so important in the coronavirus disease outbreak, and five ways you can help.

Five ways to help yourself and others:

It is important to remember that although there is a lot of concern about coronavirus, precautionary measures can significantly reduce your risk of getting infected. So, wash your hands frequently, follow good contact lens hygiene and avoid touching or rubbing your nose, mouth and especially your eyes.

1. If you wear contact lenses, switch to glasses for a while:

Contact lens wearers touch their eyes more than the average person. Consider wearing glasses more often, especially if you tend to touch your eyes a lot when you are wearing contact lenses. Substituting glasses for lenses can decrease irritation and limit you from touching your eye.

2. Wearing glasses may add a layer of protection.

Corrective lenses or sunglasses can shield your eyes from infected respiratory droplets. But they don’t provide 100 per cent security. The virus can still reach your eyes from the exposed sides of your glasses. If you are caring for a sick patient or potentially exposed person, safety goggles may offer a stronger defence.

3. Don’t skip your eye exam but take precautions.

If you’re due for an eye exam, you may be nervous about going to the eye doctors. Eye doctors sit face-to-face with many patients daily. During a slit-lamp exam, the doctor’s face will be just a few inches away from yours. But rest assured that eye doctors, like all medical professionals, follow strict hygiene and disinfection guidelines.

You might notice some changes to the routine:

Your eye doctor may use a special plastic barrier called a slit-lamp breath shield. This helps block the exchange of breath between the patient and doctor.

Your ophthalmologist may also wear a mask with a plastic shield over their eyes.

4. Eye doctors recommend the following precautions:

If you have a cough or fever, it’s essential to call your doctor’s clinic ahead of time and let them know. If your visit is not an emergency, they may ask you to stay home. If you arrive sick, your doctor may ask you to wear a protective covering or mask and to wait in a special room so that you won’t expose other patients. Your physician may wait until after your slit-lamp eye exam to talk with you or answer questions.

If you anticipate a cough or sneeze during your exam, move back from the microscope and cover your face with a tissue. Wash your hands with soap and water as soon as you can.

Stock up on eye medicine prescriptions if you can.

Experts advise patients to stock up on critical medications so that you have enough to get by if you are quarantined or if supplies become limited during an outbreak. If possible, get more than one month of essential eye medicine, such as glaucoma drops, steroid eye drops for patients with corneal grafting, and so on.

5. Avoid rubbing your eyes.

We all do it. While it can be hard to break this natural habit, doing so will lower your risk of infection. If you feel an urge to itch or rub your eye or even to adjust your glasses, use a tissue instead of your fingers. Dry eyes can lead to more rubbing, so consider adding moisturising drops to your eye routine. If you must touch your eyes for any reason — even to administer eye medicine — wash your hands first with soap and water for at least 20 seconds.

What do you have to do to protect yourself?

WHO recommends the following generic protective measures:

• Wash your hands often with soap and water for at least 20 seconds
• You must wash your hands specially before eating, after using the restroom, sneezing, coughing or blowing your nose
• If you can’t get to a sink, use a hand sanitiser that has at least 60 per cent alcohol
• Avoid touching your face — particularly your eyes, nose, and mouth
• If you cough or sneeze, cover your face with your elbow or a tissue. If you use a tissue, throw it away promptly. Then go wash your hands
• Avoid close contact with sick people. If you think someone has a respiratory infection, it’s safest to stay six feet away
• Stay home when you are sick
• Regularly disinfect commonly touched surfaces and items in your house, such as doorknobs, elevator buttons, and countertops
• Seek medical attention if you have a fever, cough and shortness of breath or red eye