Is pink eye (conjunctivitis) a sign of COVID-19?
Medically reviewed by Drugs.com. Last updated on March 30, 2020.
Conjunctivitis, or pink eye, has been observed in a small number of patients diagnosed with COVID-19, the disease caused by the new coronavirus (SARS-CoV-2).
Conjunctivitis is inflammation of the thin membrane, called your conjunctiva, which covers the front of your eye and the back of your eyelids. Your conjunctiva helps to keep your eyes moist and lubricated, but when it becomes inflamed the small blood vessels in the area become more visible, causing the whites of your eye to appear a pink or red colour.
Viral conjunctivitis is the most common cause of infectious conjunctivitis and is seen in people with a range of different viruses including the common cold, measles and the flu, so it’s not surprising that it would also be observed in patients with COVID-19. Infectious body fluids, including infectious respiratory droplets, can contaminate the conjunctiva of the eyes if an infectious person is coughing or sneezing around others.
What was the first sign that conjunctivitis might be linked to SARS-CoV-2 infection?
One of the first indications that conjunctivitis might be a symptom of COVID-19 was back in January 22, 2020, when a member of China’s national expert panel on pneumonia, Guangfa Wang, reported he had developed COVID-19. Wang had been in contact with infected patients in Wuhan and while he had worn an N95 mask, he had not worn anything to protect his eyes. After becoming infected with the virus, Wang experienced symptoms of eye redness for several days before he developed pneumonia.
What does the research tell us about COVID-19-related conjunctivitis?
Researchers in China were only able to detect SARS-CoV-2 in the tear and conjunctival secretions from the one patient with conjunctivitis and COVID-19 in their 21-patient study. SARS-CoV-2, however, was not detected in the conjunctival sac in any of the other 20 COVID-19 patients who did not have conjunctivitis.
Another group of researchers working in Singapore, however, found no evidence of the virus in tear samples from the 17 patients with COVID-19 in their study. None of the 17 patients had eye symptoms when they were diagnosed, but one patient did develop red and swollen conjunctiva later on.
Data from a much larger group of 1099 COVID-19 patients in China, indicates that only 9 (0.8%) of the patients had symptoms of conjunctival congestion.
The above results indicate that conjunctivitis is not a common symptom of COVID-19 and there is a low risk of SARS-CoV-2 being spread through tears.
What should I do if I develop conjunctivitis?
It is important to remember that the common cold, a bacterial infection or allergies can cause conjunctivitis.
Bacterial conjunctivitis is more commonly associated with pus or discharge from the eye, compared with the watery discharge that may be seen with viral conjunctivitis. Antibiotic eye drops may be necessary to treat bacterial conjunctivitis.
Allergic conjunctivitis is triggered by allergens such as pollen or dust and is more likely to be associated with itchy eyes than viral conjunctivitis. Antihistamine eye drops can help to alleviate symptoms.
There is no treatment for viral conjunctivitis. It will usually clear up on its own after a short time. If you also develop a fever, dry cough and tiredness alongside your conjunctivitis, then it may be a sign that you have COVID-19.
- Azari A, Barney NP. Conjunctivitis. A Systematic Review of Diagnosis and Treatment. JAMA. 2013 Oct 23; 310(16): 1721-1729. DOI: 10.1001/jama.2013.280318. Lu C-W, Liu X-F, Jia Z-F. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. S0140-6736(20)30313 5. https://doi.org/10.1016/. Xia J, Tong J, Liu M, et al. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020 Feb 26. doi: 10.1002/jmv.25725.
- Yu Jun IS, Anderson DE, Zheng Kang AE, Wang L-F, Rao P, Young BE, Lye DC, Agrawal R, Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients, Ophthalmology (2020), doi: https://doi.org/10.1016/j.ophtha.2020.03.026. Guan W, Ni z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2002032. American Optometric Association. Conjunctivitis. Available online at: https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/conjunctivitis. [Accessed March 30, 2020].
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