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Understanding COVID-19 Eye Symptoms: Is Your Eye Pain a Symptom of COVID-19?

The list of COVID-19 symptoms is lengthy, and some of these symptoms are related to your eyes, including eye pain, itchy eyes and pink eye. But developing new-onset eye problems doesn’t necessarily mean you have COVID-19. Don’t panic. There are many other far-more-likely causes of eye and vision-related symptoms.

Below, you’ll see a list of coronavirus eye symptoms, along with other causes of these symptoms, and helpful tips for what to do.

How does COVID-19 get into your eyes anyway?

There are many possible ways that coronavirus can enter your body, potentially including your eye’s conjunctiva, the clear, thin mucous membrane that covers part of the white of your eye and the inner surface of your eyelids.

Here’s what researchers think happens: Someone with COVID-19 coughs or sneezes and infected droplets land in your eye. It’s also theoretically possible that you can touch an infected surface, then touch your eyes and transmit the virus that way. 

Other more common ports of entry for COVID-19 infection include your mouth and nose.  

What are the common COVID-19 eye symptoms?

Eye-related symptoms may occur in anywhere from 4% to 31% of people with COVID-19, according to research published in BMJ Open Ophthalmology. The actual number may be much higher, since most coronavirus eye symptoms are usually not too severe, and may be less likely to be reported as a result.

COVID-19 eye symptoms seem to occur within two weeks of other COVID-19 symptoms, such as cough, fever, fatigue, and loss of smell or taste. Eye symptoms last for less than two weeks for the majority of people and are common across all ages and genders.

Is your eye pain a sign of COVID-19?

“My eyes hurt when I move them. Do I have COVID?” There’s a link between COVID and eye pain. The chance that a new-onset eye symptom is a sign of COVID-19 infection increases if you’ve also recently been exposed to someone with COVID-19 or have other signs of this virus, including:

If you have eyeball pain, and you’ve been exposed to someone who has COVID-19, get tested, and consult your doctor.

Top coronavirus eye symptoms

Here’s a list of the most common coronavirus eye symptoms, including sore eyes, sensitivity to light, keratitis, pink eye, inflammation of the optic nerve, and rapid, involuntary eye movement while awake.

1. Sore eyes

Sore, tired and tender eyes are among the most common COVID-19 eye symptoms, according to the BMJ Open Ophthalmology study.

What to do: If you have been exposed to COVID-19 and/or your eyes are hurting, and you have any other symptoms, get tested and quarantine until your results are in. It’s always better to be safe than sorry.

2. Light sensitivity

Light sensitivity that causes you to shield your eyes from brightness could be a COVID-19 eye symptom. Light or photosensitivity can also travel with headaches, particularly migraines, and headaches are possible COVID-19 symptoms too.

What to do: Talk to your doctor about any head pain. COVID-19 testing may be advised based on your individual risk factors and symptoms.

3. Itchy eyes

Red, itchy, burning, watery eyes may be a coronavirus eye symptom, but it’s much more likely that these symptoms are caused by eye allergies or called allergic conjunctivitis, according to the American Academy of Ophthalmology.  Eye allergies usually occur with sniffling and sneezing.

What to do: Don’t panic. Treat these allergy symptoms as you normally would unless they travel with fever, breathing issues, cough, or other COVID-19 symptoms or you have been exposed to someone with the virus.

4. Keratitis

Keratitis, an inflammation of the cornea, can be a serious and potentially vision-robbing eye condition, and some evidence suggests a possible link to COVID-19. In these cases, keratitis may progress rapidly to an infection inside the eye called endophthalmitis. These findings were presented at the 2020 meeting of the American Academy of Ophthalmology.

Keratitis symptoms may include:

What to do: If you have any signs or symptoms of keratitis, see an ophthalmologist immediately as addressing this early is the best way to preserve your vision. If you’re also experiencing symptoms of COVID-19, get tested and quarantine until you receive your results.

5. Pink Eye

Pink eye or conjunctivitis may develop in up to 3% of people with COVID-19, but COVID-19 is far from the only cause of pink eye. Colds, different viruses and bacteria can all play a role. Pink eye may be more common in kids with COVID-19 than adults, according to a study in JAMA Ophthalmology. If you’re wondering if you have pink eye or coronavirus eye symptoms, see the list below.

Pink eye symptoms may include:

What to do: If your or your child’s eyes are red, irritated, watery and/or crusted shut in the morning, or their eyes hurt, see a doctor for a proper diagnosis. Pink eye isn’t serious, but it is highly contagious. If you or your child was recently exposed to COVID-19 or is experiencing other symptoms, or you’re concerned about the link between COVID and pink eye, get tested and seek care.

6. Epiphora

This is the official medical name for tearing or watery eyes, and one study in JAMA Ophthalmology found that epiphora may travel with COVID-19. This potential COVID-19 eye symptom is often mild.

What to do: Don’t rub your eye as this will only make it worse. See your eye doctor if it is bothersome and appears to be getting worse, not better. Consider COVID-19 testing if you also have other symptoms of the virus or have recently been exposed to someone who tested positive.

7. Chemosis

The swelling of your conjunctiva (also known as chemosis) can be a coronavirus eye symptom as well, according to the JAMA Ophthalmology study.

What to do: See your eye doctor if the tearing is bothersome and appears to be getting worse, not better. Consider COVID-19 testing if you also have other symptoms of the virus or have recently been exposed to someone who tested positive.

8. Episcleritis

An inflammatory condition that affects the episcleral tissue between the conjunctiva and the sclera or the white part of your eye, episcleritis has been linked to COVID-19 in at least one case report.

What to do: This could be an early sign of COVID-19. Consider getting tested if you have recently been exposed to someone with COVID-19 or been in any ‘risky’ situations.

9. Optic Neuritis

Inflammation of the optic nerve or optic neuritis can be a sign of multiple sclerosis (MS) and there have been some reports that it can also occur with COVID-19. This COVID-19 eye symptom may cause sudden, reduced vision in the affected eye.

What to do: See your eye doctor. It’s important to identify and address the underlying disease. Optic neuritis may go away on its own, but sometimes steroids are needed to cool inflammation.

10. Eye movement abnormalities 

If your eyes rapidly move from side to side or up and down, it’s called nystagmus. This condition has been linked to severe COVID-19 infection, so it’s on the list of coronavirus eye symptoms.

What to do: If you have COVID-19 and your symptoms are severe, there are treatments available that can help stop the “cytokine storm” that may kickstart inflammation and severe immune system reaction that increases your risk for blood clots.

Dry eyes from face mask use

While wearing a face mask in crowded public places helps prevent the spread of COVID-19, it can aggravate your dry eyes, according to study in Cornea: the Journal of Corneal and External Disease. Here’s why: If your mask doesn’t fit snugly, it can push air from your nose and mouth upward toward your eyes, causing your eyes’ protective tear film to evaporate more quickly. (Tear film is made up of several layers of tears: an oily layer on the outside, a watery layer in the middle, and an inner mucus layer.)

What to do: For starters, make sure your mask fits well. Treatment for dry eye may include artificial tears or eye drops, and certain lifestyle changes such as turning off fans or other direct air. Air that circulates too quickly can increase tear evaporation. You can also use a humidifier to keep the air moist.

Some physicians recommend using facemasks with inner metal strips that bend to seal the facemask near the top, preventing your breath from blowing into the eyes. They caution that sealing a mask with body tape can actually worsen symptoms, since tape can lead to eyelid tension and/or cut down on blinking, which can cause other eye health problems.

If you are concerned that you may be experiencing dry eye symptoms, consider taking the At-Home Dry Eye Diagnostic Test.

Dry eye disease and COVID-19 face masks

People who already suffer from a condition called dry eye disease may find their symptoms worsened by wearing a face mask. Marked by stinging, eye fatigue, red eyes, sensitivity to light, and/or blurry vision, dry eye disease is more than just a nuisance.

Post-COVID-19 eye problems

Sometimes eye problems develop in the wake of a COVID-19 infection. These post-coronavirus eye symptoms tend to develop within one to six weeks of other COVID symptoms and seem to be related to blood clots that can form in your arteries, as noted by the American Academy of Ophthalmology.

These problems include:

1. Cotton wool spots

The tissue in the light-sensitive layer of tissue in the back of your eye (your retina) can swell and die if blood clots prevent nutrients from reaching it. Your eye doctor will detect white, fluffy spots that look like cotton wool during an exam if you have this post-COVID-19 eye symptom.

2. Eye stroke 

Blood clots in the arteries of your retinas can lead to a blockage in the flow of oxygen, causing cells to die. This is known as an eye stroke or retinal artery occlusion. It is marked by sudden vision loss, and can be a coronavirus eye symptom.

3. Retinal vein occlusion

When a vein within the retina is blocked, blood can't drain. As a result, the buildup of blood increases the pressure levels inside your eye, causing bleeding, swelling, and leakage. Other symptoms may include blurry vision or sudden, permanent blindness.

4. Retinal hemorrhage

Retinal hemorrhage occurs when blood vessels in your retina start to bleed. This condition can lead to blind spots and vision loss.

These eye-related COVID complications are more likely in people with:

Preventing COVID-19 eye symptoms

The good news is that we know so much more about COVID-19 today than we did in the early days of this pandemic. Taking steps to prevent infection is the best way to keep you and your loved ones safe and free from coronavirus eye symptoms.

This includes:


References:

BMJ Open Ophthalmology: “Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states.” https://bmjophth.bmj.com/content/5/1/e000632
USC Roski Eye Institute:
 “Ask the Expert: How COVID-19 Affects the Eyes (Updated 8/24/21)” https://eye.keckmedicine.org/ask-the-expert-how-covid-19-affects-the-eyes-2021/Centers for Disease Control and Prevention: “Symptoms of COVID-19” https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

American Academy of Ophthalmology: “Is It COVID-19 or Allergies?”
https://www.aao.org/eye-health/tips-prevention/coronavirus-versus-allergies-pink-eye

Schrier A, Smith E, Mehta I, et al. Keratitis progressing to endophthalmitis: a cluster in an epicenter of COVID-19. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO081.

JAMA Ophthalmology. “Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China”

https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2769877

JAMA Ophthalmology: "Characteristics of Ocular Findings of Patients with Coronavirus Disease 2019 (COVID-19) in Hubei Province, China.” https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2764083?guestAccessKey=6b204664-6c20-473d-9396-807bfb3ce7a8

American Journal of Ophthalmology Case Reports. “Episcleritis as a possible presenting sign of the novel coronavirus disease: A case report.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476899/

Neuroscience Letters. “Neuro-ophthalmologic complications of coronavirus disease 2019 (COVID-19)” https://www.sciencedirect.com/science/article/pii/S0304394020308016?via%3Dihub

Cornea: the Journal of Corneal and External Disease:” Effect of Face Mask on Tear Film Stability in Eyes With Moderate-to-Severe Dry Eye Disease” https://journals.lww.com/corneajrnl/Citation/2021/10000/Effect_of_Face_Mask_on_Tear_Film_Stability_in_Eyes.16.aspx

American Optometric Association: “Dry eye”

https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/dry-eye?sso=y

American Academy of Ophthalmology. “4 Ways COVID Leaves Its Mark on the Eye” https://www.aao.org/eye-health/tips-prevention/covid-damages-retina-eye-stroke-pinkeye

Centers for Disease Control and Prevention: “COVID-19: How to Protect Yourself & Others.” https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html