Pink eye, or conjunctivitis, and other abnormal eye conditions could be a less common symptom of COVID-19 and also a possible source of transmission, according to several recent studies.
Preliminary results, along with an anecdotal report, prompted the American Academy of Ophthalmology to recommend to healthcare workers not only to protect their mouth and nose with a mask, but also their eyes, by wearing glasses or a shield, when caring for patients who may have COVID-19.
“Existing data suggests that conjunctivitis is a rare event with COVID-19,” the Academy wrote on Friday.
“However, because conjunctivitis is a common condition overall … it may happen that ophthalmologists are the first providers to assess patients potentially infected with COVID-19 … It is possible – but not proven – that a patient with Conjunctivitis associated with COVID-19 may have an infectious virus in their eye secretions. “
The most common symptoms cited by Health Canada, the United States Centers for Disease Control and the World Health Organization are fever, difficulty breathing, dry cough, and fatigue. Other symptoms could also include aches and pains, sore throat and, more rarely, diarrhea, nausea and a runny nose. There is also growing evidence that a sudden loss of smell or taste could be an early sign of COVID-19 infection, especially for otherwise asymptomatic patients.
Data from 1,099 patients hospitalized across China with the new coronavirus found that 0.8% reported “conjunctival congestion,” according to a study published in the New England Journal of Medicine.
Another COVID-19 study of 38 patients from Hubei province who specifically examined eye conditions found that a dozen of them had eye-related symptoms, including “conjunctival congestion”. Eight of the 12 patients were considered “severe” or “critical,” suggesting that these eye symptoms were more common in patients with severe pneumonia, the study authors wrote.
“Because unprotected eyes were associated with an increased risk of transmission of SARS-CoV-1, in support of our current results, our results could suggest that SARS-CoV-2 could be transmitted by the eye” , wrote the authors. SARS-CoV-2 is the virus responsible for COVID-19, and SARS-CoV-1 is the virus responsible for SARS, which caused dozens of deaths in Canada and hundreds in China and Hong Kong in 2003.
The study published in the Journal of the American Medical Association also found that patients with eye symptoms were also more likely to have higher white blood cells and neutrophils, as well as protein C levels. – higher reactives – all indicators of possible infection – than patients without eye symptoms. Elevated levels of other blood test values, including lactate dehydrogenase, which may indicate tissue damage, have also been found.
Two other studies which, unlike the others, have not yet been peer reviewed, indicated that the virus could be detected in the tears of patients with COVID-19, but suggested that the probability of transmission by ocular secretions was relatively small.
Red eyes appeared to be a key sign of infection, Chelsey Earnest, a nurse at the Life Care Center in Kirkland, Washington, told CNN in March, even when other symptoms were not immediately evident. She described it as similar to “allergic eyes.” Life Care was one of the first deadly COVID-19 clusters in the United States.
An asymptomatic glaucoma patient is believed to be the source of infection for Li Wenliang, the Chinese ophthalmologist and whistleblower who later died of COVID-19.