COVID-19 Symptom: Eyes Pain and Redness

• “COVID eyes” refers to various eye symptoms caused by the COVID-19 virus, including conjunctivitis, dry eyes, light sensitivity, and blurry vision.
• In some cases, eye symptoms may be the first or the only presenting feature of COVID-19.
• Symptoms typically last for a few days to 2 weeks.
• Treatment mainly focuses on symptom relief using eye drops and creams.
• If COVID-related eye symptoms persist or you are concerned, seeking medical advice is recommended.

The COVID-19 pandemic has affected people in numerous ways, including through a range of symptoms that can impact the eyes, known collectively as “COVID eyes.” Various eye symptoms can also occur in patients, including conjunctivitis, watery eyes, and light sensitivity.

Maintaining good eye health is essential for overall well-being, and eye symptoms related to COVID-19 can significantly impact daily life. This article breaks down the different eye symptoms that can be caused by COVID-19, how long they typically last, their diagnosis, and what can be done to alleviate them. 

Among the different eye symptoms reported by COVID-19 patients, conjunctivitis or pink eye is one of the most common. Conjunctivitis is an inflammation of the eye’s outer surface, the conjunctiva, and can be caused by an infection, such as COVID-19, irritants, or an allergic reaction. It’s characterized by a pink or red coloration of the eye, which can be accompanied by itching, burning, or a gritty sensation. Conjunctivitis typically affects both eyes and can be highly contagious if it’s infectious. Conjunctivitis commonly presents with the following symptoms in both eyes: 1 2

• The feeling of "having something in your eye"
• Red eyes
• Watery eyes
• Swollen eyes
• Eye pain

In rare cases, conjunctivitis can progress to cause more severe eye problems like inflammation inside the eye or damage to the optic nerve. 3

"COVID eyes" also describe other eye symptoms reported with the virus. These can range in severity from mild to bothersome and include: 4 5

• Dry eyes
• Eyes hurt when you move them
• Eye discharge
• Light sensitivity
• Itchy eyes
• Blurry vision

Though uncommon, there have also been reports of patients feeling pain or pressure behind the eyes during their COVID-19 infection. 1

In rare instances, COVID-19 can lead some people to develop more long-term eye problems that can range from mild to vision-threatening. These conditions include:

• “Cotton wool" spots. Blood clots can prevent nutrients from reaching the retina, causing tissue swelling and damage. When examined closely using optical coherence tomography, the affected area appears white and fluffy, similar to cotton wool. While these spots usually do not impact a person's vision, they can be an indication of underlying retinal damage.
• Eye stroke (retinal artery occlusion). Blood clots in the arteries of the retina can block the flow of oxygen-rich blood, leading to cell death and vision loss. Symptoms of an eye stroke typically include sudden, painless loss of vision.
• Retinal vein occlusion. Blockage in a vein in the retina can cause blood to build up and pressure levels inside the eye to rise, leading to bleeding, swelling, and fluid leaks. People with this complication may experience blurry vision or sudden, permanent blindness.
• Retinal hemorrhage. Bleeding from blood vessels in the retina can cause a retinal hemorrhage, which may lead to blind spots and gradual or sudden loss of vision. This can be caused by a retinal vein occlusion or other underlying conditions.

The exact reasons COVID-19 affects the eyes still need to be fully understood. Still, it's believed to occur due to the virus's ability to bind to ACE2 receptors in the conjunctival and corneal tissues.

Here are some of the causes of COVID-19 eye issues: 6 7

• Direct contact with contaminated surfaces or droplets. The virus can spread through droplets from the nose and mouth of infected individuals. If these droplets come into contact with the eyes, they can cause conjunctivitis or other eye-related issues.
• Self-infection through hands. An individual can also get COVID-19 conjunctivitis by touching a contaminated surface and then touching their eyes, which allows the virus to enter the conjunctival tissue.
• Systemic infection. COVID-19 can also cause systemic inflammation, which can lead to various eye complications, such as retinal vasculitis, optic neuritis, and macular edema.
• Pre-existing eye conditions. People with pre-existing eye conditions, such as dry eye disease, are more susceptible to COVID-19-related eye complications.
• Inflammation. Inflammation that flares up to fight the virus can cause blood clots to form. These clots may travel through the body and reach the veins, arteries, and blood vessels of the eye.

The length of time that COVID-related eye symptoms persist varies from person to person. Most people who experience "COVID eyes" notice their onset occurs a few days before or after other viral manifestations. However, they can also arise during the acute phase of the disease. For the majority, these symptoms subside within 2 weeks. 4

Some people only begin to experience eye pain, itchy eyes, and similar symptoms weeks to months after contracting COVID-19. 5

One study that followed up with COVID-19 patients after 82 days found no evidence of permanent eye damage in those who experienced COVID-related eye symptoms. 8

Nevertheless, if you are struggling with visual symptoms related to a stroke following COVID-19 (such as only being able to see things when they’re directly in front of you), you should consult an ophthalmologist. 2

Conjunctivitis and eye symptoms generally have many underlying viral, non-viral, and allergic causes. Consequently, it may sometimes be challenging to distinguish COVID-related eye problems from those unrelated to the virus. Conditions that present similarly to "COVID eyes" but have different underlying disease processes include: 2

• Conjunctivitis caused by other viruses, bacteria, or allergies
• Herpes virus keratitis
• Scratched cornea (corneal abrasion)
• Inflammation of the iris
• Dry eyes

There’s no formal test to diagnose "COVID eyes." Instead, a diagnosis is made based on your symptoms and a recent history of having contracted the COVID-19 virus.

Most non-serious eye symptoms related to COVID-19, such as conjunctivitis, tend to be self-limiting, meaning they usually resolve independently. There are ways to treat the discomfort associated with COVID eyes. These include: 2

• Eye drops
• Cold compresses
• Eye creams

For individuals at a higher risk of developing a serious infection, such as those who wear contact lenses daily, a doctor may prescribe a short course of antibiotic eye drops as a preventive measure against potential bacterial eye infections. It's important to note that antibiotics are ineffective against COVID-19, as it’s a virus. 2

More severe eye conditions such as "cotton wool" spots, retinal artery occlusion, and other complications may require immediate medical attention from your doctor or an eye specialist (ophthalmologist). Treatment options may include: 9

• Surgery
• Diet and lifestyle changes
• Vasodilators
• Ocular massage

In summary, "COVID eyes" is a collection of symptoms, such as red, painful, swollen, or watery eyes, affecting up to 32% of those who contract COVID-19. The severity of these symptoms ranges from mild to bothersome, although in most people, they're self-limiting and resolve without treatment within 2 weeks from onset. Nevertheless, some groups may benefit from eye drops or eye creams as a form of symptomatic relief. COVID-related eye symptoms overlap with numerous other eye conditions, so if your symptoms persist or you are particularly worried about them, it's always advisable to seek medical advice.

Q: Can COVID-19 complications affect the eyes?
A: Yes, COVID-19 can affect the eyes. Some people with COVID-19 may experience eye-related symptoms such as conjunctivitis, also known as pink eye or keratoconjunctivitis. In more severe cases, COVID-19 can also cause complications such as retinal vein occlusion, retinal artery occlusion, and "cotton wool" spots. 

Q: Am I at risk of long-term eye complications from COVID-19?
A: While severe ocular complications are uncommon in people with COVID-19, some individuals are more susceptible to developing these issues than others. Those with certain medical conditions, such as diabetes, high blood pressure, blood disorders, or other conditions that impact blood vessel function, are at a higher risk.

Q: Can COVID-19 cause eye redness?
A: Yes, many people who contract COVID-19 report red eyes. Eye redness is a common symptom of conjunctivitis, one of the most common ocular manifestations of COVID-19. Other factors, such as allergies, eye strain, or other eye infections, can also cause redness.

Q: Can you get COVID-19 through your eyes?
A: COVID-19 spreads when respiratory droplets are released through coughing or sneezing contact with mucous membranes. Since the conjunctiva of the eye is a mucous membrane, it's possible to contract COVID this way.

Q: What is the most common ophthalmologic manifestation of COVID-19?
A: Conjunctivitis, commonly known as pink eye, is the most common eye-related symptom of COVID-19. It’s estimated that approximately 20% of people with COVID-19 may experience conjunctivitis. In most cases, COVID-related conjunctivitis is mild and tends to resolve on its own. 

Q: Are itchy eyes a symptom of COVID-19?
A: COVID-19 can cause itchy eyes, most commonly related to COVID conjunctivitis, which can cause itching, along with other symptoms such as redness, tearing, and discharge. 

Q: How can you treat COVID eyes?
A: For most non-serious eye symptoms related to COVID-19, such as conjunctivitis, treatment focuses on symptomatic relief using eye drops, cold compresses, and eye creams. More severe eye conditions such as "cotton wool" spots, retinal artery occlusion, and other complications may require treatments such as medications, ocular massage, and surgery.