Here’s How Pink Eye Could Be Related to COVID-19, According to Doctors
During last night’s vice presidential debate, many viewers were keenly focused on Vice President Mike Pence’s left eye, which appeared to be a bit red and blurry throughout his debate with Senator Kamala Harris.
While it’s unclear why his eye looked a bit off, it certainly caused speculation about whether or not it could be a symptom of the novel coronavirus following President Donald Trump’s positive COVID-19 diagnosis last week. After all, Vice President Pence did attend the announcement of Judge Amy Coney Barrett’s Supreme Court nomination in the White House Rose Garden on Sept. 26, which is now being referred to as a super-spreader event.
According to the Centers for Disease Control and Prevention (CDC), COVID-19 causes a wide range of symptoms that can mimic the common cold or flu, including a fever, cough, fatigue, headache, sore throat, and shortness of breath.
Because COVID-19 is caused by a relatively new virus, researchers are still learning about its potential symptoms and side effects. One that doesn’t get a lot of attention? Pink eye.
At the height of the pandemic in March, a nurse told CNN that every patient she had treated for COVID-19 at the time had red eyes. “It’s something that I witnessed in all of them,” said Chelsey Earnest, a registered nurse in Washington. “They have, like ... allergy eyes. The white part of the eye is not red. It’s more like they have red eye shadow on the outside of their eyes.”
The American Academy of Ophthalmology (AAO) later sent out official guidance on the topic, warning doctors to be especially cautious when treating patients who have red eyes. The guidance specifically says that the novel coronavirus can cause “mild follicular conjunctivitis” (a.k.a. pink eye) which is “otherwise indistinguishable from other viral causes.” It may also be transmitted by contact with conjunctiva, the mucus membrane that covers the front of the eye and lines the eyelid.
The AAO warns that patients who need to be treated for pink eye—who also have a fever and respiratory symptoms—may have COVID-19. As a result, doctors should cover their mouth, nose, and eyes when treating these patients, and disinfect tools well afterward.
The CDC hasn’t confirmed pink eye as a symptom of COVID-19, but the World Health Organization does list conjunctivitis as a “less common symptom.” Here’s what doctors think of the connection between the two.
Why might COVID-19 cause pink eye?
In general, pink eye, which is an inflammation or swelling of the conjunctiva, can be caused by a virus or bacteria, among other factors, according to the American Optometric Association (AOA). Because viruses are the most common cause of conjunctivitis, “it isn’t surprising that coronavirus could cause this symptom,” says Richard Watkins, M.D., infectious disease physician and professor of internal medicine at Northeast Ohio Medical University.
Vivian Shibayama, O.D., an optometrist with UCLA Health, agrees. “Viruses that affect the respiratory system travel up into the eyes easily,” she explains. Your lungs, throat, nose, tear ducts, and conjunctiva are all connected through your body’s mucous membranes. Even blowing your nose can cause a virus to move from your respiratory system to your eyes, the AOA says.
Does that mean pink eye is a sign of COVID-19?
Not necessarily. While it’s possible to get pink eye from the novel coronavirus, this doesn’t seem to be a very common symptom of COVID-19, says Jeffrey J. Walline, Ph.D., O.D., the associate dean for research at The Ohio State University College of Optometry. He points to a February study published in The New England Journal of Medicine, which found that less than 1% of more than 1,000 COVID-19 patients had “conjunctival congestion,” or pink eye. However, “it wasn’t necessarily restricted to the most severe cases of coronavirus,” he adds.
Pink eye has been linked to COVID-19 in other studies, too. One that was published in JAMA Ophthalmology found that eye-related symptoms like conjunctivitis were more likely to happen in people with a more severe case of the virus. Another study, published in Nature Public Health Emergency Collection, concluded that pink eye can be an early symptom of COVID-19.
However, in a study published in the journal Ophthalmology that analyzed 121 patients with COVID-19, researchers found that just eight of them had eye symptoms. Those included itching, redness, tearing, discharge, and a foreign body sensation—hallmarks of pink eye. Of the eight patients who had eye symptoms, seven had severe or critical cases of the virus, while just one was considered a mild or moderate case.
It’s important to point out that, in addition to viruses and bacteria, pink eye can also be set off by seasonal allergies (which happen to be in full swing right now), leading to itchy, watery, and puffy eyes. “The symptoms are caused by the release of the chemical histamine, which occurs when the eyes are exposed to an allergen you’re sensitive to,” William Reisacher, M.D., director of allergy services at New York-Presbyterian Hospital and Weill Cornel Medicine in New York, recently told Prevention.
Pink eye can also be set off by irritants, like air pollution, chlorine in swimming pools, and exposure to toxic chemicals, the AOA says.
If you have pink eye and it’s paired with other distinct symptoms of the novel coronavirus—dry cough, fever, loss of smell or taste, and shortness of breath—it is possible you could have COVID-19 and you should call your doctor for further guidance, Dr. Shibayama says. But, if you just have pink eye and no other symptoms, it’s likely just that.
Got it. What are the symptoms of pink eye to look out for?
A case of pink eye generally includes the following symptoms, according to the AOA and CDC:
A pink or red color in the white of the eye(s)
Swelling of the conjunctiva and/or eyelids
Increased sensitivity to light
A gritty feeling in one or both eyes
Increased tear production
Feeling like a foreign body is in the eye(s) or an urge to rub the eye(s)
Itching, irritation, and/or burning
Discharge from the eyes
Crusting of eyelids or lashes, especially in the morning
Contact lenses that feel uncomfortable and/or do not stay in place on the eye
If conjunctivitis is caused by a virus, it usually starts in one eye and can spread to the other within days, the CDC says. Discharge from the eye is also usually watery instead of thick.
Can I treat pink eye at home?
Dr. Walline stresses that pink eye is pretty common this time of year, so you shouldn’t freak out and assume you have coronavirus if you develop it. In general, you should see your eye doctor to determine the root cause of your pink eye. From there, he or she may be able to prescribe medicated eye drops if necessary.
But if you prefer treatment at home first, Dr. Shibayama recommends the following steps. Again, call your eye doctor if your symptoms don’t ease up after a few days:
Use artificial tears or an OTC antihistamine for itching
Use warm compresses to relieve discomfort
Wash your hands regularly
Don’t touch your face
Avoid wearing your contacts, if you use them
Change your pillowcases and towels often
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