COVID-19 can spread through eyes

• Eye symptoms are more common in COVID-19 affected people than previously thought
• SARS-CoV-2 virus is found in the eye secretions and it may be transmitted through these eye secretions
• Eye findings are seen more often in individuals with severe COVID-19 disease. However, eye symptom may be the first symptom of COVID-19 or it may be the only clinical feature of COVID-19

COVID-19 is primarily transmitted through droplets expelled from an infectious person. Other modes of transmission include touching contaminated objects, and fecal-oral route. During the initial phases of the pandemic, eye findings were rarely reported. In one study published in NEJM, in Feb 2020, eye findings were noticed in only 0.8% of the COVID-19 affected individuals.

As COVID-19 pandemic evolves, there are more reports on eye findings. In one recent study published in JAMA on March 31, 2020, 12 out of 38 hospitalized patients with COVID-19 (31.6%) had eye symptoms. Conjunctivitis or redness of the eyes is the most common eye finding noticed in the affected people. Other findings include increased watering, irritation, foreign body sensation and swelling of the conjunctiva.

As conjunctivitis is a common eye condition, eye doctors may be the first healthcare providers who may get in contact with COVID-19 affected individuals. In few cases, redness of the eyes or watering from the eyes may be the first symptoms of COVID-19 before the affected individuals develop other classic COVID-19 symptoms like fever, cough, shortness of breath, fatigue, and sore throat. The first Chinese doctor who raised the alarm over COVID-19, Dr. Li Wenliang, was an ophthalmologist. He acquired COVID-19 from a glaucoma patient who did not have any other symptoms. Dr. Li Wenliang later succumbed to COVID-19.

Eye findings are more common in people who have severe COVID-19 disease. Eye symptoms commonly appear in patients with severe pneumonia. The study published in JAMA reported SARS-CoV-2 virus in conjunctival specimens of COVID-19 patients. The study also suggested that eye secretions may spread COVID-19 disease to healthy individuals.

In summary, eye findings are common in COVID-19 affected individuals more than previously assumed. They are commonly seen in people who have severe COVID-19 disease like severe pneumonia. In few cases, eye symptoms may be the only manifestation or the first clinical feature of COVID-19. Eye doctors may be the first healthcare providers taking care of these patients and they should take precautions to prevent the spread of the disease. As COVID-19 can spread through eyes, affected individuals and caregivers should be careful with eye secretions.

References:

1. Guan WJ et al. Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. 2020 Feb 28
2. Wu P et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020 Mar 31
3. Hu K et al. Ophthalmic Manifestations Of Coronavirus (COVID-19). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020-.2020 Apr 13.