There’s so many COVID symptoms it’s hard to keep track!  The virus can cause a wide range of symptoms and while there are several common ones like sore throat, fever, cough and fatigue, COVID can also affect the eyes, which hasn’t been talked about enough. Eat This, Not That! Health spoke with experts who explain five different ways COVID can cause eye related problems and signs to watch out for. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Dr Brian Wachler from eyesight specialists All About Vision shares, “Light sensitivity is a condition in which bright light hurts your eyes, and another name for the condition is photophobia. Covid can cause light sensitivity in around 10% to 15% of people and one cause is from Covid infecting the eye and causing conjunctivitis (pink eye). Most people don’t realize that you can contract Covid by rubbing your eyes, so people should avoid eye rubbing and clean their hands with warm water and soap or carry hand sanitizer. Around 10% to 30% of people also experience headaches when suffering with Covid, which can also cause light sensitivity too.”

What To Do If You Have Light Sensitivity

“If light sensitivity persists, even after having COVID treatment, people should consider using preservative-free artificial tears to soothe the eye. You can also take oral flax oil to provide additional lubrication from within.vYou should also monitor screen usage too. Focusing on computers and phones reduces our blink rate by 30%, which can cause dry eyes, making light sensitivity worse. Try using night mode on your phone or computer to make the screen light more comfortable on your eyes, and reduce the impact of blue light. Simply reducing screen brightness can also help too.v= When outdoors you should wear wraparound frame design sunglasses, and not the ‘wayfarer’ type open design, along with a hat to block sunlight and reduce the impact of light sensitivity on your eyes.. However, wearing sunglasses indoors is best avoided as they can indirectly make it worse by adapting the eyes to conditions that are too dark.

What Light Sensitivity Feels Like

It can feel as though your eyes are being ‘burned’ by the light, although symptoms and intensity can vary depending on severity. The main symptoms include squinting, eye strain or pain, headaches or migraines, blinking excessively, watery eyes and feeling dizzy.  Mild cases may simply make you squint in a brightly lit room or when outside, while in severe cases this condition causes considerable pain when your eyes are exposed to any sort of light. “

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Dr. Wachler says, “COVID-19 can cause pink eye, according to the American Academy of Ophthalmology, but this is rare. Viruses are the most common cause of conjunctivitis and it can affect both eyes. The main way that the virus can affect the eye is from the hands to the eyes, for example, if you touch something infected with the virus and then rub your eyes. This is why it’s so important to wash your hands every time you get home or arrive anywhere new. You should also avoid sharing personal items like pillowcases, towels and makeup to avoid infection as it is highly contagious. Symptoms can last anywhere between five to seven days and include redness in the whites of the eyes, eyelid swelling, a gritty feeling in the eye and watery or slightly whitish discharge.  While there’s no treatment for conjunctivitis as it generally goes away on its own, there are a few things you can do to ease any discomfort. This includes taking over-the-counter pain medication, using a clean, warm compress on your eyes for a few minutes and lubricating eye drops to soothe the irritated eye.” 

According to Dr. Wachler, “In some cases, having viral conjunctivitis during a COVID-19 infection can also lead to blurry vision. Though usually mild and intermittent, it can be difficult to deal with and make it difficult to see. Blurred vision is a loss of sharpness of eyesight, making objects appear out of focus and hazy, and is very common. While it is usually mild, this can be a symptom of other more serious conditions. You should always consult your eye doctor to rule out any other conditions and make sure you can get the right treatment. If you suspect you have any issues with your eyes, you should consult your eye doctor. If you’re still testing positive, you may be able to get a virtual appointment so they can diagnose your condition and find the best treatment.”

Dr. Shelley Day Ghafoori, Austin Retina Associates’ board-certified ophthalmologist and retina disease specialist says, “Data suggest that the most common side effects of COVID-19 reported on the retina are cotton wool spots (white patches appearing on the eye). Cotton wool spots appear as fluffy white spots in the retina.  They are thought to represent focal areas of insufficient blood flow in the retina.  They may be asymptomatic or may be associated with a small visual field deficit. Because these changes are only visible during an eye exam with diagnostic retinal imaging, it is recommended that you see a specialist immediately if you’ve had COVID-19 and start experiencing blurred vision or blind spots.”

Dr. Ghafoori shares, “Additional research has shown that COVID-19 also may cause retinal vein occlusions. Vein occlusions block blood flow of veins in the eye and retina and could potentially lead to loss of vision if not treated properly. Data suggests COVID can cause changes in the retina which may only be diagnosed through an eye exam and imaging tests. She recommends seeing a specialist immediately if you’ve had COVID-19 and start experiencing blurred vision or blind spots.” 

Dr. Howard R. Krauss, MD, surgical neuro-ophthalmologist at Providence Saint John’s Health Center in Santa Monica, CA explains, “In a careful review of 129 MRIs of severely ill COVID patients who were undergoing brain MRI due to significant symptoms of brain dysfunction: Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study | Radiology (rsna.org), only 9 had MRI evidence of ocular disorders.  Eight of the nine also had MRI abnormalities within the brain. The study notes that most of these 9 patients did not have comprehensive ophthalmologic evaluations (which may have been difficult to carry out in severely ill hospitalized COVID patients).  A comprehensive ophthalmologic evaluation would include a notation as to whether or not there were symptoms such as alteration of vision or pain, would assess visual acuity, peripheral vision (visual field testing), would assess pupillary reactions and eye movements, would include a binocular microscopic evaluation of the cornea, iris, lens and vitreous or the eye, would include a dilated binocular magnified view of the optic nerve head and retina, would include optical coherence tomographic (OCT) evaluation of the optic nerve and retina and would include photography of the optic nerve and retina.  It should be acknowledged that OCT has a spatial resolution of a few microns (thousandths of a millimeter), whereas the spatial resolution of a 3T MRI may be ½ mm (500 microns).  So, although MRI is a valuable diagnostic tool, and is often requested by ophthalmologists for evaluation of problems behind the eyes, evaluations for eye disease should be initiated via comprehensive ophthalmologic evaluation.

As to the abnormalities noted in this study, they are localized to the optic nerve head or retina, but are non-specific; they may represent areas of swelling in reaction to infection, immune system reaction, bleeding or circulatory insufficiency and they could be secondary to the treatment of the disease rather than the disease itself; for example, high pressure is sometimes needed and utilized to ventilate severely ill COVID patients, and high ventilation pressure, in and of itself, may be a trigger of optic nerve, retinal or subretinal hemorrhage, swelling or circulatory insufficiency.

There are many benefits in review and critical analysis of this study:

1. It should not be taken to imply that serious ocular disorders are common in COVID;
2. It should not be taken to imply that COVID patients should routinely have MRI studies of their eyes;
3. The major benefit of this study is to highlight that in severe COVID there may be associated ocular abnormalities worthy of ophthalmologic evaluation.”

Dr. Benjamin Bert, MD, ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA shares, “All of the different ways that COVID affects the eye is still being investigated. From the earliest reports of the pandemic we learned that COVID caused conjunctivitis, or a red eye infection. One of the first people to raise concerns about COVID in China was an ophthalmologist, Li Wenliang, MD, who unfortunately passed away from contracting COVID. The prevalence of conjunctivitis has been reported to be as high as 3% of COVID infected patients. In some cases a red eye can be the only symptom or sign of a COVID infection. Live virus was found on the surface of the eye when people presented with conjunctivitis, meaning that touching an infected eye and touching your own eye could be a route of infection. One of the reasons that eye protection has been recommended as additional personal protective equipment (PPE) is that the virus particles could enter the body through the surface of the eye. The same ACE receptors found in the lung are also in some of the ocular tissues, and this was hypothesized to be the way that the inflammation and infection could occur.

One of the most recent publications regarding COVID and the eye retrospectively examined some of the sickest patients with COVID, those in the ICU who were receiving MRIs. Many of these patients are not receiving eye exams, since they are often intubated and would be unable to report any changes in vision or vision loss which would prompt an ophthalmology consultation. The study showed changes to the inner tissues of the eyes, including the retina, which appear to be most consistent with inflammation occurring in the blood vessels. The patients in the study who had an ophthalmic exam had changes consistent with blockages of the vasculature serving the retina. This led to areas of swelling and damage that would be consistent with microvascular ischemic disease, or multiple small strokes. The blood vessels in the eye are the only microvasculature that we can see without performing a biopsy of tissues, but they are similar to the blood vessels found in the kidneys and in the brain. Thus, it is not unexpected that the brains of these COVID patients were reported to have similar vascular changes and damage. One could then hypothesize that similar events are occurring in the kidneys of these patients.

There is still a lot that we have to learn about how COVID affects the eyes and if it will leave any lasting effects. What we definitely know is that during the pandemic, patients have been concerned about coming in for their routine eye care, which has caused loss of vision or progression of other diseases like macular degeneration or glaucoma. With all of the safety protocols currently in place, it is a good time to follow up for your routine care and make sure that no other conditions threaten your sight.”

Follow the public health fundamentals and help end this pandemic, no matter where you live—get vaccinated or boosted ASAP; if you live in an area with low vaccination rates, wear an N95 face mask, don’t travel, social distance, avoid large crowds, don’t go indoors with people you’re not sheltering with (especially in bars), practice good hand hygiene, and to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.