Coronavirus and the Eye

Coronavirus Disease 2019 (COVID-19) is the official name given by the World Health Organization (WHO) for the infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) a highly contagious type among the many of viruses called coronaviruses, which can make some people very sick. The sickness caused by COVID-19 can range from no symptoms in some, to mild symptoms in others and to severe respiratory illness and even death in some individuals. After exposure, a patient may experience fever, cough, fatigue, shortness of breath, headache, diarrhea, weakness, and conjunctivitis.

After one is exposed to the virus infection, it may take anywhere from 2 to 14 days to develop any of the above symptoms and even death related to its complications. On the average mean incubation period can range from 5 to 7 days, and more than 97% of those who develop symptoms do so within 11.5 days of exposure supporting current 14-day quarantine recommendations. The virus has a significant fatality rate, especially in the elderly and those with comorbidities such as diabetes, immune disorders, and respiratory diseases.

Even though current recommendations are to cover your mouth and nose, COVID-19 infection can spread through the eyes. Generally, when a patient having COVID-19 infection talks, sneezes, or coughs, virus particles can fall on a healthy person’s face nearby. The healthy person is most likely to breathe those particles through their nose or mouth or can enter their system through their eyes. Most people touch their eyes all the time and one can have these virus particles being picked up from contaminated surfaces. Limiting contact between the infected and non-infected person is key to helping reduce the spread of the coronavirus. Washing hands, protecting eyes, nose, and mouth can slow the spread of coronavirus. If one wears contact lenses, one should diligently wash their hands with soap before inserting or removing contact lenses or even switch to glasses for a while.

Glasses may even act as a barrier for people who touch their eyes frequently. Safety glasses may act as a shield against infected respiratory droplets but may not provide 100% security. As the virus can still reach eyes from the open sides and that is why one must wear safety goggles especially when caring for a sick patient or around an exposed person. The virus can cause conjunctivitis which may not be different than other viral infections and is susceptible to disinfectants commonly used to disinfect office equipment. It may be possible that patients suffering from COVID-19 associated red eyes could have infectious virus in their ocular secretions and eye care providers may be the first ones who come across such patients.

Asymptomatic transmission is a significant source of the spread of COVID-19. In fact, Dr. Li Wenliang, a 34-year-old Ophthalmologist from Wuhan, China, who sounded the initial alarms on the coronavirus, and later died from the disease, believed he was infected by an asymptomatic glaucoma patient. Dr. Wenliang alerted the author­ities to the new virus and its dangers but was accused by the local Public Security Bureau of “making false comments” that had “severely disturbed the social order.”

The CDC is distributing real-time RT PCR (rRT-PCR) assays for the in vitro qualitative detection of SARS-CoV-2 in respiratory specimens and sera. At this time there is no vaccine to prevent infection, however, trials are underway. Also, there are no proven therapies or prophylaxis for COVID-19 infection. However, recent data suggest that Remdesivir, an investigational antiviral agent may have some promise. Serum from COVID-19 survivors as a last resort therapy has been used to some success.

Imtiaz A. Chaudhry, MD Ph.D., FACS,
Houston Oculoplastics Associates,
6400 Fannin Street, Suite 2220, Houston, Texas 77030.

April 16, 2020