Instead of just a fever, cough or changes in taste and smell, the first signs of illness might include irritated eyes, hearing problems or balance issues. From the beginning of the pandemic, reports included red eyes as a common symptom. That was not surprising to scientists. And in Toronto, the risk of infection was higher among health care workers who did not wear eye protection.
But because COVID causes severe respiratory problems and other symptoms, and because most eye doctors closed their offices during lockdowns, eyes were overlooked at first, Patel says. The most common symptom is conjunctivitis, or inflammation of the eye lining. This condition affected nearly 89 percent of people with eye symptoms , researchers in Iran reported in a meta-analysis that included 8, COVID patients across 38 studies.
Other ocular symptoms can include dry eyes, redness, itching, blurry vision, sensitivity to light and the feeling that there is a foreign particle in the eye. People on ventilators often develop a type of eye irritation called chemosis, a swelling or bulging of the eye membranes and eyelids, Patel says. He suspects that as many as one third of people with COVID have some type of eye issue—even if it is just red eyes that do not bother them.
And some eye issues are not visible. Patel and his colleagues are working on a study, not yet submitted for publication, that he says will be among the first to report that the virus can cause inflammation in the tissue behind the eyeball.
Eye symptoms can show up early or late in the illness, adds Shahzad Mian, an ophthalmologist at the University of Michigan. He and his colleagues reported ocular signs and symptoms in nearly 10 percent of patients hospitalized in Michigan in March and April A person who has COVID can shed the virus through their tears, sometimes long after they have recovered from the illness. One early COVID patient was a year-old woman who travelled from Wuhan to Italy in January and was soon admitted to a hospital with a cough, sore throat and conjunctivitis in both eyes.
Even though her eyes were better by 20 days after she was admitted, researchers detected viral RNA in eye swabs on day The virus may also able to get into the body through the eyes, studies suggest—either from eye rubbing and the direct transfer of tears or from respiratory droplets that happen to land on the eye.
A monkey intervention study cannot reveal whether or how often people get infected through their eyes in real life, but the virus appears to be able to replicate in eye tissue and then make its way into the nasal passages, Mian says.
Red eyes or irritation could be a sign that someone has the illness, especially if there is a known exposure or other symptoms. In a meta-analysis, she and her colleagues found dizziness or vertigo in 12 percent of COVID patients, a ringing in the ear known as tinnitus in 4. One hypothesis of how SARS-CoV-2 might affect the ears, she says, is that inflammation caused by the virus may directly impact the auditory system.
The virus could also invade a barrier between the bloodstream and inner ear. Confirming those mechanisms has been difficult because the inner ear is notoriously hard to study, Gehrke says.
Encased in bone and located deep inside the head, it is inaccessible, and animal models do not always help. To investigate what might be happening inside the ears of people with COVID, Gehrke teamed up with researchers at several other labs to grow human ear tissues using stem cells.
With those tissues, the team was then able to show that two types of inner ear cells have the genes for making proteins—including ACE-2 receptors—that allow SARS-CoV-2 to get into cells. The same small study mentioned above found that some coronavirus patients experience overly watery eyes epiphora , but wasn't able to definitively conclude they are a symptom of coronavirus.
If you have epiphora, tears may overflow from your eyes and run down your cheeks. Watery eyes can be caused by a variety of conditions, including bacterial keratitis, corneal ulcers, eye infections , glaucoma and macular degeneration. Excessive tears also are a common symptom of allergies. Antihistamines, cool compresses, changing contact lenses and taking a break from staring at screens may help resolve watery eyes, but see an eye doctor if the problem persists.
A case report described one patient who had neurological manifestations of COVID and experienced facial spasms that included eye twitching. An eye twitch is an uncontrollable spasm of the eyelid that usually lasts a few minutes but can last longer. Eye twitching myokymia may have a variety of possible causes, including allergies, caffeine, dry eyes, stress or nutrition problems.
In many cases, it goes away on its own. Patients with persistent eye twitching should see an eye doctor. Some studies have found that COVID-positive patients report certain eye problems at close to the same rate that patients without coronavirus do. In some cases, COVID-negative patients actually had a higher rate of certain eye problems than those with the virus. In other words, it could just be a coincidence that someone has COVID and an eye issue at the same time.
This may be the case with eye flashes and floaters , two common eye issues that have been reported by some coronavirus patients. If you have eye symptoms that may be related to COVID, call your eye doctor and describe your symptoms before making an appointment. Let them know over the phone if:. You're experiencing coronavirus symptoms. If your eye problem isn't an emergency, you might need to wait to visit an eye doctor.
If you're cleared to go to the eye doctor during the pandemic, remember to wear a mask. And know that your eye doctor may take extra precautions, such as checking your temperature before you can enter the building and using a special plastic breath shield when examining your eyes. BMJ Open Ophthalmology.
October JAMA Ophthalmology. March BioMed Research International. National Institutes of Health. January November
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