Dry eyes are a common complaint, often caused by factors like screen use, environmental conditions, or aging. With the emergence of the COVID-19 pandemic, many wondered if this familiar ocular discomfort could also signal infection with the SARS-CoV-2 virus. The virus is known to impact organ systems beyond the respiratory tract, making the connection between dry eye symptoms and COVID-19 relevant for understanding the full spectrum of the disease.
Dry Eyes and COVID-19: Prevalence and Linkage
Dry eyes are one of the most frequently reported ocular symptoms associated with a COVID-19 infection. The overall prevalence of any eye-related symptom in COVID-19 patients ranges widely across studies, but is generally estimated to occur in 10% to 32% of cases. Dry eye symptoms are often the leading complaint within this group, with one meta-analysis estimating the pooled prevalence at around 13.66% of all COVID-19 patients.
The symptom alone is not a strong indicator of an active SARS-CoV-2 infection. General systemic illness, such as the high fever and dehydration often seen with COVID-19, can independently contribute to tear film instability and ocular dryness. Furthermore, dry eye disease has been observed as a lingering issue, with up to one in five recovered patients experiencing new or worsening symptoms following the acute infection.
Other Common Ocular Symptoms
While dry eyes are the most common single ocular complaint, other symptoms are often more specific indicators of the viral infection itself. The most recognized is conjunctivitis, or pink eye, which presents as eye redness, tearing, and discharge. Conjunctivitis has been reported in a significant number of patients, with some studies finding it to be the single most frequent ocular manifestation.
Other symptoms frequently associated with the infection include photophobia, which is sensitivity to light, and general eye pain or soreness. These symptoms are considered more direct manifestations than isolated dryness because they reflect the inflammatory response triggered by the virus within the ocular tissue. In some cases, conjunctivitis has been identified as the sole initial symptom of a confirmed SARS-CoV-2 infection.
Biological Reasons for Ocular Discomfort
The SARS-CoV-2 virus can directly enter cells in the eye because the ocular surface tissue, specifically the conjunctiva and cornea, expresses the Angiotensin-Converting Enzyme 2 (ACE2) receptor. The virus uses this ACE2 receptor as a gateway to infect the cells, providing a mechanism for direct viral damage to the eye. Viral RNA has been detected in the tear fluid and conjunctival swabs of some infected patients, confirming the presence of the virus in the eye.
A major cause of discomfort is the body’s systemic inflammatory response, often described as a “cytokine storm” in severe cases. This process involves the excessive release of pro-inflammatory signaling molecules, such as IL-6 and TNF-α, which circulate throughout the body. These elevated cytokine levels can damage the epithelial cells of the ocular surface and the lacrimal glands responsible for tear production.
The resulting inflammation and damage to the tear-producing goblet cells destabilize the tear film, leading directly to symptoms of dryness. This systemic inflammation can also cause vascular changes, such as increased permeability, which manifests as the redness and swelling seen in conjunctivitis. Furthermore, long-term dry eye symptoms following recovery may be linked to small fiber neuropathy, a form of nerve damage on the ocular surface caused by the persistent inflammatory state.
Seeking Care and Management
If dry eyes or other mild ocular symptoms develop alongside typical COVID-19 signs like fever, cough, or fatigue, seeking a COVID-19 test is a prudent step. For mild dryness, home management can provide relief, which includes using over-the-counter artificial tears to lubricate the eye and using a humidifier to improve air moisture. Drinking plenty of water to combat dehydration from fever and ensuring face masks fit snugly can also reduce tear evaporation.
Consulting an eye care professional is advisable if symptoms do not improve within a few days, even if they are mild. Immediate medical attention is necessary if any ocular symptom is severe or suggests a vision-threatening condition, regardless of COVID-19 status. Signs that warrant an immediate visit to an eye doctor or emergency room include:
- Intense eye pain.
- Sudden changes in vision.
- New flashes of light.
- The appearance of excessive discharge.