COVID-19, caused by the SARS-CoV-2 virus, can affect the eyes. The eyes serve as a potential pathway for the virus to enter the body, as the conjunctiva contains ACE2 receptors that the virus can bind to for cell entry. The eyes can also become a site where the body’s immune response to the infection manifests, leading to a range of ocular symptoms. These eye-related issues can vary in severity, from mild irritation to more serious vision-threatening conditions.
Common Eye Symptoms
Conjunctivitis, often known as pink eye, is the most frequently observed eye symptom during acute COVID-19 infection. This condition, characterized by inflammation of the clear membrane covering the white part of the eye and the inside of the eyelids, is estimated to occur in approximately 1% to 20% of people with COVID-19. Symptoms typically include redness, irritation, itching, a gritty sensation, and watery eyes, sometimes accompanied by discharge. While it may initially affect one eye, it can spread to both. In most instances, COVID-related conjunctivitis is mild and tends to resolve on its own within about two weeks.
Light sensitivity, or photophobia, is another common eye symptom reported by COVID-19 patients, affecting an estimated 10% to 18% of individuals. This discomfort with light can be linked to the overall inflammation or irritation caused by the viral infection. Dry eyes are also frequently reported, with studies indicating a prevalence of up to 13.66% among patients. This dryness can be a direct effect of the virus or exacerbated by other factors. These common ocular symptoms are generally a direct result of the viral infection itself or the body’s generalized inflammatory response to it.
Less Common Vision Changes
Beyond the common and typically milder symptoms, COVID-19 can lead to less frequent but potentially more serious ocular and vision-related complications. Optic neuritis, an inflammation of the optic nerve, has been reported. This condition can cause symptoms such as blurry vision, pain with eye movement, and even vision loss. It may occur during or after the infection, potentially triggered by an autoimmune reaction or widespread inflammation.
Retinal vascular occlusions, involving blood clots that block eye vessels, are another severe complication. A retinal artery occlusion, sometimes referred to as an eye stroke, can lead to sudden, painless vision loss. Similarly, a retinal vein occlusion can result in blurred vision, swelling, bleeding, or sudden blindness. These occlusions are often associated with systemic inflammation and an increased risk of blood clotting events throughout the body. “Cotton wool” spots, which are small areas of damaged retinal tissue due to blood clots, can also appear, though they typically do not affect vision but signal underlying retinal damage. Uveitis, an inflammation of the middle layer inside the eye, may also occur, causing blurry vision, floaters, red eyes, and light sensitivity.
Lingering Ocular Issues
Some individuals experience eye symptoms that persist weeks to months after acute COVID-19 infection, often referred to as “Long COVID” symptoms. Persistent dry eyes are a common complaint in this group, with one study indicating that one in five post-COVID patients reported new or worsened dry eye symptoms.
Persistent blurry vision is another lingering issue for some, which can be connected to ongoing inflammation, issues with the optic nerve, or general fatigue. Patients may also report continued eye fatigue, soreness, and pain. The new onset of floaters or changes in visual acuity that appear after the initial infection are also noted. Research continues to investigate the exact mechanisms behind these long-term effects, with current hypotheses suggesting roles for chronic inflammation, immune system dysregulation, and damage to blood vessel linings.
When to Consult an Eye Doctor
Seek professional medical attention for eye symptoms related to COVID-19. Immediate consultation with an eye doctor is recommended for sudden vision loss, severe eye pain, or the rapid worsening of any eye symptoms. Persistent blurred vision, double vision, or the sudden appearance of new floaters or flashes of light also warrant prompt evaluation.
Even if symptoms are milder, consulting a doctor is advisable if eye discomfort does not improve within a couple of weeks, or if it causes significant distress. It is particularly important to seek medical advice if eye symptoms are accompanied by other characteristic COVID-19 symptoms, such as fever, cough, or breathing difficulties.