It’s still not clear exactly how often COVID causes conjunctivitis, but it appears to be more common in young people. One early study at Wuhan Children’s Hospital in China reported that 22 percent of kids who were hospitalized with COVID there had eye symptoms. Of those, 55 percent had eye discharge. Since then estimates of eye symptoms have ranged from less than 1 percent to more than 30 percent in children, Singh and his colleagues reported in a recent review study that incorporated data from around the world. According to the American Academy of Ophthalmology, the estimated prevalence in adults is 1 to 3 percent, a number based on research in China.
WHY IS ARCTURUS CAUSING SO MANY RED EYES?
Although there is not yet an official analysis to quantify the rate of conjunctivitis caused by the latest variant, chatter among experts and early evidence from India suggests that pink eye is fairly common—especially in kids under age 12, says Shahzad Mian, an ophthalmologist at the University of Michigan. Pink eye doesn’t usually occur in isolation; kids also often have a fever, sore throat, cough or other COVID symptoms, too.
The reason why some variants cause more eye problems than others likely depends on mutations in the virus’s spike protein that make it bond more strongly to cells in the eye, experts say. Just like in the nose, lungs and upper airways, cells in the conjunctiva and other parts of the eye express ACE2 receptors, which are binding sites for SARS-CoV-2.
Arcturus isn’t the first variant that has shown an affinity for receptors in the eyes. Early in the pandemic, studies show, the Beta variant was more infectious to conjunctival cells, compared with the previous Alpha strain—leading to a higher concentration of the virus and more eye inflammation in infected individuals.
If a variant can more easily bind to a receptor, more virus particles can infect the cells, leading to a bigger immune response, Singh says. “The COVID-19 virus spike protein comes in [and] binds to this receptor, and then it triggers a chain of events, which leads to inflammation,” he says.
A COVID infection can begin in the eyes and spread systemically, or it can begin somewhere else, and the systemic changes can affect the eyes, he adds. “It can happen either way,” Singh says.
WHAT SHOULD YOU DO IF YOU DEVELOP PINK EYE?
Don’t panic. Arcturus does not appear to be any more likely than other variants to lead to hospitalization, serious complications or death, Patel says. Viral conjunctivitis generally lasts up to about a week and typically goes away without intervention.
At home, you can look for clues that might help you deduce whether a virus is involved. Viral pink eye often comes on suddenly, causing red and watery eyes that are “tearing all over the place,” Steinemann says. With a bacterial infection, discharge tends to be goopy, thick and sticky, whereas allergies cause extreme itching of the eyes and eyelids. Some symptoms can overlap, regardless of the cause.
If you notice red eyes along with a fever (another common Arcturus symptom) or other COVID-like symptoms, it wouldn’t hurt to take a COVID test. “In this day and age of COVID, if you have a viral infection of the conjunctiva,” Patel says, “it is not unreasonable to suggest you have a COVID test.”
More serious warning signs include pain and severe light sensitivity, which can suggest damage to the eye that should be checked out by a doctor to assess potential impacts on vision, Singh says. Thick yellow discharge indicates a bacterial infection that might require antibiotics. Blurry vision is another warning sign of corneal inflammation that might benefit from steroid drops.
If symptoms don’t get better, or if they worsen after a few days, Steinemann adds, it’s time to consult a doctor. Under a magnifying scope, an ophthalmologist can see enlarged glands, called follicles, that are unique to viral infections, as well as signs that indicate other causes of pink eye.
IF YOU HAVE PINK EYE FROM COVID, IS THERE ANYTHING YOU CAN DO TO FEEL BETTER?
Artificial tears, available at drugstores, can soothe discomfort, experts say. Cold compresses can also help. Try not to rub your eyes—both to avoid causing damage or secondary infections and to prevent transmission to other people.
If you have COVID and red eyes, the virus is sure to be in your tears, Patel says. So make sure to wash your hands, use separate towels from other people and avoid physical contact until the infection is gone.