If you woke up with sore eyes this morning, should you be worried you have COVID-19?
It’s unlikely, though you can’t rule it out. Getting tested is the only way to know for sure.
COVID-19 usually attacks the lungs. People often get a dry cough and run a fever. We don’t hear much about COVID-related sore eyes because they’re pretty rare.
Still, scientists suggest sore eyes could be an important COVID-19 symptom. Then again, your sore eyes might just be a symptom of allergies.
Let’s start with the basics: The U.S. Centers for Disease Control and Prevention says these are the most common COVID-19 symptoms:
Nothing about sore eyes in there, so what’s up? Well, the CDC notes that this is not the full list of COVID-19 symptoms — it’s just a list of what COVID patients experience most often. Research published in December 2020 in the journal BMJ Ophthalmology suggested less than one-fifth of COVID-positive people had eye-related symptoms. The researchers called eye soreness “the most significant” eye-related symptom among the research study subjects.
Moreover, a study published in JAMA Ophthalmology in August 2020 reported that young children infected with COVID-19 were rubbing their eyes, developing pink eye and showing other eye-related symptoms.
Of course, our knowledge of SARS-CoV-2 (a new strain of the coronavirus), which causes COVID-19, is changing every day. As of this writing (February 2021), researchers have documented symptoms similar to those of conjunctivitis (the scientific name for pink eye) in some COVID-19 patients.
Thus, there are lots of questions about the ocular issues of COVID-19. Let’s walk through a few of them.
The experts at the American Academy of Ophthalmology took a swing at this question in an article posted in January 2021. They discuss two main varieties of conjunctivitis:
Allergic, caused by allergies. Allergic conjunctivitis can make your eyes itchy, watery and bloodshot and usually happens at certain times of the year, such as during peak allergy season.
Viral, caused by viruses. Viral conjunctivitis can happen at any time of the year. It also causes a watery discharge that’s thicker than tears. Itchy and watery eyes are less likely with viral conjunctivitis.
“Another key difference between seasonal allergy symptoms and coronavirus symptoms is having a fever,” said James M. Huffman, MD, an ophthalmologist interviewed in the article. “Allergy sufferers do not have fever as a symptom, while coronavirus patients often do.”
The article concludes that if you have pink eye and COVID symptoms like fever, shortness of breath, lack of taste and other issues on the CDC’s list, then you should get tested for the virus ASAP. However, if you have pink eye issues without COVID symptoms, then allergies are the more likely culprit.
Don’t ignore a case of allergic pink eye, however. Talk to your eye doctor about treating the symptoms so they don’t disrupt your life. Bacteria can also cause conjunctivitis, so your doctor will want to assess that possibility.
Most people with COVID-19 don’t report sore eyes or any other ocular issues, according to the journal BMJ Open Ophthalmology. The journal reported on a survey of 83 people who tested positive for COVID-19. Among the survey respondents:
The scientists said sore eyes represented the most significant finding — even though it was a bit less common than itchy eyes or light sensitivity. The survey asked each participant which symptoms they had before they caught COVID. Almost none had sore eyes before getting infected — so a jump to 16% after infection looked noteworthy. The other eye symptoms happened at about the same rate before and after the people tested positive. That finding was less significant, the scientists said.Of course, more than four out of five COVID-positive people in this survey did not report eye issues. Does this suggest sore eyes are not a big deal when it comes to COVID-19?
Not at all. There’s a lot we don’t know about the risk of viruses, including the novel coronavirus, getting into the body through the eyes. This study pointed that out.
The researchers cited evidence suggesting that the COVID-19 virus could sneak into the body via the cornea, the clear half-dome covering the front-center portion of the eyeball. They also made an educated guess that COVID-19 could spread via tears into the place where it does the most damage — the lungs. How? Via the tear ducts in the eyelids that carry tears away from the eyes and into the nasal cavity. From there, the virus could be inhaled into the lungs.
Thus, scientists are going to keep watching for signs of sore eyes in people infected by the COVID-19 virus.
Researchers in Wuhan, China, the epicenter of the epidemic, studied a group of 216 children infected with COVID-19. The study was conducted between January 26 and March 18, 2020, just as the pandemic was spreading worldwide.
Of those children, 22.7% had eye-related symptoms. Of those, 55% had a fluid discharge and 39% rubbed their eyes. Just 8% had sore eyes (or ocular pain, as the researchers called it).
The main takeaway from the Chinese study was that children typically recover without major medical interventions. They might need eye drops but rarely much more intensive treatment. Another crucial finding unrelated to sore eyes: 80% of the children were confirmed to have caught the virus from a family member.
“Children with systemic symptoms (e.g., fever, cough) appeared more likely to have ocular symptoms,” the report’s authors state. They speculated that children coughing into their hands and then touching the area around their eyes could be causing ocular symptoms. Another possibility: Coughing forces viral particles in through the tear ducts, where they can infect the eye surface.
Think about the questions you get at the doctor’s office to screen you for COVID-19, such as:
Have you come in contact with somebody you know has tested positive?
Do you have a high fever, coughing, shortness of breath, nausea or other common symptoms?
If you answer yes to these kinds of questions and you have sore eyes, then you need to talk to your medical provider about a COVID-19 test.
On the other hand, if you answer no to all the COVID-screening questions and it’s allergy season, your sore eyes might simply be an allergic reaction. A visit to an eye doctor should clear things up.