Are red eyes a symptom of COVID-19?

The connection between red, bloodshot eyes and COVID-19

In some cases, red eyes can be a symptom of COVID-19, the disease caused by the novel coronavirus.

COVID-19 may cause pink eye, otherwise known as conjunctivitis. When someone has conjunctivitis, the clear layer covering the white part of each eye and the inner lining of each eyelid become inflamed.

One of the hallmark symptoms of conjunctivitis is bloodshot, red eyes.

Eye redness associated with conjunctivitis is only seen in about 1% to 3% of people infected with COVID-19, according to the American Academy of Ophthalmology (AAO).

The AAO says patients seeking treatment for conjunctivitis could be infected with COVID-19 if they also show any these symptoms:

• Fever

• Cough

• Shortness of breath or difficulty breathing

• Bluish tint to the lips or face

• Chest pain or pressure

• Extreme fatigue

• Loss of smell and/or taste

• New feelings of confusion

The coronavirus can also be spread through the eyes by touching or rubbing your eyes with fingers that are contaminated with the virus.

SEE RELATED: Are sore eyes a symptom of COVID-19?

Red eyes and conjunctivitis in COVID-19 research

The AAO cites two studies that have looked into a possible connection between conjunctivitis (pink eye) and COVID-19:

• One study published in the Journal of Medical Virology looked at 30 patients hospitalized in China for treatment of COVID-19. One of the patients had coronavirus identified in their eye secretions. The researchers say this could mean the virus can infect the conjunctiva and cause conjunctivitis. Viral loads are most often identified in and transmitted through mucous membranes.

• In another study, published in the New England Journal of Medicine, researchers discovered conjunctival congestion — the medical term for infected, red eyes — in nine of 1,099 patients with COVID-19. It’s worth noting that those with conjunctival congestion represented just 0.8% of the confirmed COVID-19 cases.

Meanwhile, a JAMA Ophthalmology study showed 12 of 38 COVID-19 patients treated at a hospital in China had symptoms consistent with conjunctivitis. For one patient, conjunctivitis was the first symptom.

Based on this early evidence, the ophthalmology group warns that patients with conjunctivitis “could represent cases of COVID-19.” Therefore, ophthalmologists and optometrists might be the first health care providers to evaluate patients with eye redness and a possible COVID-19 infection.

As explained by Rady’s Children Hospital–San Diego, viruses are the most common cause of conjunctivitis.

Viral conjunctivitis can affect both eyes. Symptoms normally last five to seven days and include:

• Redness in the whites of the eyes

• Eyelid swelling

• A sandy, gritty feeling in the eye

• Tearing

• Watery or slightly whitish drainage

Dr. Chris Stansbury, an optometrist at West Virginia Eye Consultants, told TV station WCHS that if you suspect you have conjunctivitis, you should contact an eye doctor.

“I would not recommend going to the ER, because there you may come into contact with people who actually have coronavirus,” Stansbury says. “[Eye doctors] can look at the eyes and begin to differentiate. Is it allergic? Viral? Bacterial? And then we’ll know how to treat you.”

Be sure to contact your eye doctor before heading to their office. Amid the COVID-19 pandemic, office hours and protocols have changed, and some eye doctors are now diagnosing patients through virtual visits.

SEE RELATED: Are your red eyes from COVID-19 or allergies?

Other forms of eye redness seen in COVID-19 patients

In March 2020, CNN reported that a nurse at a nursing home in Kirkland, Washington, noticed redness around the eyes in some elderly residents who had developed COVID-19.

Twenty-nine people associated with the nursing home died from coronavirus complications, including 18 residents of the nursing home.

"It's something that I witnessed in all of [the patients]," Chelsey Earnest told CNN. "You can describe it like allergy eyes. The white part of the eye is not red. It's more like they have red eye shadow on the outside of their eyes."

"But we've had patients that just had red eyes as the only symptom that we saw, and go to the hospital and pass away in the hospital," Earnest said.

Despite this observation from an early outbreak of COVID-19, this type of red eyes doesn’t appear to be a common or reliable symptom of the disease.

"In terms of a red shadow around the eyes, not on the white of the eyes, there is not enough data currently to suggest this is a symptom of COVID-19," Dr. Sonal Tuli, a clinical spokeswoman for the AAO, told Today.com.

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Page published on Friday, April 3, 2020