COVID-19 and Pink Eye Are Possibly Connected

Over the last few years, the SARS-CoV-2 virus that causes COVID-19 has evolved in an effort to try and get past our immune system’s defenses. Like with any other viral infection, when our immune system is weakened or under attack, other infections become primed for the same opportunity. Conjunctivitis (pink eye) is no different.

Studies have shown that 1 in 10 people who get COVID-19 develop eye-related symptoms like redness, dry eye, pink eye and more. And cases of pink eye in particular have been steadily increasing among those who get COVID-19, both in pediatric and adult populations.

Optometrist Alexandra Williamson, OD, shares what may be causing COVID conjunctivitis and how to soothe your symptoms if you or your child get a double dose of COVID-19 and pink eye.

Is pink eye a symptom of COVID-19?

Pink eye is the most common eye-related symptom in children with COVID-19 and it tends to be more common in children who have other severe systemic diseases like Kawasaki disease. Although research is still being done to figure out the exact cause-and-effect relationship between COVID-19 and pink eye, there’s been plenty of research that shows a pre-existing link exists between pink eye and other viral infections.

“There’s a well-demonstrated association between respiratory viral infections and a pink eye-type of appearance,” says Dr. Williamson. “Conjunctivitis occurs in viral infections, but there can also be other ocular symptoms like watering or redness, since younger kids will rub their eyes because they’re irritated.”

Like other respiratory viruses, COVID-19 enters your body through airborne respiratory droplets that make contact with your eyes, nose or mouth — so you increase your risk of catching an infection whenever you touch your face or wipe your eyes. Researchers have even found trace amounts of the SARS-CoV-2 virus in tears with people who’ve tested positive for COVID-19, suggesting there’s a potential risk for ocular transmission.

“Anatomically, the eye is connected to the nasal passages through the nasolacrimal duct, which is where our tears drain into the sinuses,” explains Dr. Williamson. “That connection makes it possible for viruses to cause problems in both places.”

It’s not uncommon then to see pink eye with an array of other viral infections — from the common cold to measles, RSV and COVID-19. But COVID-19 offers additional complications in that it doesn’t always affect everyone the same way, with people ranging from being asymptomatic (or having no symptoms) to being severely ill when they have a COVID-19 infection.

Do you always get pink eye with COVID-19?

Getting pink eye doesn’t mean you have COVID-19 and having COVID-19 doesn’t mean you’ll always get pink eye. That said, there is some potential for children and adults to develop pink eye and test positive for COVID-19 at the same time.

During the early stages of the pandemic, a study looked at 216 children hospitalized with COVID-19 in Wuhan, China, between late January and mid-March 2020. Of those children, 49 (22.7%) showed “ocular manifestations, including conjunctival discharge, eye rubbing, and conjunctival congestion.”

A total of 123 children in the study experienced a range of COVID-19 symptoms and of those, 36 (or 29.3%) also had eye issues. Of the 93 children (or 43%) who were asymptomatic, only 13 (or 14%) showed ocular symptoms.

“They found that most of the kids that did have eye problems were also showing symptoms like a fever or cough,” Dr. Williamson notes, “which tracks with what we already know about respiratory viruses in the eyes.”

More recent research suggests the prevalence of a dual COVID-19 and pink eye infection ranges from 2% to 32% depending on the study and other varying factors. Many of those studies talk about how the increased number of these sorts of eye conditions could be attributed to several other causes, like increased hand-eye contact while sick.

“These studies help eye doctors understand more about COVID-19 but it doesn’t mean that we need to be severely worried that every child that has a red or pink eye is potentially infected with COVID-19,” clarifies Dr. Williamson, noting that even these studies have their own limitations. “It’s possible these people were already infected with another virus, or their eye was red due to something else and that COVID-19 wasn’t even the reason they had symptoms or clinical signs.”

How long does COVID-related pink eye last?

Viral pink eye typically goes away within five to seven days and can last up to two weeks or longer if you’re continuing to experience additional symptoms of COVID-19 and/or other eye symptoms like:

• Red eyes.
• Dry eyes.
• Watery eyes.
• Blurred vision.
• Eye pain.
• Itching and irritation.
• Sensitivity to light.

Treating COVID pink eye

If you have COVID-19 and pink eye, you’ll want to manage the severity of your symptoms for each condition until you’re no longer infected.

Home remedies for pink eye like cool water rinses and over-the-counter (OTC) medications like ibuprofen (Advil® and Motrin®) can help reduce inflammation and other symptoms associated with the condition until it’s run its course.

There are also antibiotics available if you have bacterial pink eye, and antiviral medications if you have pink eye that’s caused by chicken pox or shingles, the herpes simplex virus or another infective agent. Seasonal allergies are also a common cause of red eyes and can often be treated with OTC antihistamine eye drops.

Mild cases of COVID-19 tend to recover on their own as you rest, hydrate and take care of your aches and pains with OTC nonsteroidal anti-inflammatory medications (NSAIDs) like naproxen sodium (Aleve®). Other treatment options for more severe cases of COVID-19 include corticosteroids like prednisone and antiviral medications like Paxlovid™.

The key thing to remember about having COVID-19 and pink eye is knowing that both of these issues, while occasionally interconnected, can linger and cause complications the longer they’re left untreated. If you experience symptoms of either COVID-19 or pink eye, you should see a healthcare provider right away to get a diagnosis for your symptoms and receive the appropriate treatment options for you.

“If you have access to an eye care provider, it’s better to be examined than to try to wait it out, as some causes of eye redness, irritation, watering and other manifestations commonly referred to as pink eye can lead to vision loss,” warns Dr. Williamson. “If you can’t get to the eye doctor, a primary care or urgent care provider may also be able to help.”