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Can Covid-19 Actually Cause Pink Eye? Here's What An Ophthalmologist Says To Watch For

While life has slowly shifted away from peak pandemic times, Covid-19 continues to remind us in many ways that we still must be cautious. Most recently, a spate of pink eye cases has arisen in connection with a new subvariant of the virus. Currently, the new variant, XBB.1.16, a.K.A. "Arcturus", accounts for about 10 percent of Covid-19 cases in the U.S.

Pink eye is especially common in children, but can infection with SARS-CoV-2 really cause pink eye? Here's what you need to know.

What is pink eye?

First, what actually is pink eye? Conjunctivitis, also known as pink eye, is an inflammation of the white areas of the eyes, known as the sclera, which can be caused by a variety of viruses and bacteria in our environments. In the case of viral pink eye, typically, both eyes will contract this condition, and it's contagious. Bacterial pink eye, which is also contagious, requires antibiotics for treatment.

Symptoms of viral pink eye are a burning sensation with watery discharge that may leave a crusty residue that could make eyelids stick shut. These symptoms usually accompany a runny nose, cough, or sore throat because the virus also affects the sinuses. This condition "can spread pretty easily," Ashley Brissette, an assistant ophthalmology professor at Weill Cornell Medicine and New York Presbyterian Hospital, tells Inverse.

In contrast, bacterial conjunctivitis can cause swelling and redness with a "milky" discharge, Brissette describes, though the eye might produce this icky stuff for only one night. While this type is also contagious, it typically stays limited to one eye.

Seasonal allergies can be another conjunctivitis culprit, making the eyes red, itchy, and watery.

Can Covid-19 cause pink eye?

The SARS-CoV-2 virus that causes Covid-19 is a respiratory infection that affects the sinuses. The virus's proximity to the eyes can infect that part of the body too, Brissette says.

"We know that if the virus is in the sinuses, it's so close to the eye that you can get contamination, and then symptoms can start to present in the eyes," she says. Still, she notes that conjunctivitis is much more likely caused by adenovirus, which causes the common cold.

The connection between conjunctivitis and Covid-19 isn't new. Brissette harkens back to the old days of 2020 when we were all getting first acquainted with the novel disease. "There were eye manifestations even back in 2020 when Covid first presented," she says. About 1 to 3 percent of adults with Covid-19 presented pink eye as a symptom, according to the American Academy of Ophthalmology.

However, the pink eye doesn't automatically indicate that you have Covid-19. "If you have pink eye, it's probably more commonly related to adenovirus, which is a general kind of common cold virus that's in the environment," Brissette tells Inverse.

What if I think I have pink eye?

There's no treatment for viral or allergy-induced pink eye, just as there's no treatment for the common cold. Brissette recommends frequent handwashing, using artificial tears to soothe red eyes (refrigerating the drops can make them feel more refreshing), and regularly changing face towels and pillowcases so viruses don't linger on surfaces that may touch others' eyes. Brissette tells her patients it can take two weeks for viral pink eye symptoms to quell.

Bacterial pink eye, on the other hand, does sometimes need to be treated. If severe enough, it can call for a round of antibiotic eye drops.

Brissette adds that if inflammation or blurry vision persists from either viral or bacterial infection, prescription eye drops can do the trick, though that rarely happens. "Oftentimes, the body just naturally heals it like it does for the common cold," she says.

The Covid-19 vaccine may also offer some extra protection, both against the virus and its comorbidities. "I think just having the vaccine will help to prevent your risk of development of Covid-19 and probably even decrease the severity of your symptoms," she says.

Above all, she says, "Good hygiene is essential."

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What Is Conjunctival Chemosis?

The conjunctiva is the clear membrane that covers the white part of the eye. Conjunctival chemosis is a swelling of the membrane. It can look like a big blister on the eyeball. The eyes may be yellowish and watery. Chemosis can get so severe that it is hard to close the eye. 

Although it can be unsightly, chemosis is usually easy to treat, although sometimes takes time to totally resolve.  Also, the condition is not contagious as some other eye conditions can be. The best solution is prevention. If you understand what causes chemosis, you may be able to avoid repeated episodes.

Allergies are the most common cause of conjunctival chemosis. Chemosis can develop after surgery on the eye. It can be caused by conjunctivitis, commonly known as pinkeye, and by a few other conditions. 

When allergies make the eyes red and swollen, the resulting condition is sometimes called allergic conjunctivitis. Studies suggest that around 40% of the population in developed countries may have this condition. The eye irritation can lead to chemosis. 

Typical allergy symptoms include:

Runny or stuffy nose

Itching

Excessive tears

Discharge from the eyes

A sensation of having something in the eye

When chemosis is triggered by allergies, doctors may treat the cause and the symptoms. They may suggest cold compresses and artificial tears to ease the symptoms of chemosis. To attack the cause, they may use antihistamines and other medicines that tamp down allergic reactions.

Another treatment involves the use of steroids. Some doctors are using steroids earlier in the course of chemosis. They want to stop what is called an inflammatory or allergic cascade, where one reaction leads to another and then to another.

The eye infection known as conjunctivitis, or pinkeye, can lead to conjunctival chemosis. Treating the conjunctivitis should make the chemosis go away. 

Some cases of pinkeye are bacterial, and some are viral. Bacterial conjunctivitis is treated with antibiotic eye drops. The usual course of treatment is 7 to 10 days. 

Viral conjunctivitis usually requires no treatment. Usually, the eyes will be better in a week or so. Antibiotic eye drops are not effective against a virus. The antiviral eye drops used for some other eye conditions do not work on pinkeye. ‌

It's difficult to distinguish between the two types of pinkeye, so some doctors routinely prescribe antibiotic ointments or drops. In severe cases of viral conjunctivitis, doctors may prescribe steroid drops.‌

Since both types are infectious, it's important to prevent them from spreading. To contain the infection, try these measures: 

Use hand sanitizer before treating the eye.

Clean the hands after touching one eye before touching the other.

Separate any towels and washcloths used in treatment from other laundry. 

Stay home from school or work if possible.

Chemosis can also follow eyelid surgery or other trauma to the eyelid. The most common cause is blepharoplasty – surgery to repair drooping eyelids. ‌

Certain conditions are risk factors for this type of chemosis. For example, chemosis may be more likely if the lower lid is slack or doesn't close well. Doctors may address some of these problems before they operate.

Chemosis can develop in the middle of surgery. Doctors can use certain surgical techniques to stop the chemosis during the surgery. They may use eye drops during the surgery to manage the chemosis.  

Some cases of chemosis appear after the surgery. They can be mild, moderate, or severe. Doctors treat them with drops, ointments, the use of an eye patch, and other measures. Sometimes the chemosis persists and further surgery is necessary.

Thyroid eye disease (TED) causes inflammation of the eyes and the tissues around the eyes, often resulting in chemosis. The usual cause of TED is  Graves' disease, an autoimmune disorder in which the body attacks its own tissues. Graves' ophthalmopathy is another term for TED.  

Graves' disease causes the body to produce too much thyroid hormone. Those with TED must control their thyroid levels carefully. Even when they do, they may still have eye problems. 

These problems may include:

Bulging eyeballs

Eyelids pulled away from the eyeballs

Swollen eye muscles

Pain with eye movement

Problems with the optic nerve 

Doctors evaluate the severity of TED by looking at seven signs or symptoms. Chemosis is one of those signs.

TED is mostly treated through lifestyle interventions. It is very important that those with TED not smoke and that they practice other good health habits. ‌

They can relieve some symptoms by wearing sunglasses and using treatments for dry eyes. They may ease swelling around the eyes by sleeping with the head elevated and by reducing sodium in the diet. Supplementing with selenium may also help.

Angioedema is an allergic reaction that usually occurs around the eyes or mouth. It causes swelling beneath the skin. When it forms around the eyes, it can trigger chemosis. 

Hives – large welts on the skin – can occur with angioedema. Both angioedema and hives usually clear up on their own. Treatment with antihistamines may ease the discomfort. Occasionally, parts of the mouth or throat will swell and interfere with breathing. This is an emergency calling for immediate medical care. 

Angioedema can be triggered by:

Foods – especially peanuts, soy, eggs, milk, fish, shellfish, wheat, and tree nuts

Medications – including blood pressure medicines, pain medications, anti-inflammatories, and penicillin

Airborne allergens such as pollen 

Other occasional triggers for angioedema include sunlight, tight clothing, exercise, hot water, and insect bites. 

If you have a conjunctival cyst, you may be able to see it. It looks like a clear blister or bubble on the eye. You may have extra tears and feel as if you have something in your eye. Sometimes, you might not notice any symptoms at all.

People who have conjunctival cysts often go to the doctor when they notice the cyst getting larger. The cyst may also become so noticeable that it is a cosmetic issue. Rarely, the cysts may cause blurred vision or affect how well your eyeball moves.

Causes of conjunctival cysts: Chemicals, allergies, and dry air can irritate the conjunctiva, leading to conjunctival cysts.

Conjunctival cyst treatment: Sometimes, conjunctival cysts go away on their own. Doctors often advise waiting to see if this happens. To make your eye feel better in the meantime, you can use:

Artificial tears or other lubricating drops

Prescription steroid drops to ease inflammation

Warm compresses, which may cause the cyst to break

Antibiotic ointment prescribed by a doctor, in case of infection

The simplest thing that your doctor can do is to drain the cyst. Doctors can also remove them but there is a chance they can come back. Another method for dealing with conjunctival cysts involves using plasma, an ionized gas produced by heating. 

Got Pink Eye? Researchers Say It Could Be A Sign Of COVID. What To Know About The Symptom

Depending on who you ask, America is still in the midst of the COVID-19 pandemic that plunged the world into a health emergency. Some people still choose to mask, swab their noses with at-home tests and work from home out of caution.

After more than three years of living amid a once-in-a-century health crisis, the World Health Organization announced Friday that it's ending the COVID-19 global health emergency. Services in the U.S. And Washington state are beginning to phase out public resources targeted at COVID-19, such as Washington's Say Yes! COVID Test website and the federal government's free at-home test program.

In Washington, 71% of the population is fully vaccinated against the virus, and the small amount of active cases that still occur has only continued to decrease week by week in 2023, according to the Washington State Department of Health.

But COVID will continue to plague society much like the common cold, according to experts. Recently, some researchers claim you can spot a coronavirus illness masquerading as another type of infection: pink eye.

The American Academy of Ophthalmology reported in April that conjunctivitis, the medical name for pink eye, could be a symptom of coronavirus infection. To be more specific, the symptoms of pink eye are associated with a new strain of the omicron COVID-19 variant – XBB.1.16, also known as "Arcturus."

"One new feature of cases caused by this variant is that it seems to be causing conjunctivitis, or red and itchy eyes, in young patients," states Matthew Binnicker, director of the Clinical Virology Laboratory at Mayo Clinic in an online release. "This is not something that we've seen with prior strains of the virus."

Here's what to know about the connection between pink eye and COVID, what symptoms to watch for and when to seek treatment.

Pink eye as a COVID symptom

The American Academy of Ophthalmology says that "COVID conjunctivitis," or pink eye, "is one of the ocular manifestations of the coronavirus" and that it's a form of viral conjunctivitis.

"There are reports in which conjunctivitis was the only sign of COVID-19," the group says. "Other reports showed that the patients of COVID-19 developed conjunctivitis later in their course of disease after hospitalization."

Conversations about how COVID could possibly cause pink eye-related symptoms began even as far back as 2020. But recently, research has shown that the COVID-19 virus can be "found in the eye's tear film," triggering pink eye symptoms, according to the University of Nebraska Medical Center's Truhlsen Eye Institute. The Nebraska scientists note that pink eye is rarely the sole symptom associated with a positive coronavirus infection. They add that the symptom may occur in severe cases of COVID-19.

Symptoms of pink eye

John Hopkins Medicine states these are the most common symptoms of pink eye:

Pink or red discoloration in one or both eyes

A "gritty feeling" and/or itching, irritation or burning in one or both eyes

Clear, thin drainage of liquid and increased shedding of tears and/or stringy and/or thick, white or green discharge from the eyes

Eyelid swelling and/or eyelids matted together in the morning

Blurred vision

Seeking medical treatment for pink eye

If someone has multiple symptoms associated with pink eye, they should seek medical attention from a doctor, the Centers for Disease Control and Prevention advises. The center recommends this especially for people who are experiencing worsening symptoms or if their condition doesn't improve after 24 hours of being on antibiotics.

More vulnerable groups of people experiencing symptoms of pink eye should seek treatment, including those already experiencing the following medical complications:

Weakened immune system

HIV infection

Seeking cancer treatment

For those who want to wait out a case of pink eye, the good news is that the infection usually begins to see signs of improvement after two to five days, and it clears up after a week to two weeks for those who don't seek medical care, the CDC states.

Antibiotics to treat pink eye are usually prescribed as a topical treatment, such as eye drops or ointment.

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