CORONAVIRUS (COVID-19) AND EYES

covid19, coronavirus

CORONAVIRUS (COVID-19) & EYES : RECOMMENDATIONS

BACKGROUND

The Coronavirus COVID-19 pandemic is the defining global health crisis of our time and the greatest challenge we have faced since World War Two. Since its emergence in Asia late last year, the virus has spread to every continent except Antarctica.

Infection started in December 2019, an outbreak of apparently viral pneumonia of unknown etiology emerged in the city of Wuhan, in the Chinese province of Hubei.

Dr Li Wenliang, MD, a 33 year-old ophthalmologist working in Wuhan, was the first to raise the alarm about the virus in late December. Using the Chinese social media platform Weibo, Li attempted to warn his colleagues about a cluster of SARS-like pneumonia cases. Dramatically, Wuhan Central Hospital confirmed his death on February 7, after a series of conflicting reports about his condition. The American Journal of Ophthalmology wished to posthumously recognize Dr Li for his prescient and heroic post and hoped that lessons from this ongoing crisis could be learnt at all levels, from physicians on the ground to the highest levels of government.

On January 9, 2020, the Chinese health authorities and the World Health Organization (WHO) officially announced the discovery of a novel coronavirus (first named 2019-nCoV, then officially SARS-CoV-2, which differs from the viruses SARS-CoV, responsible for the SARS outbreak in 2003, and MERS-CoV, responsible for an ongoing outbreak that began in 2012 in the Middle East).

This new virus is the pathogen responsible for this infectious respiratory disease called Covid-19 (COronaVIrus Disease 2019).

After an epidemic outbreak in China in January, during month of February 2020, the epidemic soon evolved worldwide into a pandemic with the outbreaks in South Korea, Japan, and Singapore, and the appearance of new outbreaks in Iran and Europe (Italy, France, Spain). In these countries, we are witnessed a community transmission with no identifiable link with cases imported from China.

In March, the WHO counted almost as many cases inside China as outside of China.

Nowadays, countries are racing to slow the spread of the virus by testing and treating patients, avoiding social interactions, limiting travel, quarantining citizens, and cancelling large gatherings such as sporting events, concerts, and schools.

We are in uncharted territory, and rapid research into this novel virus is allowing us to learn more about it every day. This is why we decided to write this article gathering all up-to-date official and useful information about COVID19 related to eye health.

Also, patients with keratoconus more often wear lenses and glasses. Thus, they have legitimate questions about their visual correction and the risk of infection with covid19. This page aims to provide answers to these questions.

Authors of this Article

Dr Damien Gatinel
MD, PhD
Head, Anterior Segment and Refractive Surgery Dept.
Rothschild Foundation,
Paris, France

mazharian, adrien mazharian, dr mazharian

Dr Adrien Mazharian
MD
Fellow, Anterior Segment and Refractive Surgery Dept.
Rothschild Foundation, Paris, France


Thanks to Dr Guillaume Debellemanière, Dr Alice Grise-Dulac and Dr Radhika Rampat for their contribution.

CAN COVID-19 INFECTION AFFECT THE EYES ?
FACTS

Our eyes may play an important role in the spread and prevention of the new coronavirus pandemic. Whilst masks can protect the mouth and nose against COVID-19 infection, they leave the eyes exposed. According to the American Academy of Ophthalmology (AAO), people can contract the coronavirus through their eyes.

Researchers from the National University Hospital in Singapore with colleagues from the NHS Foundation Trust (London) suggests in a paper that there is a low risk for infected patients to transmit the virus through their tears, but that the risk is not zero.

Also, reports on coronavirus patients suggest that the virus can get into a person’s eye and cause conjunctivitis. According to the AAO and JAMA, conjunctivitis could be a rare symptom of COVID-19 ( in about 1% to 3% of people from studies). As such, the Academy said, eye doctors should be looking out for COVID-19 symptoms, such as a cough, a fever, and shortness of breath, in patients who come to their emergency clinics with pink eye.

Another research team, from the Hospital of the Zhejiang (China), conducted a study on 30 patients with COVID19 between January 26 and February. Among them, two samples of tears and conjunctival secretions from a patients with conjunctivitis were tested positive for COVID19 by PCR (polymerase chain reaction), while the 58 other samples were tested negative.

Thus, experts say there are two ways one can get the virus through their eyes:

1/ When a sick person coughs or talks, virus particles (here an example video) can spray from their mouth or nose onto another person’s face. You’re most likely to inhale these droplets through your mouth or nose, but they can also enter through your eyes.

2/ You can also become infected by touching something that has the virus on it, like a table or doorknob, and then touching your eyes.

covid19 pink eye
RECOMMENDATIONS

1/ Avoid touching your eyes, nose, and mouth with unwashed hands

2/ Wash your hands before eating, after using the restroom, sneezing, coughing or blowing your nose.

3/ Avoid close contact with people, practice social distancing

4/ Regularly disinfect commonly touched surfaces and items in your house, such as doorknobs and counter tops.

5/ Ophthalmologists should also wear protective gear and regularly disinfect surfaces and equipment.

COVID-19 & EYE RUBBING
FACTS

We already knew that it is harmful to rub the eyes in a vigorous and prolonged way since this habit causes the appearance and the evolution of the keratoconus. Here, a simple contact with the conjunctival mucosa can be harmful and a source of contamination if your hands are dirty.

German researchers analyzed the brain’s electrical activity before and after spontaneous face touching, and their findings suggested that we touch our faces more than 40 times per day, as a way to relieve stress and manage our emotions. One study found that, on average, people touch their faces 23 times an hour.

The mucous membranes (like conjunctiva) in the eyes could be an entry point for germs or the coronavirus that causes COVID-19.  We can also become infected by touching something that has the virus on it, like a table or doorknob.

In general, a virus will survive the longest on nonporous surfaces made of metal and plastics, including door knobs, counters and railings. A virus will die sooner on fabrics or tissues.

The risk of picking up a virus by hand-to-face contact depends on a number of factors, including the type of virus, quantity of virus on the surface, type of surface, how long ago the virus was left behind, how much time the infected person spent in the area as well as the temperature and humidity levels.

eye rubbing
RECOMMENDATIONS

1/ Wash your hands frequently

2/ Don’t touch surfaces then touch your eyes, don’t forget your hands are only clean until the next surface you touch

3/ Avoid rubbing your eyes (and nose and mouth too, especially before hands washed)

4/ If you really need to rub your eyes, consider using a gentle cleansing wipe or wash them with normal saline solution (after hands washed)

5/ Try to identify triggers for face touching, like dry skin or itchy eyes, and use moisturizers or eye drops (after hands washed) to treat those conditions so you are less likely to rub or scratch your face.

6/ Don’t use gloves, it can become contaminated too and a give a false reassurance.

COVID-19 & CONTACT LENSES
FACTS

There is currently no evidence to suggest that there is any increased risk of infection through contact lens wear. Remember to follow strict hygiene measures, such as thorough handwashing, along with optimal wear and care procedures.

These include replacing your lenses as prescribed, case hygiene for reusable lenses and avoiding lens wear if you are unwell (in particular with any cold or flu-like symptoms).

However, some eye doctors suggest avoiding wearing contact lenses altogether, in order to avoid any eye infection (unrelated to coronavirus), that could lead to an unnecessary hospitalization in severe cases. Nevertheless, contact lenses themselves will not give you COVID 19.

In response to COVID-19, public health organisations and government health officials are putting in place plans to ensure that people receive the right advice, care and support as well as benefiting from the most accurate information.

covid contact lens
RECOMMENDATIONS

Here are some recommendations from BCLA (British Contact Lens Association) and AOA (American Optometric Association) :

1/ Always wash and dry your hands thoroughly before handling contact lenses and lens cases.

2/ Always wash and dry your hands thoroughly before applying a contact lens, even if the lens is new and directly from the packaging.

3/ Always wash and dry your hands before removing your contact lenses.

5/ Discontinue lens wear if you are sick

6/ Do not use tap water rince your lenses or wash your eyes with lenses on

7/ Substituting glasses for lenses can decrease irritation and encourage you to pause before touching your eye

8/ If you have a contact lens prescription that is nearing expiration or has expired, contact your doctor. Don’t use contact lens if expired.

9/ Stop wearing your contact lenses immediately if you have these symptoms: Redness, Swelling, Eye Pain, Blurry vision, Light sensitivity, Eye burning, or Foreign body sensation.

COVID-19 & GLASSES
FACTS

Glasses are not proven to offer enough protection against COVID-19. There is no scientific evidence that wearing spectacles or glasses provides protection against COVID-19 or other viral transmissions.

The AAO however says corrective lenses or sunglasses can shield eyes from infected respiratory droplets, but adds they don’t provide 100 percent security.

Wearing glasses may add a layer of protection, but the virus can still reach your eyes from the exposed sides, tops and bottoms of your glasses.

As much as we wash our faces, we should also consider the cleanliness of our glasses, as they go on our faces. We set our glasses down in different places (tables, desks, counters) and then we place them on our faces. So, we should practically treat them as washing our hands.

RECOMMENDATIONS

1/ Disinfect your Glasses twice per day and wash your hands after

2/ Avoid touching your glasses without washing your hands before

COVID-19 & EYE CARE
FACTS

For everyone’s health and safety, ophthalmologists and other doctors are being urged not to see patients during the coronavirus pandemic except for urgent or emergency care.

This is important to limit contact, even between doctors and patients is key to helping reduce the spread of the coronavirus. Patients routine visits should be rescheduled.  Any eye surgeries and procedures that are not emergencies will be postponed.

RECOMMENDATIONS

1/ Cataract surgeries can be postponed, as well as all refractive surgeries and eyelid surgeries for functional or aesthetic purposes.

2/ Procedures or surgeries intended to treat chronic glaucoma, as well as corneal tissue transplants must be evaluated individually.

3/ Intra-vitreous injection are sometimes essential, but their programming can be adjusted over time and must be evaluated individually too.

4/ Ophthalmic examinations, outside of an emergency context, may be postponed.

5/ Treatments and eyedrops must be continued and can be easily renewed by pharmacists, even by telemedicine procedures or conventional consultations if necessary.

COVID-19 & DIGITAL EYE STRAIN
FACTS

In this digital age where the computer, mobile phone and tablet are very much a part of our daily lives, eye strain from the overuse of these gadgets can cause ocular fatigue, headaches and difficulty focusing, which may potentially impact our vision over the long-term.

Quarantaine leads to extended periods of computer use that makes the eyes work harder. As a result, the unique characteristics and high visual demands of computer and digital screen device viewing make many individuals susceptible to the development of vision-related symptoms.

Uncorrected vision problems can increase the severity of Digital Eye Strain symptoms.

Viewing distances and angles used for this type of work are also often different from those commonly used for other reading or writing tasks. As a result, the eye focusing and eye movement requirements for digital screen viewing can place additional demands on the visual system.

In most cases, symptoms of Digital Eye Strain occur because the visual demands of the task exceed the visual abilities of the individual to comfortably perform them. At greatest risk for developing Digital Eye Strain are those persons who spend two or more continuous hours at a computer or use a digital screen device every day.

RECOMMENDATIONS

1/ Adjust the colour and brightness of the screen to a comfortable level. The position of the screen should be at a lower level than the eyes. Anti-glare screens can be useful.

2/ Limit screen time. Finding alternatives such as reading an actual paper book rather than an electronic book can reduce digital eye strain.

3/ Take occasional breaks and then by observing the 20/20/20 rule: For every 20 minutes of close work or screen time, take a 20 second break to look at something 20 feet further away.

20/20/20 rule
CORONAVIRUS (COVID-19) REAL-TIME WORLDWIDE MAP

Here is a nice real-time map made by google about worlwide statistics of COVID-19.


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