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Conjunctivitis linked to coronavirus, colds and flu: Protect your eyes

woman with pink eye

You’ve got a hacking cough, runny nose and other symptoms of a cold, flu or other virus and then your eyes get red and weepy and your lids may be puffy. You may have viral conjunctivitis

Some of the same viruses that cause seasonal illnesses such as colds and flu also can cause conjunctivitis. 

How can this happen? If you’re sick, you may transfer viruses to your eye by blowing your nose then wiping away a tear or simply touching the area around your eye. 

Coronavirus and conjunctivitis 

Now doctors have found that the new coronavirus can cause pink eye, according to the American Academy of Ophthalmology (AAO). 

The novel coronavirus, which causes a disease known as COVID-19, is a virus first seen in humans in an outbreak that began in late December 2019 in Wuhan, China. The new coronavirus is believed to have jumped from animals to humans and has spread around the globe. 

The World Health Organization declared COVID-19 a pandemic on 11 March 2020. 

SEE RELATED: Coronavirus: How eyes may play a role in its spread

There are two main ways the new coronavirus and other viruses could get into the eye and possibly cause conjunctivitis: 

1. Coughs and sneezes

First, the coronavirus could get into the eye through aerosol transfer. “That’s if you’re standing within six feet of someone who has the virus, and they cough or sneeze, and you aren’t wearing any protective eyewear,” says Stephanie Marioneaux, MD, clinical spokeswoman for the AAO. 

2. Touching the eyes

The coronavirus can also be transferred from the hands to the eyes. For example, you could get coronavirus in your eye if someone with the virus touches a shopping trolley handle, then you use the same trolley and touch your eyes, Marioneaux says. 

The good news is that only about 1% to 3% of coronavirus patients get conjunctivitis, according to the AAO.

Adenovirus conjunctivitis: the most common type 

Coronavirus is front and centre right now, but you may not have heard of the most common cause of viral pink eye: adenoviruses. 

The symptoms of adenovirus infection can resemble a cold or the flu and may include: 

  • Fever

  • Gastrointestinal symptoms such as diarrhea and nausea

  • Inflammation of airways and lungs, known as acute bronchitis

  • Sore throat

  • Pneumonia

  • Conjunctivitis

Conjunctivitis symptoms typically involve a red, infected eye, a watery discharge and a sandy, gritty feeling in the eye.

Adenoviruses are the group of viruses that cause the common cold and many other common upper respiratory conditions.

An adenovirus can be the cause of a mild conjunctivitis with no other symptoms or be the cause of the most serious form of conjunctivitis known as epidemic keratoconjunctivitis (EKC). This particular type of conjunctivitis tends to occur in clusters and is highly contagious and uncomfortable.

Adenoviruses can live on surfaces for a long time, Marioneaux says. “They can last on a door handle for 30 days and still be just as infectious as on day one,” she says. 

There also are many other viruses, and strains of viruses, that can cause conjunctivitis.

Can the flu cause conjunctivitis eye?

Some strains of the flu may cause conjunctivitis. However, it’s not nearly as common a cause as adenovirus, Marioneaux says. 

How can you prevent viral conjunctivitis in your eyes? 

Prevention is the best medicine. Here are four ways to reduce your chances of getting viral conjunctivitis: 

1. Wash your hands the right way

Review the five steps to washing hands correctly from the U.S. Centers for Disease Control and Prevention (CDC). You must wet your hands, turn off the tap, apply soap, lather and scrub for 20 seconds, then rinse. After washing your hands, air dry them or use a clean towel. 

2. Don’t touch your eyes

Resist the urge to dab, rub or wipe your eyes, or touch other parts of your face, whether or not you have symptoms of illness right now. “Do not touch your eyes unless you use a clean tissue,” Marioneaux says. 

3. Avoid sharing personal items

Don't share items such as contact lens cases, eye drops, face makeup or makeup brushes, pillowcases, or bath or hand towels, the CDC recommends. Conjunctivitis is very contagious and a patient can cause the spread from one eye to the other.

4. Switch from contacts to glasses

Contact lens wearers may want to switch to glasses temporarily. “Many contact lens patients touch their eyes without even thinking about it,” Marioneaux says. “So if you're very concerned you could wear glasses until the coronavirus scare is over.” 

It’s hard to overstate the importance of good hygiene practices. 

“You just never know what your hands have come in contact with when you touched the door handle, used the pencil or signed the credit card box behind customer number 1,000,” Marioneaux says. Where possible use contactless payments.

Viral conjunctivitis treatment: What you should know

There is no treatment for viral pink eye, including conjunctivitis caused by the new coronavirus, but it typically goes away on its own in one to two weeks. 

If you’re diagnosed with viral conjunctivitis, your optician may recommend these home remedies for pink eye to help ease your symptoms: 

  • Take an over-the-counter pain medication to ease any discomfort.

  • Put a warm compress on your eye for a few minutes, using a clean flannel or each time and a different flannel for each eye to avoid the transfer of the condition from one eye to the other.

  • Use lubricating eye drops, also known as “artificial tears,” to soothe the irritated eye. Be careful not to touch the tip of the bottle to your eye so you don’t spread the infection. 

You should know that it’s common for health care providers to incorrectly prescribe antibiotic eye drops for viral conjunctivitis, especially if you go to a GP or urgent care provider who may have little experience with differentiating eye infections. 

In fact, one study of antibiotic use for pink eye found that most people with acute conjunctivitis are getting the wrong treatment. The study found that 60% of patients get prescribed antibiotics even though these drugs are usually not necessary. 

It is often the patient or parent who assumes that a typical viral conjunctivitis will not resolve without the aid of a topical medication and may even pressure a practitioner into prescribing. This is an incorrect assumption.

This is a problem for two big reasons: 

1. Incorrect antibiotic use can cause resistance

If a patient is given an antibiotic unnecessarily, it may be less effective in the future for treating more serious infections, Marioneaux says. “Patients who don’t need antibiotics are sometimes being given medications we reserve for our toughest cases.” 

2. Antibiotics may make viral conjunctivitis worse

"Antibiotic eye drops can interfere with your body’s immune response, which is what ultimately gets rid of viral conjunctivitis," Marioneaux says. If this happens, healing can be delayed. 

It’s important to get correctly diagnosed by a vision care provider to avoid incorrect treatment and get the proper diagnosis, education and plan. It may be difficult to distinguish viral conjunctivitis caused by adenovirus from other eye infections caused by a variety of viruses or bacteria.

"A red eye could have a variety of causes," Marioneaux says. 

SEE RELATED: Are red eyes a coronavirus symptom?

What to do if you’re sick and have eye symptoms 

What if you come down with a fever, sniffles or other symptoms and develop what looks like conjunctivitis? 

“Avoid any kind of DIY diagnosis,” Marioneaux says, adding that eye redness, even while you’re sick, doesn’t necessarily mean you have an infection. 

For example, irritation, redness or swelling could be caused by allergies, antihistamines, cough medicine or other medications that dry out your sinuses and may cause dry eyes too. 

"That’s why it’s important to consult an eye care professional to find out what’s really going on with your eyes," Marioneaux says. 

But with COVID-19 spreading rapidly around the world, it’s more important than ever to take precautions not to spread viruses. 

Here’s what to do if you have an eye issue and also have a fever, cough, shortness of breath or any other symptoms of illness: 

Put off non-urgent appointments

If you have a routine eye test scheduled, postpone your visit to the optician until you are well.

See an eye care professional

Don’t get treatment for a medical eye problem from a family doctor or urgent care centre practitioner. Opticians specialise in issues involving the eye therefore have more experience in diagnosing and treating these conditions.

Call your optician before you visit

Call your optician to describe your symptoms and discuss your eye problem before going into the practice. Let them know if you have symptoms of COVID-19 or think you may have been exposed. 

If you are sick and have an urgent eye problem that requires face to face attention, your optician should ask you to wear a face mask and sit in a separate waiting area away from other patients. 

Your optician will use protective gear such as eye goggles, a face mask, gown, gloves and a slit lamp breath shield while examining you. 

What to do if you think you have conjunctivitis

Conjunctivitis is self-limiting, the symptoms involved typically last 7-10 days. It is most contagious during the first three to four days after the onset of pink eye.

Avoid sharing items with others and touching the eye during the entire course of the condition. See your optician to help you determine the cause of your conjunctivitis and develop the best treatment and plan.

THINK YOU MIGHT HAVE CONJUNCTIVITIS? Find an optician near you, call them to talk about your symptoms, and then make an appointment (if warranted).

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