“Sore Eyes” as the Initial Symptom of COVID-19

“Sore Eyes” in COVID-19

It has been suggested that this may now be the most informative ocular symptom of COVID-19, replacing “conjunctivitis.”

The most significant ocular symptom experienced by those suffering from coronavirus disease 2019 (COVID-19) was sore eyes

TOC

“Sore Eyes”: The Initial Symptom of COVID-19

Although coronavirus disease (COVID-19) is a respiratory disease, it is known to be
accompanied by “conjunctivitis,” a type of eye inflammation.

Conjunctivitis: How to Tell Whether It Is Contagious or Not

The World Health Organization (WHO) added conjunctivitis to the list of COVID-19 symptoms,
and showed that the coronavirus is carried via the conjunctiva (the white part of the eye):
The conjunctiva may be a route of entry.

The effectiveness of using face shields and protective glasses to reduce risk has also been demonstrated.

Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states.¹

This is a study based on an online questionnaire of 83 men and women aged 18 or older who had been diagnosed with COVID-19.

The questionnaire was conducted from April 16 to July 20, 2020.

○ Most important COVID-19 symptoms
Dry cough: 66%
Fever: 76%
Fatigue: 90%
Loss of smell and taste: 70%

○ Eye symptoms
Photophobia (light sensitivity): 18%
Eye pain: 16%
Itchy eyes: 17%

○ Eye pain (sore eyes) was significantly higher after onset than before onset (P = .002).

○ In 81% of COVID-19-positive people, eye symptoms appeared within 2 weeks of the other symptoms.
　In 80%, symptoms lasted for less than 2 weeks.

○ There was no significant difference between the timing of eye symptoms and that of other symptoms (P = .147).

○ There was no significant difference in eye symptoms by age (P < .05), nor by sex (P > .05).

As an ocular symptom of COVID-19, “eye pain” is more important than “conjunctivitis.”

While it is important that ocular symptoms are included in the list of possible COVID-19 symptoms, we argue that sore eyes should replace ‘conjunctivitis’ as it is important to differentiate from symptoms of other types of infections, such as bacterial infections, which manifest as mucous discharge or gritty eyes

“Eye pain” (sore eyes) should replace “conjunctivitis” as the ocular symptom of COVID-19:

Bacterial conjunctivitis is characterized by copious eye discharge and a gritty sensation.
* Bacteria and viruses are completely different microorganisms.

“Conjunctivitis” is a term with a very broad meaning and should be used with care.

Diagnosing Conjunctivitis: The Basic Examination and Additional Tests When Needed

Diagnosing Conjunctivitis: The Basic Examination and Additional Tests When Needed Very many patients visit the eye clinic with the complaint of “red eyes.” The causes are varied: viruses, bacteria, allergies, and more. Uveitis can also mak…

This is what the authors write.

Conjunctivitis: How to Tell Whether It Is Contagious or Not

Conjunctivitis: How to Tell Whether It Is Contagious or Not When you are told “it’s conjunctivitis,” • I may have to keep my child home from school, daycare, or kindergarten• Can they go to the pool?• Do they have to …

The Cornea (Black of the Eye) May Also Be an Important Route of Entry for the Coronavirus

The corneal limbus (the border between the black and white of the eye) is rich in stem cells and is a site of strong immune response.

It expresses a large amount of ACE2 (angiotensin-converting enzyme 2) messenger RNA.

It has been shown that the spikes of the SARS-CoV-2 protein enter through ACE2 expressed on healthy human cells².

The cornea is richer in ACE2 than the conjunctiva (white of the eye):
It has been suggested that this may be an entry route for the novel coronavirus (SARS-CoV-2).

Views from the Front Line in Fukuoka City

A classmate from Nagasaki University School of Medicine works in administration at a public health center in Fukuoka City.

I heard from him that many people infected with COVID-19 say their eyes hurt, and I wrote about it on the website.

The number of cases in the paper I introduced is still small, but impressions and opinions from the front line are valuable.

I will continue to practice medicine with care.

1. Pardhan, S., Vaughan, M., Zhang, J., Smith, L., Chichger, H., 2020. Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states. BMJ Open Ophth 5, e000632. https://doi.org/10.1136/bmjophth-2020-000632
2. Yan, R., Zhang, Y., Li, Y., Xia, L., Guo, Y., Zhou, Q., 2020. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science 367, 1444–1448. https://doi.org/10.1126/science.abb2762