In the spring of 2023, reports emerged of COVID-19 patients displaying a seemingly novel symptom: conjunctivitis [1]. While eye symptoms have been noted in patients from the beginning of the pandemic [2, 3], many of these recent cases can be explained by a new strain of the virus, XBB.1.16 or Arcturus [1]. The new strain has already made its way to at least 33 countries and, as of April 2023, was the second most prevalent SARS-CoV-2 subvariant [4]. With Arcturus spreading around the world and contributing to a significant uptick in COVID-19-related eye symptoms [1, 4], it has become essential for medical practitioners to familiarize themselves with how COVID-19 affects the eyes.
Even before medical professionals identified the Arcturus strain, researchers had already noted how people infected by SARS-CoV-2, particularly children, experienced eye symptoms [2]. In Wuhan, China, a 2020 study of 216 children between 2 and 11 years old found that 22.7% of them displayed “various ocular manifestations” [2]. The rate at which adults present ocular symptoms appears to be lower, with research estimating it to be around 1 to 3% [2]. Altogether, this means that approximately 1 out of every 10 COVID-19 cases affect patients’ eyes [5].
While the mechanism through which COVID-19 causes conjunctivitis (inflammation of the membrane of the eyes) remains unknown, the reason why some variants cause eye problems while others do not is attributed to mutations in each variant’s spike protein [1]. While variants like Arcturus and Beta have demonstrated an affinity for binding to receptors in the eyes, other variants like Alpha have not, thereby explaining why cases of conjunctivitis are more common in people infected by the former two than the latter [1]. On the mechanism front, scientists also suggest that ocular symptoms, rather than being the result of a direct viral infection, are “more likely associated with a systematic inflammatory reaction.” [5]. Thus, one can surmise that the spike protein associated with Arcturus may be predisposed to triggering this reaction.
Although the spread of the Arcturus strain may increase the incidence of eye symptoms among COVID-19 patients, conjunctivitis is not typically cause for concern and, as yet, Arcturus does not appear to be more dangerous than other variants [1]. Other, more serious eye symptoms, such as retinal vein occlusion, optic nerve abnormalities, and orbital cellulitis, have also been documented among COVID-19 patients, but they occur much more rarely [5].
In response to COVID-19-associated ocular symptoms, people can take various precautions. People should be wary of touching their eyes and make sure to wash their hands regularly [2]. Other precautions, such as habitual cleaning of one’s contact lenses, not sharing cosmetics with others, and using a clean tissue or towel each time one wipes one’s face and eyes, are also helpful in avoiding COVID-19 infection and associated inflammation [2]. Healthcare workers, in particular, should wear face shields or other forms of protective eyewear to avoid eye-based infection [3]. When treating critically ill patients, particularly those that require mechanical ventilation, they should take special precautions to avoid causing ocular surface injury [3].
As alarming as a new strain of COVID-19 sounds, evidence suggests that current vaccines protect well against Arcturus [6]. Nevertheless, by recognizing the way that COVID-19 can manifest in the eyes and adopting these recommendations, one has a higher likelihood of not contracting the disease and suffering from the aforementioned symptoms.
References
[1] E. Sohn, “What Is Causing So Much Pink Eye?,” Scientific American, Updated May 12, 2023. [Online]. Available: https://www.scientificamerican.com/article/what-is-causing-so-much-pink-eye/.
[2] V. Hazanchuk, “Pink Eye May Be a Symptom of COVID-19 in Children,” American Academy of Ophthalmology, Updated April 21, 2023. [Online]. Available: https://www.aao.org/eye-health/news/pink-eye-symptom-covid19-coronavirus-children.
[3] W. Binotti and P. Hamrah, “COVID-19-related Conjunctivitis Review: Clinical Features and Management,” Ocular Immunology and Inflammatory, vol. 31, no. 4, pp. 778-784, 2023. [Online]. Available: https://doi.org/10.1080/09273948.2022.2054432.
[4] A. Johnson, “What To Know About ‘Arcturus’: New Covid Variant Causing Pink Eye,” Forbes, Updated April 27, 2023. [Online]. Available: https://www.forbes.com/sites/ariannajohnson/2023/04/27/what-to-know-about-arcturus-new-covid-variant-causing-pink-eye/?sh=5e33c9fd1553.
[5] M. Mahoney et al., “Pediatric Conjunctivitis: A Review of Clinical Manifestations, Diagnosis, and Management,” Children, vol. 10, no. 5, pp. 1-9, April 2023. [Online]. Available: https://doi.org/10.3390/children10050808.
[6] E. Berger, “Covid officials say new ‘Arcturus’ variant could be linked to conjunctivitis,” The Guardian, Updated May 9, 2023. [Online]. Available: https://www.theguardian.com/world/2023/may/09/covid-variant-arcturus-conjunctivitis.
