En español | By now, face masks have become a part of our daily wardrobe, offering a sense of security by denying potentially deadly airborne virus particles entry into our nose and mouth.
But a recent bit of news has become something of an eye-opener: A few weeks ago, virologist and epidemiologist Joseph Fair, appearing on NBC's Today show from a hospital bed, claimed he had contracted COVID-19 through his eyes. Fair said he'd been aboard a packed flight from New York City to New Orleans and believed he was taking “max precautions” — wearing a mask and gloves, and diligently wiping down his seat. But his eyes were exposed. “You can still get this virus through your eyes,” Fair asserted, “it's the best guess I have of probably how I got it.”
Four months earlier, Wang Guangfa, a respiratory specialist at Peking University, was infected by the coronavirus after coming into contact with patients in the Chinese city of Wuhan, with a mask covering his mouth and nose but without eye protection.
All of which begs the question: Are we putting ourselves at risk by leaving our eyes exposed? Can we actually catch the coronavirus through our eyes? It may be possible, says John Brooks, M.D., chief medical officer for the Centers for Disease Control and Prevention (CDC) COVID-19 response. “The virus could enter the body through mucous membranes that cover the white parts of our eyes,” says Brooks, “but it would be very hard to prove.”
To be sure, infectious diseases, in general, can be transmitted through various routes, the eyes included. When a person who is infected coughs, sneezes or talks, the virus can travel in tiny particles from their mouth or nose into another person's face. “These droplets are most likely to be inhaled through your nose or mouth, but they can also enter the body through the eyes,” says Viral Juthani, M.D., assistant professor of ophthalmology and visual sciences at the Albert Einstein College of Medicine in New York City. “You can also become infected if you touch a contaminated surface that has coronavirus on it, like a handle or doorknob, and then touch your eyes.”
What's more, says Sonal Tuli, M.D., associate professor of ophthalmology at the University of Florida, and a clinical spokesperson for the American Academy of Ophthalmology, “We know that many other viruses, such as the influenza virus, can cause both respiratory symptoms and ocular symptoms. You can be coinfected.”
This is not all that surprising, since our eyes, nose and throat are connected by a nifty bit of plumbing, known as the nasolacrimal system, that carries tears from the ocular surface to the nasal cavity and down the back of the throat. When we cry, our nose runs; put medicine in your eyes and you'll often feel and taste it in the back of the throat.
For the most part, however, health experts believe we're probably more likely to become infected via our nose and mouth, than through our eyes, in part, says Tuli, “because our nose and mouth provide a direct passageway to the lungs,” whereas infectious particles that enter through our eyes have to take a more roundabout route.
Also, notes James Cherry, M.D., a distinguished research professor and infectious disease expert at the David Geffen School of Medicine at UCLA, our tears contain antibodies that can help detect and latch onto unfriendly antigens, such as bacteria and viruses, and destroy them.
More reassurance: The low rate of eye complications — most notably, viral conjunctivitis (or pink eye) — in coronavirus patients. Health officials believe that conjunctivitis develops in just 1 to 3 percent of people with coronavirus. A study of hospitals in China published in the New England Journal of Medicine found “conjunctival congestion” in only 0.8 percent of patients with a confirmed diagnosis of COVID-19. What's more, says Tuli, “You have to wonder: Was the eye the initial source of the infection, or did the infection travel backwards to the eye?”
By the way: If you start to notice the telltale symptoms — redness, irritation, watery discharge — don't panic. There are a host of different causes for conjunctivitis.
Regular handwashing (at least 20 seconds with soap and warm water), social distancing and covering your mouth and nose can go a long way toward lowering our risk for infection, says Brooks.
A few more ways to keep your eyes safe:
- Don't touch your eyes. Research from the National Institutes of Health found that people touched common objects an average of 3.3 times per hour and their faces an average of 3.6 times per hour. If you feel an urge to itch, rub or simply adjust your glasses, use a tissue. Dry eyes, in particular, can lead to rubbing. “You can use moisturizing drops so you're less likely to rub,” says Tuli. If allergies are behind the rubbing, consider over-the-counter antihistamine eye drops. In general, “be aware of what you're doing,” says Tuli, who was amazed at how often she touched her face when watching herself during Zoom calls. And, yes, there's an app for that: A new Fitbit Ionic app, JalapeNO! ("Treat your hands as if you have been chopping jalapeno peppers for a family of seven billion people,” says the site), trains you to keep your mitts away from your eyes, nose and mouth by vibrating every time your hands venture northward.
- Consider wearing glasses. “For people who are in close contact with infected patients, like healthcare workers, eye protection such as safety goggles or a face shield are recommended,” says Juthani. “For others who are practicing social distancing, additional eye protection is not universally recommended,” though if you're still concerned, you can slip on eye protection for an extra layer of safety. “Someone told me, ‘I've got an elderly mother. I want to do everything possible to protect her,'” says Tuli. “Well, in that case, glasses might not be a bad idea.” What's more, glasses will discourage you from touching your eyes. Wraparound styles will offer the best protection, since respiratory droplets sprayed in your direction can reach your eyes through the exposed sides, tops and bottoms of traditional specs.
- Be careful with the contacts. Contact lenses in and of themselves do not increase your risk of infection — as long as you're careful, says Tuli. “The reason people get into trouble is because they don't wash their hands before they put them in and take them out.” Now is the time to get really good about contact lens hygiene. “Clean your contacts regularly,” says Tuli. “Or, if you can, consider switching to one-day disposable contacts. Doing all of these things is probably enough.” And it goes without saying: Definitely take a break from wearing contact lenses if you have pink eye.