A new variant of the virus that causes COVID is attracting international attention, not just for its rapid spread, but for its tendency to cause an unexpected symptom: conjunctivitis, or “pink eye.”
The strain, officially known as XBB.1.16 and colloquially as Arcturus, is a sub-variant of Omicron. It was first detected in India, where it spread rapidly, but has been identified in dozens of countries and now accounts for more than 12.5% of cases in the United States, according to the Centers for Disease. Control and Prevention. The World Health Organization has classified Arcturus as a “variant of interest”, meaning it has genetic changes that may affect its behavior, as well as an advantage over other variants in circulation.
Wherever it goes, Arcturus has generated reports of red and irritated eyes, especially in children. While bloodshot eyes can sound alarming, experts say, viral pink eye isn’t usually a cause for concern on its own, and Arcturus shows no signs of being more dangerous than previous variants. Still, knowing that pink eye can result from COVID infection can help people detect it earlier and prevent further transmission.
American scientist asked the experts why Arcturus seems to target the eyes and when you should see a doctor.
What is pink eye and what causes it?
Pink eye, known to doctors as conjunctivitis, describes inflammation of the conjunctiva, a thin transparent mucous membrane that covers the white part of the eyeball. This inflammation causes blood vessels to become clogged, which makes eyes look red or pink, says Thomas Steinemann, clinical spokesperson for the American Academy of Ophthalmology.
Other symptoms of conjunctivitis can include watery eyes and sensitivity to light from an inflamed cornea, which splits light like ground glass, says Bhupendra Patel, plastic surgeon and eye disorders specialist at John A. Moran Eye. from the University of Utah. Center.
An estimated six million people in the United States visit a health care provider each year for conjunctivitis, often due to viral infections, Patel and a colleague wrote in a review article. Adenovirus is by far the most common cause of viral conjunctivitis and is responsible for 90% of these infections. The flu, herpes viruses, and other viruses can also cause pink eyes. In addition to viruses, bacterial infections, chemical exposures, allergies, damaged contact lenses, and physical trauma can trigger the disease.
Why does COVID sometimes cause pink eyes?
Experts have known since the start of the pandemic that COVID can cause eye symptoms such as pain, itching, burning and the telltale pink tint of conjunctivitis. Like other coronaviruses, including the SARS virus that caused an outbreak in 2002-2003, the virus that causes COVID-19, SARS-CoV-2, was tearfully isolated. And higher concentrations of virus in tears are linked to more severe eye symptoms, says Rohan Singh, an ocular immunology researcher at Massachusetts Eye and Ear, a teaching hospital affiliated with Harvard Medical School.
In fact, one of the first people to report the existence of SARS-CoV-2 was Li Wenliang, a Chinese ophthalmologist who experts say caught the virus from a patient with asymptomatic glaucoma. He eventually died of the disease.
It’s still unclear exactly how often COVID causes conjunctivitis, but it seems to be more common in young people. An early study at Wuhan Children’s Hospital in China reported that 22% of children hospitalized with COVID there had eye symptoms. Of these, 55% had ocular secretions. Since then, estimates of eye symptoms have ranged from less than 1% to more than 30% in children, Singh and colleagues reported in a recent review study incorporating data from around the world. According to the American Academy of Ophthalmology, the estimated prevalence in adults is 1-3%, a figure based on research in China.
Why does Arcturus cause so many red eyes?
Although there is no official analysis yet to quantify the rate of conjunctivitis caused by the latest variant, expert discussions and early evidence from India suggest that pink eye is quite common, especially in children younger than 12, says Shahzad Mian, an ophthalmologist at the University of Michigan. Pink eye usually does not occur in isolation; children also often have a fever, sore throat, cough or other symptoms of COVID.
Why some variants cause more eye problems than others likely depends on mutations in the virus’ spike protein that cause it to bind more tightly to cells in the eye, experts say. Just like in the nose, lungs and upper respiratory tract, cells in the conjunctiva and other parts of the eye express ACE2 receptors, which are binding sites for SARS-CoV-2.
Arcturus is not the first variant that has shown affinity for receptors in the eyes. At the start of the pandemic, studies show that the beta variant was more infectious for conjunctival cells, compared to the previous Alpha strain, leading to a higher concentration of the virus and greater eye inflammation in infected people.
If a variant can bind to a receptor more easily, more virus particles can infect cells, leading to a stronger immune response, Singh says. “COVID-19 virus spike protein enters [and] binds to that receptor, and then it sets off a chain of events, which leads to inflammation,” he says.
A COVID infection can start in the eyes and spread systemically, or it can start elsewhere, and systemic changes can affect the eyes, he adds. “It can happen both ways,” Singh says.
What should you do if you develop pink eye?
Don’t panic. Arcturus does not appear to be more likely than other variants to lead to hospitalization, serious complications or death, Patel says. Viral conjunctivitis usually lasts up to about a week and usually goes away without intervention.
At home, you can search for clues that might help you deduce if a virus is involved. Viral pink eye often comes on suddenly, causing red, watery eyes that “tear all over,” says Steinemann. With a bacterial infection, the secretions tend to be slimy, thick and sticky, while allergies cause the eyes and eyelids to be extremely itchy. Some symptoms may overlap, regardless of the cause.
If you notice red eyes accompanied by fever (another common symptom of Arcturus) or other COVID-like symptoms, it wouldn’t hurt to get a COVID test. “In the time of COVID, if you have a conjunctival viral infection,” says Patel, “it’s not unreasonable to suggest you get a COVID test.”
The most serious warning signs include pain and strong sensitivity to light, which can suggest eye damage that should be examined by a doctor to assess potential impacts on vision, Singh says. A thick yellow discharge indicates a bacterial infection that may require antibiotics. Blurred vision is another warning sign of corneal inflammation that could benefit from steroid drops.
If symptoms don’t improve or if they get worse after a few days, Steinemann adds, it’s time to see a doctor. Under a magnifying glass, an eye doctor can see enlarged glands, called follicles, which are unique to viral infections, as well as signs of other causes of pink eye.
If you have pink eyes from COVID, is there anything you can do to feel better?
Artificial tears, available at pharmacies, can soothe discomfort, experts say. Cold compresses can also help. Try not to rub your eyes, both to avoid causing damage or secondary infections and to prevent transmission to others.
If you have COVID and red eyes, the virus is sure to be in your tears, says Patel. So be sure to wash your hands, use towels separate from other people, and avoid physical contact until the infection clears.