During the new coronavirus disease (COVID-19) epidemic, protecting the eyes is as important as protecting the mouth and nose and cleaning hands to prevent the transmission of the disease.
Coronavirus can affect the eye as well as the respiratory system, and even the first findings may appear in the eye. The 34-year-old Chinese ophthalmologist, who first suspected coronavirus infection and warned the authorities on this issue, later died due to the disease that developed due to this virus.
Coronavirus (SARS-CoV-2) causes mild follicular conjunctivitis, similar to another viral conjunctivitis, which occurs with symptoms such as redness of the eye, watering, and slight burr. Conjunctivitis may be an early symptom of the disease or it can be seen in the late period in serious hospitalized patients. It is thought that the conjunctiva is transmitted by the virus through airborne droplets or from hand to eye.
In a study conducted in China, it was reported that approximately 1/3 of the patients developed “red-eye” due to viral conjunctivitis. However, different rates are mentioned in different sources. In the notification of the American Academy of Ophthalmology, it is recommended to consider other causes of red-eye, if there are no other findings of the disease, in which viral conjunctivitis due to COVID is seen in 1-2%.
When the patient applies to the ophthalmologist, Coronavirus infection should be considered if there are complaints such as fever, cough, breathing difficulties, and/or a history of COVID-19 infection in the surrounding people, as well as conjunctivitis. During the examination of the patients, the ophthalmologist should use a mask and glasses to cover their mouth, nose, and eyes.
The virus that causes COVID-19 infection is sensitive to alcohol and bleach-containing disinfectants that ophthalmologists routinely use to protect examination areas and devices from other viral factors. For this reason, it is important to clean the device and environment using these disinfectant solutions and air conditioning before and after each patient examination. Hands should be washed before and after each patient examination.
SARS-CoV-2 RNA (virus genetic material) was detected in the tears of patients with COVID-19 conjunctivitis. This situation indicates that the virus is present in the tears of the patients and that conjunctivitis develops. Therefore, it should be considered that infectious viral particles may be found in the tears of patients with COVID with conjunctivitis.
What Are The Precautions To Be Taken For Eye Hygiene During The Coronavirus Epidemic?
One of the most important measures to be taken is to pay attention to hand hygiene and to wash hands frequently and by the rules. What is meant by washing hands according to the rules is to rub the upper and lower surfaces of the hands with soap and rubbing them under running water for at least 20 seconds.
If you cannot pay attention to contact lens cleaning, not using contact lenses and avoiding touching the face, nose and especially the eyes are also precautions to be taken.
It is very important to avoid touching the eyes. For those who wear glasses, glasses can act as a protective shield. On the other hand, if the person frequently touches the glasses with their hands, glasses can also be a source of infection. During this period, if possible, glasses should be used instead of contact lenses.
If contact lenses must be worn, daily disposable contact lenses can be used. Those who have to wear contact lenses should wash their hands carefully, as described above, with soap for at least 20 seconds before putting on and removing them. When using contact lenses, it is necessary to pay attention to the rules more than ever and make a maximum effort not to touch the eye.
It should be kept in mind that the two most important factors in preventing the disease are good hand washing and maintaining a personal safe distance.
Prescription glasses or sunglasses partially protect the eye from infected droplets. The use of visors or swimming goggles, which are more protective, is necessary for the examination and care of infected patients.
If you need to use any drops regularly for your eye treatment, it would be appropriate to have enough drops at hand during the quarantine period for 3 months.
Often patients with dry eyes or allergic conjunctivitis scratch their eyes more often. For this reason, more frequent use of teardrops is recommended. However, washing hands with soap for at least 20 seconds is necessary to prevent any contamination even after tears and after dropping.
It is necessary to avoid scratching the eyes. Antiallergic drops can be used in the treatment of allergic conjunctivitis in patients with severe itching. If scratching is needed, it is better to use a clean paper napkin instead of hands.
Protection of the Ophthalmologist and the Patient During Examination
During the eye examination, both the patient and the ophthalmologist should wear a mask and not speak. The reason for this is that some of the patients are likely to carry the disease without showing symptoms, and the saliva that will come out of the mouth during the speech, etc. It is the possibility of having a virus in tiny particles called droplets to be formed by secretions.
Also, placing a transparent screen called a “breathing shield” between the patient and the physician in the device called the biomicroscope used during the examination reduces the contamination through droplets.
It is preferred that the patient’s relative is not in the room during the examination.
Which Patients Should Consult an Eye Doctor During the COVID-19 Outbreak? Which Patients Should Ophthalmologists Examine?
It is appropriate to postpone eye examination and surgical procedures for patients who do not have serious eye health problems. It would be appropriate to postpone surgery, laser, eyeglass examination, and other non-emergency treatment procedures until after the epidemic has passed.
However, if there are any of the following situations, the patient should apply to the ophthalmologist without waiting;
- Sudden vision loss in the eye,
- Patients with blurred vision, visual field loss,
- Eye pain, nausea, vomiting, headache,
- Red-eye symptoms.
- Patients who have had intraocular injections due to macular degeneration or diabetic retinopathy should consult their ophthalmologist about whether their condition is urgent.
If fever or cough is present, an eye examination should be avoided if possible. If there is an emergency, the ophthalmologist should be informed beforehand. In such a case, the ophthalmologist will have to examine the patient under full protection, taking additional precautions.
Methods of sending photos to their doctors and making videoconferences or phone calls through various smartphone and computer applications (such as WhatsApp, Zoom, Houseparty) have been increasingly used during the epidemic period.
In this way, patients can consult their physicians and get preliminary information about whether an examination is required or they can ask for help about the current status of their pre-existing diseases and what to do.