Understanding the Possible Connection Between Pink Eye and COVID-19 in Kids

One of the more difficult aspects of the current novel coronavirus (COVID-19) is keeping track of potential new symptoms and links to other conditions. Case in point: a new study that shows a potential overlap between coronavirus and eye conditions like conjunctivitis, more commonly known as pink eye.

Given that many young students are attending class in person this fall despite the pandemic and the prevalence of pink eye — and similar eye issues — among youngsters, this potential connection is sure to create concern and confusion among parents.

But there’s a nuance to both the study and the overall context of these illnesses that gets lost in translation to headlines. We talked to optometrist Alexandra Williamson, OD, about the study and the potential link between coronavirus and irritated, gunky eyes.

The eye-and-virus connection

Before worrying about the potential connection between pink eye and coronavirus, it’s important to understand that there’s already a preexisting link.

“There’s a well-demonstrated association between respiratory viral infections and a pink eye-type of appearance,” notes Dr. Williamson. “Conjunctivitis occurs in viral infections, but there can also be other ocular symptoms like watering or redness since younger kids will rub them because they’re irritated.”

She adds, “Anatomically, the eye is connected to the nasal passages through the nasolacrimal duct, which is where our tears drain into the sinuses. And that connection makes it possible for viruses to cause problems in both places.”

It’s not uncommon, Dr. Williamson says, to see an array of viral infections from the common cold to measles to COVID-19 do the same thing. COVID-19, though, complicates matters because it doesn’t affect everyone uniformly, with infected patients ranging from being asymptomatic to being severely ill.

What the study found

The study looked at 216 children hospitalized with COVID-19 in Wuhan, China during the early stages of the pandemic, between late January and mid-March 2020. Of those children, 49 (22.7%) showed “ocular manifestations, including conjunctival discharge, eye rubbing, and conjunctival congestion.”

A total of 123 children in the study experienced a range of COVID-19 symptoms and of those, 36 (or 29.3%) also had eye issues. Of the 93 children (or 43%) of the children who were asymptomatic, only 13 (or 14%) showed ocular symptoms.

“They found that most of the kids that did have eye problems were also showing symptoms like a fever or cough,” Dr. Williamson notes, “which tracks with what we already know about respiratory viruses in the eyes.”

The study also took time to note that the increased number of these sorts of eye issues in child patients over adult patients could be attributed to a number of other causes, like increased hand-eye contact.

It also outlined other limitations of the study including the lack of face-to-face examinations with children due to the virus and the inability to collect detailed descriptions of symptoms in some of the younger patients because they were too young to accurately describe what they were experiencing.

Understanding the study

In other words, yes, the study shows there’s something to the idea that there’s a possible connection between COVID-19 and eye issues. But there’s not enough evidence to say for certain if that connection is direct or coincidental. As with so many other aspects of this novel coronavirus, more research is necessary.

So how concerned should parents be about the study? Dr. Williamson says we need to keep the study’s limitations and the authors’ caveats in mind. It’s essential to keep the context in which the study was done in mind when digesting the findings.

“The doctors in this study looked at chart notes, not directly at the patients when compiling the data. And they weren’t in a traditional eye doctor setting with specialized eye exam equipment,” notes Dr. Williamson.

She also stresses the possibility of co-infections: “It’s possible these patients were already infected with pink eye or another virus and that COVID-19 wasn’t even the reason they had those symptoms.” The authors of the study do note a history of allergic conjunctivitis in some of the patients.

Putting it in perspective

Like so many other COVID-19-related studies, this research is in the very early stages and, as Dr. Williamson notes, we have to keep things in perspective.

“The number of COVID-19 patients that have been reported to have eye symptoms is relatively low. And when you have a population that small, it’s really hard to get a picture of the story because we just don’t have as many data points,” she says.

That doesn’t mean the study isn’t useful; it just means we have something new to consider and explore further. “It’s another piece of data helping eye doctors understand more about this new coronavirus but it doesn’t mean that we need to be severely worried that every child that has pink eye is potentially infected with COVID-19,” she says.

“I don’t think that our practical guidelines need to change as of yet,” she adds, “I think this is just one more piece of data for us to consider.”