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What Is Causing So Much Pink Eye?

A new variant of the virus that causes COVID is drawing international attention, not just for its rapid spread but for its tendency to cause one unexpected symptom: conjunctivitis, or "pink eye."

The strain, known officially as XBB.1.16 and colloquially as Arcturus, is a subvariant of Omicron. It was first detected in India, where it has been spreading quickly, but it has been identified in dozens of countries and now makes up more than 12.5 percent of cases in the U.S., according to the Centers for Disease Control and Prevention. The World Health Organization has categorized Arcturus as a "variant of interest," which means it has genetic changes that could affect its behavior, along with an advantage over other variants in circulation.

Everywhere it goes, Arcturus has generated reports of red, irritated eyes, especially in children. While bloodshot eyes can look alarming, experts say, viral pink eye isn't usually anything to worry about on its own, and Arcturus is not showing signs of being more dangerous than previous variants. Still, knowing that pink eye might result from a COVID infection can help people detect it sooner and prevent further transmission.

Scientific American asked experts about why Arcturus appears to be targeting the eyes and when you should consult a medical provider.

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 engorged, which is what makes eyes looks red or pink, says Thomas Steinemann, a clinical spokesperson for the American Academy of Ophthalmology.

Other symptoms of conjunctivitis can include watery eyes and a sensitivity to brightness as a result of an inflamed cornea, which splits light like frosted glass, says Bhupendra Patel, a plastic surgeon and specialist in eye disorders at the University of Utah's John A. Moran Eye Center.

An estimated six million people in the U.S. See a health care provider each year for conjunctivitis, often because of viral infections, Patel and a colleague wrote in a review paper. Adenovirus is by far the most common cause of viral conjunctivitis and is responsible for 90 percent of such infections. Influenza, herpesviruses and other viruses can also cause pink eye. In addition to viruses, bacterial infections, chemical exposures, allergies, compromised contact lenses and physical trauma can trigger the condition.

Why does COVID sometimes cause pink eye?

Experts have known since the pandemic's beginning that COVID can cause eye symptoms such as pain, itching, burning and the telltale pink hue of conjunctivitis. Like other coronaviruses, including the SARS virus that caused an outbreak in 2002–2003, the COVID-causing virus SARS-CoV-2 has been isolated in tears. And higher concentrations of the virus in tears are linked to more severe eye symptoms, says Rohan Singh, an ocular immunology fellow at Massachusetts Eye and Ear, a Harvard Medical School–affiliated teaching hospital.

In fact, one of the first people to flag the existence of SARS-CoV-2 was Li Wenliang, a Chinese ophthalmologist who experts suspect caught the virus from an asymptomatic glaucoma patient. He eventually died from the illness.

It's still not clear exactly how often COVID causes conjunctivitis, but it appears to be more common in young people. One early study at Wuhan Children's Hospital in China reported that 22 percent of kids who were hospitalized with COVID there had eye symptoms. Of those, 55 percent had eye discharge. Since then estimates of eye symptoms have ranged from less than 1 percent to more than 30 percent in children, Singh and his colleagues reported in a recent review study that incorporated data from around the world. According to the American Academy of Ophthalmology, the estimated prevalence in adults is 1 to 3 percent, a number based on research in China.

Why is Arcturus causing so many red eyes?

Although there is not yet an official analysis to quantify the rate of conjunctivitis caused by the latest variant, chatter among experts and early evidence from India suggests that pink eye is fairly common—especially in kids under age 12, says Shahzad Mian, an ophthalmologist at the University of Michigan. Pink eye doesn't usually occur in isolation; kids also often have a fever, sore throat, cough or other COVID symptoms, too.

The reason why some variants cause more eye problems than others likely depends on mutations in the virus's spike protein that make it bond more strongly to cells in the eye, experts say. Just like in the nose, lungs and upper airways, cells in the conjunctiva and other parts of the eye express ACE2 receptors, which are binding sites for SARS-CoV-2.

Arcturus isn't the first variant that has shown an affinity for receptors in the eyes. Early in the pandemic, studies show, the Beta variant was more infectious to conjunctival cells, compared with the previous Alpha strain—leading to a higher concentration of the virus and more eye inflammation in infected individuals.

If a variant can more easily bind to a receptor, more virus particles can infect the cells, leading to a bigger immune response, Singh says. "The COVID-19 virus spike protein comes in [and] binds to this receptor, and then it triggers a chain of events, which leads to inflammation," he says.

A COVID infection can begin in the eyes and spread systemically, or it can begin somewhere else, and the systemic changes can affect the eyes, he adds. "It can happen either way," Singh says.

What should you do if you develop pink eye?

Don't panic. Arcturus does not appear to be any more likely than other variants to lead to hospitalization, serious complications or death, Patel says. Viral conjunctivitis generally lasts up to about a week and typically goes away without intervention.

At home, you can look for clues that might help you deduce whether a virus is involved. Viral pink eye often comes on suddenly, causing red and watery eyes that are "tearing all over the place," Steinemann says. With a bacterial infection, discharge tends to be goopy, thick and sticky, whereas allergies cause extreme itching of the eyes and eyelids. Some symptoms can overlap, regardless of the cause.

If you notice red eyes along with a fever (another common Arcturus symptom) or other COVID-like symptoms, it wouldn't hurt to take a COVID test. "In this day and age of COVID, if you have a viral infection of the conjunctiva," Patel says, "it is not unreasonable to suggest you have a COVID test."

More serious warning signs include pain and severe light sensitivity, which can suggest damage to the eye that should be checked out by a doctor to assess potential impacts on vision, Singh says. Thick yellow discharge indicates a bacterial infection that might require antibiotics. Blurry vision is another warning sign of corneal inflammation that might benefit from steroid drops.

If symptoms don't get better, or if they worsen after a few days, Steinemann adds, it's time to consult a doctor. Under a magnifying scope, an ophthalmologist can see enlarged glands, called follicles, that are unique to viral infections, as well as signs that indicate other causes of pink eye.

If you have pink eye from COVID, is there anything you can do to feel better?

Artificial tears, available at drugstores, 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 other people.

If you have COVID and red eyes, the virus is sure to be in your tears, Patel says. So make sure to wash your hands, use separate towels from other people and avoid physical contact until the infection is gone.

The 'silent Symptom' Of Crohn's Disease You Might Spot In Your EYES – And 4 Other Signs

CROHN'S Disease is a lifelong condition that causes parts of the digestive system to become inflamed.

It's estimated that over 155,000 UK adults are currently living with it.

1

Though symptoms of the condition affect sufferers' digestive systems, some signs can appear in your eyes and other parts of the body

Although sufferers will have periods of good health, there are flare-ups where symptoms are more active.

The main symptoms are digestive - such as diarrhoea and stomach cramps - but sufferers also experience fatigue and weight loss.

It is one of the two main forms of Inflammatory Bowel Disease - the other is a condition known as Ulcerative Colitis.

Signs of the condition, which tends to get worse over time, can also crop up in other parts of the body.

From your eyes to your skin and joints, here's where you might spot silent symptoms of Crohn's.

1. Your eyes

Some people with Crohn's might actually be affected by eye problems.

The most common condition to affect Crohn's sufferers peepers is episcleritis, according to York and Scarborough Teaching Hospitals NHS Foundation Trust.

This affects the layer of tissue covering the sclera - the white outer coating of the eye - making it red, sore and inflamed.

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Episcleritis tends to flare up at the same time as digestive issues do.

But there are two other eye conditions linked with Crohn's: scleritis - when the sclera itself is inflamed - and uveitis.

This is when the iris, the coloured part of your eye, becomes inflamed.

2. Your skin

The most common skin problem to affect people with Crohn's is erythema nodosum.

This appears usually appears on sufferers legs, in the form of raised red and violet coloured swellings that are tender.

It's more common in women than men and strikes one in seven people with the condition, according to York and Scarborough Teaching Hospitals.

Erythema nodosum tends to coincide with Crohn's flare-ups but can ease with treatment.

More rarely, a condition called pyoderma gangrenosum affects people with Crohn's Disease. 

This starts as small tender blisters or pustules, which become painful, deep ulcers. They can occur anywhere on the skin, but most commonly appear on people's shins or near their stoma if they have one.

It'll sometimes be linked to a symptom flare-up, but not always.  

3. Your mouth

Chron's can occasionally affect people's mouth.

This variation of the disease is often referred to as 'orofacial granulomatosis' and is more likely to affect children, although it is rare.

It typically causes swollen lips and mouth fissures, but some people with Crohn's may develop mouth ulcers during flare-ups.

4. Your joints

A common complication or Crohn's are inflamed joints, known as arthritis.

It's most common when Crohn's affects the colon, known as Crohn's Colitis.

The large joints in peoples' arms and legs - including the elbows, wrists, knees and ankles - are likely to be inflamed and sore.

But these symptoms usually improve when sufferers intestinal symptoms are treated, and there is generally no lasting damage to the joints. 

In some cases, the joints in the spine and pelvis become inflamed – this is a condition called ankylosing spondylitis or sacroiliitis, in its less severe form.

This can flare up independently of Crohn's and often causes pain on the joints on either side of the lower part of the spine.  Stiffness and pain in the spine itself may eventually lead to loss of flexibility. 

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5. Your liver

One in 50 people with Crohn's will be affected with a rare disease called Primary Sclerosing Cholangitis, in which the bile ducts inside and outside the liver progressively decrease in size due to inflammation and scarring.

 Symptoms include fatigue, itching, jaundice, and weight loss.

What are the common symptoms of Crohn's disease?

Common symptoms include recurring diarrhoea, abdominal pain and cramping - usually worse after eating and extreme tiredness.

Unintended weight loss and blood and mucus in your stools are also common symptoms.

People may only experience one of the above symptoms, varying from mild to severe.

There may also be weeks or months where symptoms are mild or non-existent.

Less common symptoms include a high temperature, feeling sick and being sick, joint pain and swelling, inflammation and irritation of the eyes and mouth ulcers.

If you have persistent diarrhoea, abdominal pain, unexplained weight loss or blood in your stools, visit your GP.

Pharmacist Warns Common Hay Fever Habit Could Cause More Serious Eye Problems

A pharmacist has warned people that suffer with hay fever and other allergies should avoid rubbing their eyes as it could cause bigger problems that last longer

If you suffer from allergies, your eyes may be most impacted (Stock Image)(Getty Images/iStockphoto)

If you suffer with hay fever, or any other allergies, you'll know how irritating it can be around the things that trigger you.

At some point in their lives, one in four people will be affected by allergies, and they can cause sneezing, coughing, rashes, blocked noses, headaches, and itchy red eyes.

They can also provoke respiratory illnesses such as asthma, and skin conditions such as eczema.

The most common allergies involve pollen, dust mites, animal dander (flecks of skin shed by pets), mould, household chemicals, and certain foods.

But if your eyes are affected, they can feel itchy, swollen, gritty, and also look red.

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If you suffer with allergies, it can be seriously irritating (Stock Image)(Getty Images/Science Photo Library RF)

Community pharmacist Sultan Dajani, from Golden Eye, shared how allergies can cause wider eye problems, and how to combat the issues you may face.

Sultan said: "When we encounter an allergen, either from inhaling, swallowing, or simply by the skin coming into contact with it, the body goes into fighting mode and the immune system overreacts to the substance.

It may be tempting to rub your eyes, but it can cause a whole host of issues (Stock Image)(Getty Images/iStockphoto)

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