Can COVID-19 Cause Itchy Eyes?
New Insights Into Ocular Effects Of Coronavirus Infection
Coronavirus invaded multiple ocular cell types and caused a variety of pathologic changes but, surprisingly, no inflammation, a small autopsy study showed.
Ocular tissue from patients who had COVID-19 at autopsy showed that the SARS-CoV-2 spike RNA localized in neuronal cells of the retina, ganglion cells, corneal epithelia, scleral fibroblasts, and oligodendrocytes of the optic nerve. Common pathologic changes associated with coronavirus infection included cytoid bodies, vascular changes, and retinal edema.
The study was the first to demonstrate presence of the virus in multiple ocular cell types by means of in-situ hybridization (ISH), which validated previous studies that relied exclusively on polymerase chain reaction (PCR)-based methods, reported Daniel S. Chertow, MD, MPH, of the National Institute of Allergy and Infectious Diseases, and co-authors in the American Journal of Pathology.
"What was surprising was the absence of inflammation, contrasting with what we have seen in other viral infections of the eye such as herpesvirus, where infection is typically associated with significant inflammation and tissue damage," Chertow said in a statement from the journal. "This study shows important new insights into SARS-CoV-2 ocular pathogenesis. Specifically, this is the first report to definitively localize SARS-CoV-2 to the retinal inner and outer nuclear cells, retinal ganglion cells, and ocular surface by ISH."
The research highlights the eye as a potential target of coronavirus infection and supports further study to evaluate short- or longer-term ocular effects of COVID-19, he added.
"This research is interesting in that it shows that the majority of people who passed away from COVID-19 had some evidence of the virus in their eyes – either the presence of virus itself in a minority – or the presence of viral RNA," said Sonal Tuli, MD, of the University of Florida in Gainesville and spokesperson for the American Academy of Ophthalmology. "They address the lack of inflammation, as most of the changes they saw were related to the indirect effects of the virus, such as blood clots and leakage from the blood vessels, rather than inflammation due to the tissues getting infected by the virus. That is another interesting finding. In addition, I would suspect that most were on steroids at the time they passed away so any inflammation, if present, would be suppressed."
Studies have shown that SARS-CoV-2 infects tissues throughout the body, including ocular tissues and fluids. In a previous study, investigators found viral nucleocapsid (n) RNA in ocular fluids or tissue in autopsy cases of 23 of 38 patients who had COVID-19. By means of PCR techniques, viral RNA was detected in the cornea, choroid/sclera, lens, retina, optic nerve, vitreous humor, and aqueous humor in 14-59% of cases.
Despite prior studies, information about cellular localization of SARS-CoV-2 remained limited, Chertow and co-authors noted. Viral particle localization in specific ocular cells can provide information about the ocular effects of viral infection. Toward that end, the authors re-examined a subgroup of eyes from the prior autopsy study. The objectives were to evaluate macroscopic and microscopic histopathology and cellular localization by ISH analysis of SARS-CoV-2 spike gene RNA.
The study involved eyes from 25 patients. Ocular tissue from four patients was evaluated by ISH to characterize cellular location of the spike gene RNA. Eyes from the remaining 21 patients were examined by histopathology.
Investigators identified potential COVID-19-associated macroscopic lesions in the retina in six of 21 eyes. Microscopic examination revealed small neovascularization, retinal sclerotic vessels, retinal vascular occlusion with fibrin/thrombi in retinal vessels, and vitreous hemorrhages. Eleven eyes contained cytoid bodies in the nerve fiber layer of the neuroretina and/or optic nerve head. Seven eyes had focal loss of photoreceptor cells, and 14 eyes exhibited retinal/choroidal vascular dilation, congestion, and tortuosity.
Six eyes had serous retinal edema in the inner and outer nuclear layers, and five eyes had optic nerve head edema. Two eyes had fluid accumulation in the outer plexiform layer. Evidence of inflammation was limited to one eye with mild lymphocyte infiltration on the optic nerve and one eye with minimal choroidal monocytic inflammation.
Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow
Disclosures
The study was supported by the National Institute of Allergy and Infectious Diseases, National Eye Institute, National Cancer Institute, the Doris Duke Charitable Foundation, Genentech, the American Association for Dental Research, and the Colgate-Palmolive Company.
The authors reported no relevant relationships with industry.
Primary Source
American Journal of Pathology
Source Reference: Sen HN, et al "Histopathology and SARS-CoV-2 cellular localization in eye tissues of COVID-19 autopsies" Am J Pathol 2023; DOI: 10.1016/j.Ajpath.2023.02.016.
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7 Types Of Eye Infections, Their Symptoms, And How To Treat Them
Examples of types of eye infections include conjunctivitis, keratitis, and cellulitis. Symptoms can include itchiness, discharge, vision changes, and more. Treatment can depend on whether the infection is bacterial or viral.
While many minor eye infections heal well on their own, others can be serious and may cause permanent vision loss.
It is important to contact a health professional if a person has changes with their eyes or vision that could indicate an infection.
This article looks at the different potential eye infections and how to treat them.
Often called "pinkeye," this is the most common eye infection.
The conjunctiva is a thin layer of tissue that covers the whites of the eyes and insides of the eyelids. Conjunctivitis is an infection or inflammation of the conjunctiva.
A person may get the infection in one eye or both.
Types of conjunctivitis include:
Irritation from getting a chemical or foreign object in the eye can also cause conjunctivitis. A person may have excessive eye watering or discharge from the eye if this happens.
No matter what the cause of pinkeye, telltale symptoms include:
A health care professional can often recognize conjunctivitis by examining the eye and discussing the person's symptoms.
Many people can treat viral conjunctivitis at home.
Learn more about how to treat conjunctivitis at home here.
Medical treatments for pinkeye by type include:
A person should avoid touching their eye and should wash their hands frequently to avoid spreading conjunctivitis to others.
It is wise to contact a pediatrician if an infant has signs of conjunctivitis.
Keratitis is inflammation or infection of the cornea, which is the clear outer layer on the colored part of the eye.
The Centers for Disease Control and Prevention (CDC) state that improper contact lens care increases the risk of keratitis. Wearing lenses for too long or not cleaning and storing them correctly can increase the chance of germs getting into the cornea.
Without treatment, keratitis can cause scarring on the cornea and permanent loss of vision.
The different types of keratitis include:
Symptoms of keratitis include:
A doctor may need to use a special light to view the eye or send a sample of cells to a lab for testing to determine which type of keratitis a person is experiencing.
Treatment of keratitis may require antibiotic, antiviral, or antifungal medicine in the form of eye drops or pills.
Endophthalmitis is an infection of the fluid or tissue inside the eye. It requires immediate medical treatment, or it may cause blindness.
According to 2018 research, worldwide cataract surgery is the most common cause of this condition.
Two common types of endophthalmitis include:
Symptoms of endophthalmitis include:
The American Society of Retina Specialists say that most cases of endophthalmitis require antibiotic or antifungal injections and possibly emergency surgery.
Cellulitis is a bacterial or fungal infection. It can affect the skin and the eyes.
Two types of cellulitis may affect the eyes:
Symptoms of cellulitis in the eye include:
A doctor may diagnose cellulitis of the eye with certain scans or a blood test. They may also take a small sample of cells from the eyes or nose.
Cellulitis requires antibiotic treatment. Sometimes a person needs antibiotics given in the hospital. More severe cases may require surgery to drain fluid from the infection.
A stye is an infection in the eyelid, usually in an eyelash follicle or one of the oil glands of the eyelid.
Bacteria can cause a stye that may occur if a person touches their eye with unwashed hands or after touching their nose.
A stye may appear on the eyelash line or just inside the edge of the eyelid.
Symptoms include:
Most styes will clear on their own with home care.
A person can use a warm compress for 15 minutes, four times a day. They can also gently massage the nodule.
Learn more about how to get rid of a stye here.
Blepharitis is inflammation of the eyelids. Causes include bacterial infection, allergies, clogged oil glands in the eyelids, and certain skin conditions.
There are two main types of blepharitis:
Symptoms of blepharitis are:
A doctor may diagnose blepharitis through an eye exam and discussion of symptoms.
Blepharitis symptoms respond to home care. Regular cleaning of the eyelids and eyelashes with water and baby shampoo is helpful.
If a person has dandruff or rosacea, they can talk to a doctor about effective treatment for these conditions to help keep blepharitis under control.
Severe cases of blepharitis may require antibiotics or steroids.
Uveitis is inflammation of the uvea, which is the middle layer of the eyeball that contains the iris.
Doctors associate uveitis with certain health conditions, including:
Symptoms of uveitis include:
Doctors may diagnose uveitis with an eye exam, health history, blood tests, and imaging tests, such as an MRI.
Treatment may include steroids in the form of pills, eye drops, or injections.
Some eye infections, such as a stye or blepharitis, respond well to home care. However, other eye infections, such as endophthalmitis, are serious and can potentially lead to a permanent loss of vision.
If a person has signs of an eye infection, they should contact a doctor. Severe symptoms, such as extreme pain or a sudden loss of vision, require emergency medical care.
Likewise, if symptoms of a stye, blepharitis, or conjunctivitis fail to improve with home care, people should see a doctor.
There are many different types of eye infections. Most are not a cause for concern. However, some are an ocular emergency, and a person should seek medical help to reduce the chances of vision loss.
If a person notices bothersome changes with their eyes or vision, they should speak to a doctor.
Rheumatoid Arthritis Affects More Than Just Your Joints: Note The Unusual Symptoms Of The Condition
Rheumatoid Arthritis (RA) is an autoimmune condition that primarily affects the joints. It leads to inflammation and pain and occurs when the immune system doesn't work properly and attacks the lining of the joints, called the synovium. The condition can negatively impact many parts of the body, most commonly the hands, knees or ankles. However, RA is not just a joint problem. It can affect other organs and parts of the body too. Dr Shaloo Bhasin Gagneja, Senior Consultant-Rheumatology, Manipal Hospital, Gurugram, explains how and discusses how people with RA can improve their quality of life.
Rheumatoid Arthritis (RA) Goes Beyond Joint Problems"RA is a condition that is often misunderstood as a simple joint problem, but the reality is that it goes far beyond that," said Dr Gagneja, adding, "The joint pain and stiffness that are characteristic of RA are just the beginning."
According to the Mayo Clinic, the chronic inflammatory disorder can also damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels.
Also Read: Beware Of These Triggers That Can Worsen Joint Pain In Rheumatoid Arthritis
The Arthritis Foundation describes RA as a systemic disease, meaning it can affect many parts of the body.
The charity said, "In addition, the drugs used to treat RA can also cause health problems. Many of these problems, such as bone thinning or changes in kidney function, cause no immediate symptoms so your doctor may monitor you through lab tests or checkups."
How Rheumatoid Arthritis Affects The EyesOne common eye issue associated with rheumatoid arthritis is dry eyes, which can result from RA-related conditions like Sjögren's syndrome, which causes a decrease in the amount of moisture in the eyes and mouth, according to Mayo Clinic.
In addition, RA can also lead to inflammation of the eye's white part, known as scleritis or episcleritis, leading to redness, pain, and potential vision problems.
Moreover, RA may increase the risk of uveitis, a condition that can result in eye pain, redness, and blurred vision.
Skin Problems Associated With RAArthritis can also cause skin issues, which is often triggered by RA-related inflammation of the blood vessels, also known as vasculitis. It can lead to rashes characterised by small red dots, says the Arthritis Foundation. In certain cases, medications used to treat RA, such as corticosteroids, can cause thinning of the skin and susceptibility to bruising, the charity adds further.
Impact On LungsBesides causing fatigue, fever, loss of appetite, redness and pain of eyes, and skin rash, Dr Gagneja said that RA can also lead to breathing difficulties, hinting at how RA can impact lung health too. According to the Mayo Clinic, lung issues associated with rheumatoid arthritis include scarring (interstitial lung disease) leading to breathlessness and cough, lung nodules (rheumatoid nodules), and pleural inflammation with possible fluid buildup causing breathing difficulties.
Also Read: How Temperature Changes Influence The Risk Of Gout Attack: Measures To Take
Rheumatoid Arthritis Can Also Cause Easy BruisingThere are a combination of factors behind why RA causes easy bruising. One primary reason is the use of certain medications to manage RA, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, which can affect blood clotting, making it easier for blood vessels to break and result in bruises.
Additionally, chronic inflammation in RA can lead to fragile blood vessels and compromised platelet function, contributing to easy bruising. Reduced mobility and joint pain in RA may also lead to accidental bumps and injuries, further increasing the likelihood of bruising.
Managing The ConditionDr Gagneja said, "Managing RA requires a comprehensive approach that addresses all aspects of the disease. This may involve medication to control inflammation and pain, physical therapy to improve mobility, and counselling to address the emotional impact of living with a chronic illness."
"It is important that people be aware about this condition and its potential impact on their lives. By understanding the severity of this condition and the available treatment options, patients can take an active role in managing their symptoms and improving their quality of life," she added.
Remember, with appropriate treatment and self-care, it is possible for patients with RA to lead fulfilling and productive lives, despite the challenges posed by the condition.
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