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.
ABOUT THE AUTHOR(S)
Emily Sohn is a freelance journalist covering health, science and the environment in Minneapolis.
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FAQs
Why am I getting pink eye so much? ›
Risk factors for pink eye include: Exposure to someone infected with the viral or bacterial form of conjunctivitis. Exposure to something you're allergic to, for allergic conjunctivitis. Using contact lenses, especially extended-wear lenses.
What gets rid of pink eye fast? ›If you're having bacterial pink eye symptoms, the fastest way to treat them is to see your doctor. Your doctor can prescribe antibiotic eye drops. According to a review from the Cochrane Database of Systematic Reviews, using antibiotic eyedrops can shorten the duration of pink eye.
Why have I gotten pink eye 3 times? ›Persistent conjunctivitis could be a sign that there is an underlying illness, preventing your body from fighting the disease. This could be a rheumatic disease such as arthritis, systemic lupus erythematosus. It can also be Kawasaki's disease.
Why does my pink eye keep getting worse? ›Pink eye and bacterial conjunctivitis should begin to improve within a week or so. If your symptoms aren't getting better or are still getting worse, this could be a sign that you have another more serious type of eye infection. It could also mean that the infection in your conjunctiva has spread to your cornea.
What deficiency causes pink eye? ›Conjunctivitis can be triggered by a vitamin B2 (riboflavin) deficiency, but supplementing with the entire B complex can increase the availability of vitamin B2 without inducing deficiencies of the other B vitamins. Riboflavin plays an essential role in maintaining the structure and function of the ocular surface.
What kills the pink eye virus? ›Your doctor may prescribe an antibiotic, usually given topically as eye drops or ointment, for bacterial conjunctivitis. Antibiotics may help shorten the length of infection, reduce complications, and reduce the spread to others. Antibiotics may be necessary in the following cases: With discharge (pus)
What is commonly misdiagnosed as pink eye? ›It's common to mistake allergies, styes, iritis, keratitis, and blepharitis for pink eye, but they can have different causes and require different treatments. Your best option is to set up an exam with our team to identify what's causing your symptoms and get the treatment that you need.
How do you know if pink eye is viral or bacterial? ›Color or tint of the whites of eye: Salmon (light pink) color may be a sign of a viral infection. A reddish color is more likely to be a bacterial conjunctivitis. If it's in one or both eyes: If you have pink eye that's in both eyes, a virus is probably causing it.
How long can pink eye live on sheets? ›This depends on what caused the pink eye and the conditions of the surface on which it lives. However, most bacteria are not able to survive after 2 to 8 hours, though some last for 2 days or more. Viruses tend to be more hardy, with most surviving 24 to 48 hours. Some viruses can last up to 8 weeks.
Can you be more prone to pink eye? ›It's one of the most common eye problems for both children and adults. You're more likely to get pink eye if you: Come in contact with someone else who has pink eye. Recently had a respiratory infection, like a cough or a cold.
What day is pink eye the worst? ›
Typically, when contracted, pink eye can last up to two weeks. If you have viral or bacterial conjunctivitis, symptoms are usually the worst about three to five days after the infection begins.
What happens if pink eye isn't getting better? ›Pink eye usually does not have long-term complications. Rarely, the cornea becomes chronically inflamed, leading to permanent vision problems. You should see an ophthalmologist if your pink eye does not resolve or if it gets worse after a week of treatment.
What are the stages of pink eye? ›Stages of bacterial pink eye
A typical bacterial case may start like viral pink eye, with slight irritation and redness. Then drainage in the form of pus will become noticeable. This is usually white, yellow or yellow-green in color. As it dries, it will leave a crusty film on the eyelids.
Eating probiotics and a diet rich in vitamins A, K, C, and B can help to improve eye health and ward off infection. If conjunctivitis already has its pink grip on your peepers and it isn't a bacterial infection, try these remedies to ease your symptoms.
Can pink eye be stress related? ›Stress does not cause pink eye, but one cause of viral conjunctivitis is the herpes virus, which stays dormant in a person's body and can be activated when they experience stress. This can lead to cold sores on the lip, skin rashes, or eye infections such as pink eye.
What foods help heal conjunctivitis? ›Vitamin A and B2 have also been found valuable in the treatment of conjunctivitis. The patient should take liberal quantities of natural foods rich in these two vitamins. The valuable sources of vitamin A are whole milk, curds, butter, carrots, pumpkins, green leafy vegetables, tomatoes, mangoes and papayas.
What are the three types of pink eye? ›There are three main types of conjunctivitis: allergic, infectious and chemical.
What's the difference between pink eye and conjunctivitis? ›Conjunctivitis is most often caused by germs such as viruses and bacteria. "Pink eye" most often refers to a highly contagious viral infection that spreads easily among children. Conjunctivitis can be found in people with COVID-19 before they have other typical symptoms.
What's the difference between pink eye and bacterial pink eye? ›Viral and bacterial conjunctivitis cause similar symptoms, including redness, swelling, itching, and discharge. However, viral conjunctivitis usually causes a thin, watery discharge, while bacterial conjunctivitis causes a thicker discharge.
How long does it take for antibiotic eye drops to work for pink eye? ›If your doctor thinks the pinkeye is caused by bacteria, he or she may prescribe antibiotic eyedrops or eye ointment to kill the bacteria. With antibiotic treatment, symptoms usually go away in 2 to 3 days.
Should you bathe conjunctivitis? ›
Conjunctivitis will normally get better on its own, without any medical treatment, in around one to two weeks. Bathing and cleaning the eyelids with sterile pads/cotton wool and clean water (Boil the water and then let it cool down), is normally all that is needed.
How does bacterial pink eye start? ›Bacterial conjunctivitis can spread from person to person in many ways. These include from hand-to-eye contact, via eye contact with contaminated objects, through sexual encounters with eye to genital contact, or vertically from mother to baby. Bacteria can also spread by large respiratory tract droplets.
Do I need to wash my sheets everyday if I have pink eye? ›Bacterial pink eye requires antibiotics to treat correctly. Take the whole course of antibiotics (these are usually eye drops), throw out any eye makeup or contacts that you've used, wash your pillowcases daily (or at least change them daily), and do not touch your eyes.
Does pink eye get worse over night? ›Medicate At Night
“Germ-caused conjunctivitis intensifies when your eyes are closed. That's why it tends to get worse at night when you're asleep,” says Petersen. “To combat that, put any prescribed antibiotic ointment in your eyes before you go to bed.
Regardless of the cause, there is no evidence that direct exposure to sunlight will help pink eye, and too much sun can be bad for your eyes, just like your skin.
What time of year is pink eye most common? ›Pink eye is more common in the winter months. Get top tips for preventing conjunctivitis.
How long should you stay home with pink eye? ›Anyone with pink eye due to infection should stay away from work or school until symptoms clear. The time it takes for pink eye to clear up will depend on the type. It often resolves in 7–10 days , but some people may need treatment.
How do you know when pink eye is completely gone? ›In many cases, bacteria-caused pink eye will clear in one to two days when treated with antibiotics. Viral pink eye takes a little longer—about one week. The best advice is to consult a health care professional to determine when you or your child's pink eye symptoms are mild enough to interact with others again.
Why is my pink eye not resolving with antibiotics? ›Since conjunctivitis is usually viral, antibiotics won't help. They may even cause harm by reducing their effectiveness in the future or causing a medicine reaction. Instead, the virus needs time to run its course. This typically takes around 2 to 3 weeks.
What is stage 4 pink eye? ›Stage four is the most extreme pink eye stage and in this stage, many vet professionals recommend removing the infected eye due to risk factors for the affected animal and the cattle herd. This is because the ulcer will likely extend completely through the cornea, resulting in the iris protruding through the ulcer.
How long does it take for pink eye to go away with drops? ›
If your doctor thinks the pink eye is caused by bacteria, your doctor may prescribe antibiotic eyedrops or eye ointment to kill the bacteria. With antibiotic treatment, symptoms usually go away in 2 to 3 days.
Can you get pink eye again after just having it? ›Viral conjunctivitis refers to viruses that can infect the conjunctiva. If the person comes into contact with the bacteria or virus again, they could get conjunctivitis again.
How do you know if pink eye is bacterial or viral? ›Color or tint of the whites of eye: Salmon (light pink) color may be a sign of a viral infection. A reddish color is more likely to be a bacterial conjunctivitis. If it's in one or both eyes: If you have pink eye that's in both eyes, a virus is probably causing it.
What age group gets pink eye the most? ›In the United States, bacterial conjunctivitis is more prevalent in children than in adults; 23% of cases are reported in children aged 0-2 years, 28% in children aged 3-9 years, and 13% in children aged 10-19 years. Adults account for 36% of cases.
How can you tell if conjunctivitis is viral or bacterial? ›Viral and bacterial conjunctivitis cause similar symptoms, including redness, swelling, itching, and discharge. However, viral conjunctivitis usually causes a thin, watery discharge, while bacterial conjunctivitis causes a thicker discharge.
Why wont my pink eye go away? ›Viral pink eye often improves on its own in 7 to 10 days. But it can last longer. If your symptoms last longer, call your doctor. If the pink eye is caused by an allergy or chemical, it won't go away until you avoid what's causing it.
How long does pink eye actually last? ›Viral: Pink eye caused by a virus usually clears up within 1 to 2 weeks. But it can take as long as 3 weeks. Bacterial: Even without treatment, mild bacterial conjunctivitis can resolve on its own within a week. More severe cases can take as long as 2 weeks.