COVID conjunctivitis is inflammation of the conjunctiva (the clear membrane covering the white of the eye and inner eyelids) caused directly or indirectly by infection with the SARS-CoV-2 virus, the virus that causes COVID-19. It often presents with red eyes, tearing, irritation, itching, and sometimes a discharge. While most cases are mild and self-limited, conjunctivitis can be the first or only sign of COVID-19 in some people, and in rare cases may reflect more serious systemic infection. Early in the pandemic, clinicians noticed that SARS-CoV-2 could infect ocular surface cells, leading to conjunctival inflammation and potentially serving as both a site of viral entry and a source of viral shedding.NCBI PMC Ophthalmology Advisor
COVID conjunctivitis is an inflammation of the transparent membrane that lines the white part of the eye and the inside of the eyelids (the conjunctiva) caused directly or indirectly by the novel coronavirus SARS-CoV-2. Scientists have detected the virus or its RNA in tears, conjunctival swabs, and even corneal tissue, proving that the eye can act both as an entry point for infection and as a site where the virus replicates. Cellular studies have shown that conjunctival and corneal epithelial cells possess the key docking proteins—angiotensin-converting enzyme-2 (ACE2) and the serine protease TMPRSS-2—needed for SARS-CoV-2 to fuse with the cell membrane and start its life-cycle. Clinically, the illness usually presents as a self-limiting, “pink-eye”-style redness, but it can occasionally progress to more aggressive kerato-conjunctivitis or trigger neuro-inflammatory cascades that affect deeper ocular structures. Conjunctival infection may precede, accompany, or follow the familiar respiratory symptoms of COVID-19, and some patients develop ocular problems weeks or months after recovering from the acute disease. Because the conjunctiva is so exposed, COVID conjunctivitis has public-health relevance: unprotected eyes can theoretically transmit virus-laden droplets to caregivers, and irritation makes patients rub their eyes and contaminate their hands, amplifying spread. The condition therefore bridges ophthalmology, virology, immunology, and infection-control practice. PubMedScienceDirectBMJ Open Gastroenterology
2. Why does it happen?
When coronavirus-laden droplets land on the ocular surface, some viral particles bind to ACE2 receptors on conjunctival or corneal cells. TMPRSS-2 “primes” the viral spike protein, letting the virus slip inside and hijack the cell’s machinery. The infected cells release “danger” molecules such as interferons, interleukin-6, and tumor-necrosis-factor-alpha; these summon immune cells that make the eye red, sore, watery, and light-sensitive. Meanwhile, the virus and inflammatory mediators can destabilize tear-film proteins and lipids, causing a gritty foreign-body sensation and fluctuating vision. Because the ocular surface is heavily innervated, cytokine bursts sometimes spill into the trigeminal pathway, explaining why some patients complain of headache or neuralgic pain around the orbit. If the cornea is involved, tiny epithelial defects can allow secondary bacterial colonization, raising the risk of keratitis. Fortunately, the infection is usually mild: meta-analyses covering thousands of patients put the prevalence of eye symptoms between 3 % and 11 %, and most episodes resolve within two weeks with supportive care. Nevertheless, severe or prolonged conjunctival disease signals a higher systemic viral load, a dysregulated immune response, or a co-existing ocular disorder that needs attention. PMCOphthalmology AdvisorFrontiers
Because the conjunctiva has ACE2 receptors and TMPRSS2 (proteins that facilitate viral entry), the eye is biologically plausible as a site of infection. Most patients recover fully from the eye symptoms, but conjunctivitis has also been associated in some studies with more severe systemic COVID-19 illness.Journal of Infection
Types / Clinical Presentations of COVID Conjunctivitis
COVID conjunctivitis can vary in severity and appearance. Key presentations include:
Mild viral conjunctivitis – redness, watery discharge, gritty feeling, often unilateral or bilateral, resembling other viral conjunctivitides.MDPI
Follicular conjunctivitis – small raised lymphoid follicles on the tarsal conjunctiva, sometimes seen in SARS-CoV-2 infection.www.elsevier.com
Chemosis and ocular surface swelling – conjunctival edema (chemosis) that may accompany inflammation.PMC
Pseudomembranous or membranous conjunctivitis – more severe, with fibrinous material forming on conjunctiva (described in some cases of SARS-CoV-2, particularly with marked inflammation).www.elsevier.com
Ocular pain or photophobia – occasionally reported especially when deeper involvement or associated ocular surface irritation exists.PMC
Most patients recover without long-term sequelae, but unusual cases have reported transient visual changes or complications if mismanaged.PMC
SARS-CoV-2 can reach ocular tissues either through droplets contacting the eye surface or via systemic spread. Viral binding to ACE2 receptors on conjunctival and corneal epithelial cells, aided by TMPRSS2 protease, allows entry and local replication, triggering an inflammatory response. The immune system’s reaction leads to redness, swelling, and tearing. Tear fluid can contain viral RNA, making the eye a potential, though not the primary, route of transmission.Lippincott Journalswww.elsevier.com
Although clinicians sometimes lump every red eye under one umbrella, closer observation shows several overlapping patterns:
Acute follicular conjunctivitis – The commonest phenotype. Small gray-white “follicles” (collections of lymphocytes) pepper the inside of the lower lids. It resembles adenoviral pink-eye and lasts 7-14 days.
Papillary conjunctivitis – Tiny “cobblestone” bumps, more obvious on the upper tarsal plate, linked to robust mast-cell and eosinophil activation. Patients often itch.
Membranous or pseudomembranous conjunctivitis – Fibrinous exudate coats the palpebral conjunctiva, adhering like wet tissue paper. Removal may reveal bleeding points. It reflects intense local inflammation.
Hemorrhagic conjunctivitis – Flame-shaped subconjunctival bleeds blur the distinction between redness and bruise. Micro-vascular fragility from viral endothelial damage plus coughing-induced venous spikes likely contribute.
Keratoconjunctivitis – The corneal epithelium shows punctate defects or map-dot opacities; vision blurs, and photophobia dominates. Tear-film disruption, immune infiltration, and direct viral cytotoxicity converge here.
Delayed or post-infectious conjunctivitis – Appears days to months after negative nasopharyngeal swabs. Thought to be immune-mediated, analogous to multisystem inflammatory syndrome, with elevated interleukin-17 and immune complexes. Sometimes relapses. PMCBMJ Ophthalmology
Main causes and risk factors
Below are twenty distinct drivers or facilitators of COVID-related conjunctival inflammation, each unpacked in simple language.
High systemic viral load – More circulating virus increases the chance that droplets containing infectious particles reach the eye.
Direct droplet exposure – Sneezes, coughs, or aerosolized procedures propel virus toward the conjunctiva, bypassing masks.
Eye-rubbing behavior – Touching one’s face with contaminated hands seeds virus onto the ocular surface.
Lack of eye protection – Healthcare workers without goggles during aerosol-generating tasks have measurably higher rates of conjunctivitis.
Up-regulated ACE2/TMPRSS-2 expression – Certain genetic backgrounds, smoking, or topical steroid use can increase receptor density, giving the virus more “doors.”
Tear-film instability or dry eye disease – A thin or patchy tear film fails to wash away pathogens effectively.
Contact-lens wear – Lenses trap virus-laden tears against the conjunctiva, and insertion/removal introduces mechanical trauma.
Allergic conjunctival disease – Pre-existing allergic inflammation primes vessels and immune cells, lowering the infection threshold.
Diabetes mellitus – Hyper-glycemia impairs neutrophil chemotaxis and epithelial healing, making infection easier.
Systemic immunosuppression – Chemotherapy, biologics, or HIV reduce antiviral defenses.
Advanced age – Tear production and innate immunity decline, while comorbidities accumulate.
Pediatric immune hyper-reactivity – Children’s vigorous innate responses can paradoxically produce more overt conjunctival signs.
New SARS-CoV-2 variants with ocular tropism – Laboratory data hint that certain spike mutations increase adhesion to ocular glycans.
High environmental viral burden – Crowded, poorly ventilated spaces raise ocular exposure.
Prolonged screen time – Reduced blink rate dries the ocular surface, diminishing its self-cleaning function.
Air pollution – Particulate matter irritates the conjunctiva, up-regulating ACE2 and inflammatory cytokines.
Vitamin-A deficiency – A malnourished ocular surface loses mucin-secreting goblet cells, easing viral docking.
Lagophthalmos or incomplete eyelid closure – During sleep the cornea may desiccate and micro-abrade, offering viral entry points.
Nasolacrimal duct reflux – Forceful nose-blowing can push infected secretions back toward the eye.
Poor compliance with hand hygiene – The simplest but most persistent driver; unwashed hands repeatedly deliver pathogens to the conjunctiva. MDPIPMC
Common symptoms
Each symptom below is unpacked so readers can visualize and understand it.
Red or “pink” eye – Inflamed blood vessels dilate, coloring the normally white sclera.
Watery discharge – Serum leaks out of engorged capillaries; the fluid is mostly tears mixed with inflammatory proteins.
Gritty, foreign-body sensation – Shed epithelial cells and exposed nerve endings trick the brain into feeling “sand” in the eye.
Itching (pruritus) – Histamine released by mast cells stimulates itch-specific nerve fibers.
Burning or stinging – Tear-film hyper-osmolarity and cytokines activate nociceptors.
Photophobia – Inflamed trigeminal endings amplify light-triggered signals, making normal daylight painful.
Eye pain or soreness – Deeper neuro-inflammatory involvement irritates ciliary nerves.
Mild blurred vision – Tear-film irregularities scatter light; corneal epithelial edema further distorts focus.
Eyelid swelling (chemosis) – Plasma proteins tug water into the loose subconjunctival tissue, ballooning it outward.
Mucus strings – Goblet cells pump out sticky mucins as a defense, which clump with cell debris.
Excessive tearing (epiphora) – Reflex tearing tries to dilute and flush out irritants but may overwhelm drainage.
Subconjunctival hemorrhage – Ruptured micro-vessels leave bright-red patches that look alarming but are usually harmless.
Crusting on waking – Overnight, dried exudate glues the lashes together until warm tears dissolve it.
Headache radiating from the brow – Sensitized supra-orbital nerves share pathways with ocular pain fibers.
Visual halos at night – Irregular tear film and corneal edema scatter point-light sources like street lamps, producing rainbow rings. NCBIFrontiers
Further diagnostic tests
A. Physical-exam–based tests
1. External ocular inspection
A torch-light survey notes lid swelling, conjunctival redness, discharge color, and any subconjunctival hemorrhage. Experienced clinicians can estimate severity and exclude dangerous mimics such as scleritis.
2. Visual-acuity measurement
Reading a Snellen or logMAR chart detects subtle corneal involvement: a drop of two lines may signal keratitis and warrants slit-lamp evaluation.
3. Slit-lamp biomicroscopy
A magnified, oblique beam lets the examiner count follicles, inspect corneal epithelium, and gauge aqueous flare. It is the definitive office test for grading conjunctivitis.
4. Pupillary light reflex
Checking for equal, brisk constriction rules out optic-nerve or cranial-nerve palsy masquerading as photophobia. ScienceDirect
B. Manual tests
5. Schirmer tear test
A narrow strip of filter paper placed in the lower fornix measures basal tear output. Values under 10 mm/5 min suggest dry-eye overlap.
6. Fluorescein staining
A drop of orange dye turns vivid green under cobalt-blue light, highlighting epithelial defects on cornea or conjunctiva.
7. Digital tonometry (finger palpation)
Gently pressing the globe through closed lids gives a rough idea of intra-ocular pressure when instruments are unavailable, ensuring no hidden glaucoma.
8. Eyelid eversion and tarsal examination
Flipping the upper lid reveals papillae, membranes, or foreign bodies, guiding management. MDPI
C. Laboratory and pathological tests
9. Conjunctival RT-PCR for SARS-CoV-2
A sterile swab rolled over the inferior fornix captures epithelial cells and tears; positive RNA confirms direct ocular infection.
10. Tear-film viral culture
Special biosafety labs can grow live virus from tears, proving infectivity, although this is rarely done clinically.
11. Complete blood count (CBC)
Lymphopenia, neutrophilia, or thrombocytopenia signal systemic COVID-19 severity and co-agulopathy risk.
12. C-reactive protein (CRP)
An elevated CRP mirrors systemic inflammation and correlates with ocular symptom persistence.
13. Conjunctival impression cytology
A cellulose acetate filter gently lifts superficial cells; microscopy can show cytopathic changes and quantify goblet-cell loss. PMC
D. Electro-diagnostic tests
14. Visual-evoked potentials (VEP)
Electrodes on the scalp record cortical responses to checkerboard flashes; prolonged latencies hint at optic-nerve or retinal pathway insult by neuro-inflammation.
15. Electro-retinography (ERG)
Contact-lens electrodes gauge retinal photoreceptor and bipolar-cell activity; abnormalities may accompany kerato-conjunctivitis in severe systemic disease.
16. Electro-oculography (EOG)
Measures the standing potential between the cornea and retina while the eye moves; reduced light-rise may reflect widespread retinal pigment epithelium stress. NCBI
E. Imaging tests
17. Anterior-segment optical coherence tomography (AS-OCT)
Cross-sectional, high-resolution images quantify conjunctival and corneal thickness, visualize epithelial defects, and monitor healing over time.
18. Standard corneal OCT
Maps stromal reflectivity; hyper-reflective foci indicate inflammatory cell infiltration in kerato-conjunctivitis.
19. Orbital ultrasonography (B-scan)
A gel-coated probe on closed lids rules out posterior scleritis or orbital cellulitis when pain seems disproportionate.
20. Chest computed tomography (CT)
While not an eye test per se, identifying ground-glass opacities or pulmonary emboli helps stage systemic COVID-19 and guide anticoagulation, which indirectly protects ocular vessels. ScienceDirect
Non-Pharmacological Treatments
These are the core supportive interventions for symptom relief, transmission reduction, and ocular surface protection. Each is described with what it is, why it’s used, and how it works.
Artificial tears (lubricating eye drops) – These are preservative-free saline or lubricant drops that moisten the ocular surface, relieving dryness, irritation, and the gritty feeling that comes with conjunctivitis. They dilute inflammatory mediators and help flush out irritants.MDPI
Cold compresses – Applying a clean, cool compress over closed eyelids reduces inflammation, swelling, and discomfort from conjunctival hyperemia. Cold causes vasoconstriction, which decreases redness and soothes itching.MDPI
Eyelid hygiene – Gentle cleaning of eyelid margins with diluted baby shampoo or commercial eyelid scrubs keeps the eyelids free of crust and potential secondary bacterial contamination, especially if discharge is present. It supports barrier health and prevents rubbing-infection cycles.MDPI
Avoiding eye rubbing – Rubbing spreads virus particles on the ocular surface and can worsen inflammation. Encouraging patients to resist touching their eyes reduces autoinoculation and transmission.MDPI
Proper hand hygiene – Regular handwashing or alcohol-based sanitizer use before touching the face or eyes prevents transfer of virus to the ocular surface from contaminated hands.MDPI
Face/eye protection (goggles or face shields) – Especially for healthcare workers or close contacts, physical barriers prevent droplets from reaching the ocular surface, reducing risk of initial infection.Lippincott Journals
Isolation / avoiding close contact – Keeping infected individuals separated limits spread through respiratory droplets that could eventually contaminate the eyes of others. Social distancing and mask use also play into this.Ophthalmology Advisor
Environmental hygiene (surface disinfection) – SARS-CoV-2 can survive on surfaces; cleaning frequently touched items reduces indirect transfer to hands then to eyes.CDC
Adequate hydration – Maintaining systemic hydration keeps tear film healthy and reduces ocular surface dryness, mitigating discomfort. (General supportive care principle supported in viral illnesses).MDPI
Rest and sleep – Proper rest supports immune function and helps the body resolve viral inflammation more efficiently. Fatigue can worsen perception of eye irritation.Office of Dietary Supplements
Use of humidifiers – Adding moisture to dry air helps maintain tear film integrity and reduces ocular surface irritation from dryness.MDPI
Avoidance of contact lenses during active eye symptoms – Contact lenses can trap virus or irritate an inflamed eye; switching to glasses prevents further mechanical irritation and contamination.Cleveland Clinic Journal of Medicine
Eye protection during sleep (if rubbing is habitual) – Soft mittens or awareness strategies to minimize unconscious rubbing helps avoid self-transfer. (Inference based on transmission prevention principles.)MDPI
Reducing screen time / eye strain – Excessive near work can exacerbate subjective discomfort; giving the eyes frequent breaks allows better healing.MDPI
Avoiding smoky/polluted environments – Irritants worsen conjunctival inflammation; staying in clean air reduces irritation and secondary inflammation.MDPI
Warm compress (if associated meibomian dysfunction or obstructive blepharitis) – In cases where eyelid inflammation coexists, a warm compress can soften secretions and help eyelid margin health, indirectly improving ocular comfort.MDPI
Patient education about symptom recognition and hygiene – Teaching patients early signs and proper handling reduces delay in care and limit spread.MDPI
Tear conservation strategies (e.g., blinking exercises) – Encouraging full blinks improves tear distribution and ocular surface lubrication.MDPI
Avoid sharing towels, cosmetics, or pillows – Personal items can carry virus; isolation of these prevents fomite spread to others’ eyes.Ophthalmology Advisor
Monitoring and self-assessment logs – Patients tracking redness, discharge, vision, and systemic symptoms can identify worsening early and seek timely care. (Best-practice patient self-management inference supported by general infectious disease guidance.)Nature
Drug Treatments
Because COVID conjunctivitis is usually a manifestation of systemic infection, treatment focuses on both the underlying SARS-CoV-2 infection (when indicated) and the ocular inflammation/symptoms.
A. Systemic Antiviral / COVID-19–Directed Therapies (used when the patient has confirmed COVID-19 with risk of progression)
Nirmatrelvir with Ritonavir (Paxlovid)
Class: SARS-CoV-2 protease inhibitor boosted with CYP3A inhibitor.
Dosage: 300 mg nirmatrelvir with 100 mg ritonavir orally twice daily for 5 days in eligible non-hospitalized adults at high risk for progression.
Purpose: Directly inhibits viral replication, reducing severity and duration.
Mechanism: Nirmatrelvir inhibits the viral main protease (Mpro), blocking replication; ritonavir slows its metabolism to maintain effective levels.
Side Effects: Altered taste, diarrhea, hypertension, potential significant drug-drug interactions due to ritonavir’s effect on liver enzymes. Requires medication review before use.Infectious Diseases Society of AmericaNCBIMinnesota Department of Health
Remdesivir
Class: Nucleotide analog prodrug (RNA polymerase inhibitor).
Dosage: Typically intravenous administration; for outpatient early disease, a 3-day course; hospitalized patients with oxygen needs get longer courses per protocol.
Purpose: Reduce progression to severe disease.
Mechanism: Incorporates into viral RNA, causing premature termination of replication.
Side Effects: Elevated liver enzymes, infusion-related reactions, renal monitoring sometimes considered.CDCNCBI
Molnupiravir
Class: Nucleoside analog inducing viral error catastrophe.
Dosage: Oral, usually 800 mg twice daily for 5 days (used when first-line agents aren’t suitable).
Purpose: Second-line antiviral for those at risk but where Paxlovid/remdesivir are inappropriate.
Mechanism: Introduces mutations during viral replication, leading to nonviable progeny.
Side Effects: Diarrhea, nausea, dizziness; lower efficacy compared to Paxlovid.CDCThe Lancet
Combination / Rescue Therapy (e.g., remdesivir plus nirmatrelvir/ritonavir)
Class: Dual antiviral strategy.
Purpose: Used in persistent or relapsing viral replication, especially in immunocompromised patients.
Mechanism: Targeting viral replication at multiple steps may overcome monotherapy failure.
Side Effects: Additive risk of drug interactions; careful clinical judgment required.Nature
Supportive systemic therapy (e.g., judicious use of anti-inflammatory treatment in severe systemic disease) – not for ocular use alone but may reduce systemic inflammatory milieu that indirectly benefits conjunctival inflammation. (Example: use of systemic corticosteroids or immunomodulators in severe COVID-19 per guidelines, under specialist care.)Infectious Diseases Society of America
B. Ocular (Topical) Symptom-Directed Treatments
Topical artificial tears (as “drug” when medicated) – Although non-prescription, they are often formulated as over-the-counter ophthalmic agents to relieve symptoms. Frequent instillation (e.g., 4–6 times/day) reduces discomfort.MDPI
Topical antihistamine/mast cell stabilizers (e.g., olopatadine, ketotifen)
Class: Anti-allergic eye drops.
Purpose: Reduce itching and some hyperemia (especially if allergic-type component or irritation present).
Mechanism: Block histamine receptors and stabilize mast cells to prevent mediator release.
Side Effects: Mild burning, dry eyes.AAO Journal
Topical corticosteroids (only under ophthalmologist supervision)
Class: Anti-inflammatory steroid drops (e.g., loteprednol, prednisolone acetate).
Purpose: For severe inflammation or pseudomembrane formation not responding to basic care.
Mechanism: Suppress immune-mediated inflammation; reduce conjunctival swelling and discomfort.
Side Effects: Increased intraocular pressure, cataract risk with prolonged use, possible worsening of viral replication if misused — must be carefully managed.AAO Journal
Topical antibiotic prophylaxis (e.g., polysporin ophthalmic or erythromycin ointment)
Class: Broad-spectrum antibacterial eye ointments.
Purpose: Prevent secondary bacterial infection when discharge is purulent or eyelid margin involvement is suspected.
Mechanism: Local suppression of bacterial colonization.
Side Effects: Minimal; possible local irritation or allergic contact dermatitis.AAO Journal
Topical antiviral therapy (rare and not standard for COVID conjunctivitis) – Most viral conjunctivitides (including COVID-related) do not have approved topical antivirals; use is limited to specific viruses like herpes simplex. Emphasis remains on supportive care. This is a cautionary note to avoid off-label unproven topical antivirals for SARS-CoV-2 ocular infection unless in a trial.MDPI
Dietary Molecular Supplements
These supplements are aimed at supporting the immune system and possibly reducing the risk or severity of respiratory viral infections, including SARS-CoV-2. Evidence varies by supplement; dosages are typical adult recommendations when used responsibly, and a healthcare provider should tailor to individual needs and check for interactions.
Vitamin D
Dosage: Common supplementation ranges from 1,000 to 4,000 IU daily depending on baseline levels; higher loading may be used under medical supervision if deficient.
Function: Supports innate and adaptive immunity, modulates inflammatory cytokine release.
Mechanism: Vitamin D receptor activation influences gene expression that reduces pro-inflammatory responses and enhances antimicrobial peptide production.
Evidence: Supplementation linked to reduced risk of acute respiratory infections; deficiency associated with worse COVID-19 outcomes.SMWOffice of Dietary Supplements
Vitamin C
Dosage: 500 mg to 1,000 mg twice daily (higher doses used short-term in illness, but beware of gastrointestinal upset).
Function: Antioxidant, supports white blood cell function, regenerates other antioxidants.
Mechanism: Scavenges reactive oxygen species; supports barrier integrity and leukocyte activity.
Evidence: May reduce severity/duration of respiratory infections; data in COVID-19 are mixed but potentially beneficial in deficiency.U.S. PharmacistVerywell Health
Zinc
Dosage: 8–11 mg daily (upper supplement limit 40 mg/day for adults unless guided).
Function: Critical for antiviral immunity and wound healing.
Mechanism: Inhibits viral replication in some viruses, modulates T-cell function, supports mucosal barrier.
Evidence: Zinc supplementation early in viral illness may shorten duration; necessary for proper immune response.EatingWellU.S. Pharmacist
Quercetin
Dosage: 500 mg twice daily is used in some supportive protocols (bioavailability varies).
Function: Bioflavonoid with antioxidant and potential antiviral properties.
Mechanism: May inhibit viral entry and replication, stabilize cell membranes, and modulate inflammation.
Evidence: Included in immune support discussions, often combined with zinc for synergistic effect.U.S. PharmacistVerywell Health
Omega-3 Fatty Acids (EPA/DHA)
Dosage: 1,000 mg of combined EPA/DHA daily (studies in hospitalized COVID used 400 mg EPA + 200 mg DHA for 14 days).
Function: Anti-inflammatory, modulates immune cell function.
Mechanism: Precursor to specialized pro-resolving mediators that help resolve inflammation and support cell membrane health.
Evidence: Trials showed improved survival in critically ill COVID-19 patients receiving omega-3 supplementation.Office of Dietary Supplements
Probiotics
Dosage: Variable by strain; common formulations provide 1–10 billion CFUs daily.
Function: Support gut microbiome, which has downstream effects on systemic immunity.
Mechanism: Modulate gut-associated lymphoid tissue, enhance mucosal immunity, reduce systemic inflammation.
Evidence: Gut health is linked to better immune response; some evidence suggests probiotics can reduce respiratory infection risk.EatingWellOffice of Dietary Supplements
Melatonin
Dosage: 3–10 mg at bedtime (used more in experimental/adjunct settings).
Function: Regulates circadian rhythm and has anti-inflammatory and antioxidant effects.
Mechanism: Suppresses overactive inflammatory signaling, scavenges free radicals.
Evidence: Discussed as adjunct in managing inflammation in COVID-19 (mostly theoretical/early data).U.S. Pharmacist
Selenium
Dosage: 55 mcg/day (upper limit ~400 mcg/day).
Function: Supports antioxidant enzymes (glutathione peroxidase) and immunity.
Mechanism: Reduces oxidative stress, supports T-cell proliferation.
Evidence: Adequate selenium status linked to better viral infection outcomes in general; deficiency may impair immune response.Office of Dietary Supplements
B Vitamins (especially B6 and B12)
Dosage: B6 around 1.3–2 mg/day, B12 2.4 mcg/day (higher doses used if deficiency present).
Function: Support energy metabolism and immune cell function.
Mechanism: Cofactors for immune signaling pathways and antibody production.
Evidence: General immune support; deficiencies can impair immune response.ScienceDirect
N-acetylcysteine (NAC)
Dosage: 600–1,200 mg daily (with medical guidance).
Function: Precursor to glutathione, antioxidant, mucolytic.
Mechanism: Replenishes intracellular glutathione, reduces oxidative stress, may thin secretions.
Evidence: Explored as supportive therapy in viral respiratory illnesses to reduce oxidative damage; some emergent discussion in COVID contexts.ScienceDirect
Regenerative / “Hard Immunity” / Stem Cell–Related Therapeutic Approaches
These are not standard of care for mild COVID conjunctivitis but have been studied in severe or persistent COVID-19 for immune modulation and tissue recovery. The evidence is evolving, and usage should be limited to clinical trials or specialized centers.
Mesenchymal Stem Cells (MSCs) from Umbilical Cord or Bone Marrow
Dosage: Varies by trial (commonly intravenous infusions of 1–3 ×10^6 cells/kg, sometimes repeated).
Function: Immune modulation and tissue repair.
Mechanism: Secrete anti-inflammatory cytokines, suppress cytokine storm, promote regeneration by paracrine signaling, and enhance endothelial stabilization.
Evidence: Meta-analyses and clinical trials show MSC therapy is generally safe, reduces inflammation, improves clinical outcomes in severe COVID-19 pneumonia, and has long-term safety data up to years.PubMedBioMed CentralPubMed
MSC-derived extracellular vesicles (MSC-EVs / exosomes)
Dosage: Still experimental; dosing based on protein content or vesicle count in trials.
Function: Deliver regenerative and immunomodulatory signals without whole-cell transplant.
Mechanism: Contain microRNAs, proteins, and lipids that reduce inflammation and promote healing.
Evidence: Early clinical trials suggest benefit in lung injury and systemic inflammation in COVID-19; safety profile favorable.Minnesota Department of Health
Combined or prolonged antiviral + MSC rescue in persistent infection (immune-refractory)
Dosage: Individualized (e.g., extended antiviral course plus MSC infusions).
Function: Aim to suppress persistent viral replication while modulating dysregulated immune response.
Mechanism: Dual approach—direct viral suppression plus immune regulation.
Evidence: Emerging practice in complex, persistent cases, especially immunocompromised.Nature
Limbal Stem Cell–related ocular surface regenerative approaches (for severe conjunctival scarring context)
Dosage: Surgical transplantation, not a “drug” per se; involves cultivated limbal stem cell grafts.
Function: Restore ocular surface stem cell population after scarring injuries (e.g., severe cicatrizing conjunctivitis).
Mechanism: Replaces damaged epithelial progenitors to re-establish healthy conjunctiva/cornea interface.
Evidence: Used in symblepharon and cicatrizing disease reconstruction; must avoid transplant during active inflammation.EyeWiki
Amniotic membrane–based biological scaffolds / extracts (AMEED)
Dosage: Applied surgically or as drops in advanced surface disease.
Function: Facilitate healing, reduce inflammation, provide substrate for epithelial regrowth.
Mechanism: Contains growth factors and anti-fibrotic agents that modulate scarring and promote regeneration.
Evidence: Reviewed as safe and effective in ocular surface reconstruction, including conjunctival fornix obliteration.Annals of Eye SciencePMC
Oral mucosal or conjunctival autograft in severe scarring after surgical release (adjunct regenerative surgical approach)
Dosage: Surgical procedure; graft applied after excision of fibrotic tissue.
Function: Reconstruction of normal anatomical relationships and restoration of surface epithelium.
Mechanism: Replaces cicatricial tissue with healthy tissue containing regenerative capacity.
Evidence: Good long-term anatomical and cosmetic outcomes in symblepharon management.ScienceDirect
Note: For COVID conjunctivitis itself, these regenerative therapies are not routine; their inclusion here is primarily in the context of severe systemic COVID or complicated ocular surface scarring from secondary processes.Nature
Surgeries / Procedural Interventions
COVID conjunctivitis is rarely a primary surgical disease, but chronic or cicatrizing sequelae (often from secondary immune-mediated scarring or overlapping ocular surface disorders) might require procedures:
Symblepharon Release
Procedure: Surgical excision of adhesions between palpebral and bulbar conjunctiva.
Why Done: To restore mobility of the eyelid and eyeball, prevent restricted eye movement, and relieve discomfort from adhesion.
Context: Severe conjunctival scarring from chronic inflammation or cicatrizing conjunctivitis.PubMedEyeWiki
Amniotic Membrane Transplantation (AMT)
Procedure: Placement of a preserved amniotic membrane onto the ocular surface/fornix after scar excision.
Why Done: Reconstruct fornix, reduce fibrosis, promote healing of epithelial defects, and prevent recurrence of adhesions.
Evidence: Effective in both early and advanced fornix obliteration; safe with adjunctive anti-fibrotic strategies if needed.PMCAnnals of Eye Science
Conjunctival Autograft / Oral Mucosal Grafting
Procedure: Harvest of patient’s own conjunctival or oral mucosa to reconstruct lost or scarred conjunctival surface after excision.
Why Done: Provides healthy tissue to prevent recurrence of symblepharon or cicatricial defects, especially when local tissue is deficient.
Evidence: Long-term success in reconstructing anatomy with low recurrence when combined appropriately.ScienceDirect
Cicatrix Lysis with Biological Spacer Placement (e.g., using grafts or mitomycin C adjunct)
Procedure: Surgical lysis of fibrotic bands with insertion of tissue substitutes or application of anti-scarring agents.
Why Done: Prevents re-adhesion and modulates healing to preserve ocular surface.
Evidence: Core in management of complex conjunctival cicatrizing diseases.ScienceDirect
Limbal Stem Cell Transplantation (for severe ocular surface stem cell deficiency)
Procedure: Transplantation of limbal epithelial stem cells (autologous or cultivated) to regenerate corneal/conjunctival epithelium.
Why Done: Restore epithelial health when native stem cell population is destroyed by scarring, inflammation, or burns.
Note: Must be timed after inflammation is controlled.EyeWiki
Prevention Strategies
COVID-19 Vaccination – Reduces risk of systemic infection, which by extension lowers risk of ocular manifestations like conjunctivitis.CDC
Proper mask use – Masks reduce respiratory droplet spread that could reach the eye indirectly.Ophthalmology Advisor
Eye protection (goggles/face shields) in high-risk settings – Shields droplets from contacting conjunctiva.Lippincott Journals
Frequent handwashing or sanitizer use – Avoid transferring virus from hands to eyes.MDPI
Avoid touching or rubbing the eyes – Limits self-inoculation.MDPI
Isolation when symptomatic or COVID-positive – Stops spread to others and reduces chance of ocular involvement being spread.Ophthalmology Advisor
Disinfection of shared surfaces and personal items – Reduce fomite-mediated spread.CDC
Avoid sharing towels, cosmetics, pillows – Personal items can harbor and transfer virus to eyes.Ophthalmology Advisor
Proper contact lens hygiene or temporary discontinuation during outbreaks – Contact lens manipulation can introduce virus; better to use glasses if infection risk is high.Cleveland Clinic Journal of Medicine
Ventilation / indoor air quality improvement – Diluting viral particles in air lowers chance of overall infection, including any ocular seeding.Ophthalmology Advisor
When to See a Doctor
Seek ophthalmic or medical evaluation if any of the following occur:
Eye pain beyond mild irritation (suggests deeper involvement).
Blurry vision or decreased vision (could signal corneal involvement or complications).
Light sensitivity (photophobia) not improving with basic care.
Purulent or greenish discharge (possible secondary bacterial infection).
Symptoms persisting beyond 10–14 days or worsening instead of improving.
Development of pseudomembrane or severe conjunctival scarring signs.
Signs of systemic worsening of COVID-19 (shortness of breath, high fever, persistent cough) in someone with eye symptoms.
Immunocompromised status with ocular symptoms (higher risk of complications).
Recurrent conjunctivitis despite treatment (may need workup for other causes).
Any suspicion of keratitis (corneal involvement) – e.g., foreign body sensation, significant tearing, or a cloudy spot.AAO JournalCleveland Clinic Journal of Medicine
Early evaluation ensures no sight-threatening complications are missed and appropriate escalation (e.g., surgical intervention for scarring) can be timely.
What to Eat and What to Avoid (Nutrition Guidance)
What to Eat (Support Immune and Recovery)
Leafy green vegetables – Rich in vitamins (A, C, folate) and antioxidants to support immune cell function.
Citrus fruits and berries – High in vitamin C, aiding white blood cell response and antioxidant protection.U.S. Pharmacist
Lean proteins (eggs, fish, legumes) – Provide amino acids for antibody and cell repair.
Fatty fish (salmon, mackerel) – Source of omega-3s that reduce inflammation and support immune regulation.Office of Dietary Supplements
Nuts and seeds – Provide zinc, selenium, and healthy fats beneficial for immunity.Office of Dietary Supplements
Probiotic-rich foods (yogurt, kefir, fermented vegetables) – Support gut-immune axis.Office of Dietary Supplements
Whole grains – Provide sustained energy and micronutrients without spiking blood sugar.
Garlic and ginger – Traditional anti-inflammatory and antimicrobial adjuncts; some immune modulation properties.
Hydrating fluids (water, broths) – Maintain mucosal hydration and overall physiological support.
Foods high in vitamin D (fortified dairy, mushrooms, if dietary) or supplementation if sunlight exposure is insufficient.SMW
What to Avoid
Excess refined sugar and high-glycemic foods – Can impair immune function and promote inflammation.
Highly processed foods (trans fats, artificial additives) – Associated with chronic inflammation.
Excessive alcohol – Suppresses immune responses and can dehydrate.
Overconsumption of saturated fats – May contribute to low-grade inflammation.
Unverified herbal “boosters” with no evidence or potential interactions (e.g., unregulated mixtures).Verywell Health
Excessive caffeine (if causing poor sleep) – Sleep is critical for immune recovery; caffeine late in day can interfere.
High sodium ultra-processed meals – May worsen underlying cardiovascular stress when systemic infection is present.
Avoiding “immune suppression” diets (extreme calorie restriction) – Undernutrition impairs defense.
Raw or unpasteurized products in immunocompromised states – Infection risk from other pathogens.
Excessive supplementation without medical guidance – Too much zinc, vitamin D, or others can be harmful.EatingWell
Frequently Asked Questions (FAQs)
Can COVID-19 spread through the eyes?
Yes, the virus can be present in tears or on the ocular surface; while not the primary route, the eye can be a portal of entry or exit, so eye protection and hygiene help reduce risk.Lippincott JournalsIs conjunctivitis an early sign of COVID-19?
It can be, and in some people, red eye is the first or only symptom. However, it’s not the most common presentation, so context (other symptoms, exposures) matters.PMCHow long does COVID conjunctivitis last?
Usually 1–2 weeks, with most resolving completely with supportive care. Persistent or worsening symptoms require evaluation.MDPIDo I need antiviral eye drops?
No specific antiviral drops for SARS-CoV-2 conjunctivitis are standard. Treatment is mainly supportive unless part of a clinical trial.MDPIShould I wear contact lenses if I have red eyes during COVID?
It’s best to stop contact lens use until the eye clears to prevent irritation and potential contamination.Cleveland Clinic Journal of MedicineCan conjunctivitis from COVID cause permanent vision loss?
Rarely. Most cases are mild, but complications from mismanagement or secondary scarring (especially in cicatrizing conditions) could threaten vision if untreated.PubMedDoes vaccination prevent ocular involvement?
Vaccination reduces overall infection risk and thus indirectly reduces the chance of developing ocular symptoms like conjunctivitis.CDCWhen should I see an eye doctor?
If you have eye pain, vision changes, purulent discharge, or symptoms worsen/persist beyond 10–14 days.AAO JournalCleveland Clinic Journal of MedicineCan tears spread COVID to others?
Potentially, because viral particles can be in tear fluid; avoid sharing towels and touching your eyes then surfaces.Lippincott JournalsIs it safe to use steroid eye drops for COVID conjunctivitis?
Only under close ophthalmologist supervision in selected severe inflammatory cases, because improper use can mask infection or increase risk of other complications.AAO JournalAre there home remedies that can worsen it?
Rubbing the eyes, using unclean compresses, or applying non-sterile substances can worsen inflammation or introduce secondary infection.MDPIWill supplements cure COVID conjunctivitis?
No. Supplements support immune health and may help overall recovery, but they do not cure the viral infection directly.U.S. PharmacistOffice of Dietary SupplementsCan severe systemic COVID cause worse eye findings?
Yes, more severe systemic disease and prolonged viral replication have been associated with more pronounced ocular manifestations and may reflect a higher inflammatory burden.Journal of InfectionIs surgery ever needed for conjunctivitis from COVID?
Not for the acute viral conjunctivitis itself—only for chronic scarring complications (like symblepharon) or other secondary cicatrizing conditions.ScienceDirectEyeWikiHow do I avoid spreading eye-related COVID symptoms to family?
Isolate, practice hand hygiene, avoid sharing personal items (towels, pillows), use separate washcloths, and clean surfaces frequently.Ophthalmology Advisor
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 01, 2025.
