Contact lenses and glasses

Clinical Question

Recommendations for contact lens use to prevent COVID-19 transmission

Key Findings

  • Evidence supports the use of eye protection, particularly for healthcare workers, to prevent infection with SARS-CoV-2. There is no evidence that contact lens (CL) use in itself imposes a greater risk of infection.
  • The American Academy of Ophthalmology recommends that all CL users should switch to using glasses since glasses provide an additional layer of eye protection.[1]
  • The American Optometric Association states that CL wear during COVID-19 is safe as long as the individual exercises proper hygiene behaviors.[2]
  • Contact lens wearers should discontinue CL use if they have any malaise or are sick with cold or flu-like symptoms.[2][3]

Summary of Information

Are Contact Lenses Considered Risk Factors for Coronavirus Infection?

There is currently no scientific evidence to suggest that there is an increased risk of infection through CL wears. However, unhealthy hygiene habits of CL wearers can increase the risk of infection. Habits such as touching and rubbing the eyes to adjust lenses and improper washing of hands before touching lenses etc.[1] For CL wearers, touching the eyes is inevitable. Thus, the practice of safe hygiene behaviors and proper care for CL is strongly recommended to ensure proper protection from coronavirus.[1][2][3]

COVID-19 can spread through the eyes:

Virus particles from coughs or talks can enter through the eyes.1 Also, touching and rubbing eyes can transfer viruses, thus limiting eye exposure can be helpful.1 SARS-CoV-2 has been detected in the tears and conjunctival secretions in COVID-19 patients with conjunctivitis.[4] In one study, tears of COVID-19 patients were collected and tested. The results show coronavirus may occasionally cause conjunctivitis, however it is rare with only 1-3% of patients developing conjunctivitis.[5]

CL users can be exposed to coronavirus through these modalities of transmissions:

Descriptive text is not available for this image

Figure taken from Zeri, 2020.

What recommendations are there for contact-wearing healthcare workers (HCW)?

Switching to glasses may be particularly applicable to HCW.6 A HCW who was part of the expert task force who visited Wuhan was infected despite being fully gowned with protective wear.[6] He was reported to have unilateral conjunctivitis as the first symptom, followed by fever a few hours later.[6] This report caused HCW in China to urge the use of eye protection.[6] In one small study, HCW who were compliant with proper eye protection and protective wear while working with MERS patients or worked with the patients’ bodily fluids showed no serum evidence of MERS-Cov antibodies.[7] The lack of transmission in HCW working with MERS patients suggests eye protection is important. In addition, WHO advised that HCW should not touch any mucosal membranes and to use eye protection (goggles) or facial protection (face mask).[8]

Spectacle Lens Wear

Although the American Academy of Ophthalmology recommends the switch to glasses, it should be noted that there is no scientific evidence that wearing spectacles can provide protection against SARS-Cov-2.[9] There is no evidence that standard spectacles can provide the same protection as goggles and shields.[9] The CDC states, “personal eyeglasses are NOT considered adequate eye protection”.[10] There are two confounding factors that do not support the use of personal glasses. First, for part-time spectacle wearers, the protection is intermittent and their increased frequency of putting on and removing their glasses adds to the potential of touching their faces.[9] Second, SARS-Cov-2 can remain on hard plastic surfaces (frames and lenses) for hours to days.[9] A study showed that SARS-Cov-2, similarly to SARS-Cov-1, could be detected up to 72 hours on plastic.[11] Upon touching their spectacles, the virus can potentially be transferred to wearers’ fingers and more. Thus, spectacles should be regularly cleaned if worn in addition to frequent hand washing.[9]

Author Information

Authors: Thanh Tran, BS, UCSD
Completed on: April 4, 2020
Last revised on: Not yet revised

Reviewed by: Gary Smithson MD
Reviewed on: April 7, 2020

This summary was written as part of the CoRESPOND Earth 2.0 COVID-19 Rapid Response at UC San Diego. For more information about the project, please visit http://earth2-covid.ucsd.edu

References

  1. Mukamal R. Coronavirus Eye Safety. American Academy of Ophthalmology. https://www.aao.org/eye-health/tips-prevention/coronavirus-covid19-eye-infection-pinkeye. Published March 10, 2020. Accessed April 18, 2020.
  2. Contact lens wear during COVID-19. https://www.aoa.org/covid-19-patient-resources/contact-lens-wear-during-covid-19. Accessed April 18, 2020.
  3. Zeri F, Naroo SA. Contact lens practice in the time of COVID-19. Cont Lens Anterior Eye. 2020.  [PMID:32201054]
  4. Xia J, Tong J, Liu M, et al. Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol. 2020.  [PMID:32100876]
  5. Seah IYJ, Anderson DE, Kang AEZ, et al. Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients. Ophthalmology. 2020.  [PMID:32291098]
  6. Li JO, Lam DSC, Chen Y, et al. Novel Coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol. 2020;104(3):297-298.  [PMID:32086236]
  7. Wiboonchutikul S, Manosuthi W, Likanonsakul S, et al. Lack of transmission among healthcare workers in contact with a case of Middle East respiratory syndrome coronavirus infection in Thailand. Antimicrob Resist Infect Control. 2016;5:21.  [PMID:27222710]
  8. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125. Accessed April 18, 2020.
  9. Jones L, Walsh K, Willcox M, et al. The COVID-19 pandemic: Important considerations for contact lens practitioners. Cont Lens Anterior Eye. 2020.  [PMID:32273245]
  10. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Published February 11, 2020. Accessed April 23, 2020.
  11. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-1567.  [PMID:32182409]