As most areas in the US have recently experienced an uptick in new COVID-19 infections, questions regarding both possible downstream transmission via the ocular surface and contact lens wear safety have resurfaced and abound once again. It’s hard to imagine, but we still have patients present after over 3.5 years dealing with the disease who have concerns about wearing their contact lenses. Not to mention the few who have refused annual examinations worried about contracting the infection while in our office. 

Each day, I have several patients who raise the concern for potential eye transmission and, specifically, if they can still wear contact lenses safely.  Unfortunately, we still have gaps in knowledge as it relates to transmission and lens wear safety. So, let’s look at what we now know about COVID infections and the eye and how might we address patient concerns. 

To start, it goes without saying that COVID-19 is here to stay. Just like influenza, new variants will appear every year. Like the flu vaccine, COVID vaccines may either be robustly effective with some durability or have a limited protective effect. This is all based on our ability to predict which variant(s) might hit a certain area.

Eye Transmission

The likelihood for the ocular surface being the gateway for SARS-CoV-2 infection or transmission is low but certainly feasible.^1,2 Concerns remain for possible downstream transmission through the tears even without ocular signs and symptoms, even with the low prevalence of virus found in tears. The ocular surface serving as a reservoir may cause conjunctivitis and discomfort.^1,3 SARS-CoV-2 receptors in the eye have been documented and may explain the relative viral trophism to the ocular surface similar to other viruses.³

The eye’s microbiome along with natural defense mechanisms (lactoferrin and IgA with other protective proteins and the blink mechanism) may keep the probability of SARS-CoV2 binding to ACE2 receptors low, thereby protecting the eye from the coronavirus.³ Researchers determined that late-stage COVID-19 patients might not harbor an ocular reservoir of SARS2, making it likely that transmitting SARS-CoV-2 via ocular tissues and fluids is low.⁴ However, it’s likely the viral load in real time PCR testing of human tears may remain below detection threshold levels.² Also, when there is any viral load detected on the ocular surface, it might come directly from the sinuses.³

 

Contact Lens Safety

Several reports have examined the safety of lens wear and there is no evidence to suggest any added risk of contracting an infection through contact lens wear.^5,6 A recent review shows nothing to the contrary.

Overall, even though the ocular surface has the likely potential to serve as a reservoir and source of SARS-CoV-2 (via hand-eye contact or aerosol), the infection rate remains low.^1,2,4 The CDC continues to suggest there is no added risk for COVID-19 infection with lens wear when proper hygiene practices are employed (www.cdc.gov/contactlenses/observance-resources.html). The CDC provides a number of tools and materials to help promote contact lens health. 

Various tips in order to avoid infections such as COVID include onstant reminders to avoid overnight wear, wash hands thoroughly and frequently, clean and replace contact lens storage cases and keep their lenses away from water. Remind patients to have back-up glasses and encourage them to call their eyecare provider with any questions.

To summarize several reports that have examined the safety of lens wear, there is no evidence to suggest any added risk of contracting a COVID-19 infection through contact lens wear.⁶ Overall, even though the ocular surface has the likely potential to serve as a reservoir and source of SARS-CoV-2 (via hand-eye contact or aerosol), the infection rate remains low.^1,2,4

Eyecare providers must continue to reassure lens wearers that they are at a very low risk for infection. More than ever, it gives us both the responsibility and opportunity to emphasize the importance of highlighting the much-needed steps for good lens wear hygiene. Education in the office also helps deflate rumors that contact lens wear is unsafe with any new resurgence.

1. Chen X, Yu H, Mei T, et al. SARS-CoV-2 on the ocular surface: is it truly a novel transmission route? Br J Ophthalmol. 2020;105(9):110-23. 2. Qu JY, Xie HT, Zhang MC. Evidence of SARS-CoV-2 transmission through the ocular router. Clin Ophthalmol. 2021;15:687-96. 3. Guemes-Villahoz N, Burgos-Biasco B, Vidal-Villegas B, et al. Novel insights into the transmission of SARS-CoV-2 through the ocular surface and its detection in tears and conjunctival secretions: a review. Adv Ther. 2020;37(10):4086-95.. 4. Bayyoud T, Iftner A, Iftner T, et al. Absence of severe acute respiratory syndrome-coronavirus-2 RNA in ocular tissues. Am Rep. 2020;19:100805. 5. Bhargava R. Contact lens use at the time of SAR-CoV-2 pandemic for healthcare workers. Indian J Med Res. 2020;151(5):392-4. 6. Jones L, Walsh K, Wilcox M, et al. The COVID-19 pandemic: important considerations for contact lens practitioners. Cont Lens Anterior Eye. 2020;43(3):196-203.