Public Health

Pandemic’s impact on patients’ eye health comes into focus

Jennifer Lubell , Contributing News Writer

COVID-19 is a systemic disease that affects many areas of the body, including the eyes. All sorts of mental health issues can affect vision, including anxiety, stress and depression, said AMA Trustee David Aizuss, MD, an ophthalmologist in Los Angeles.

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“We know that vision’s a complex psychosocial process where we build a model of the world around us and this can definitely be affected by our mental state,” Dr. Aizuss said during a recent episode of “AMA COVID-19 Update” about computer vision syndrome and mask-associated dry eye.

Other pandemic habits such as prolonged screen time and wearing masks can affect eye health too.

During the episode, Dr. Aizuss shared what physicians and patients should know about COVID-19’s effects on the eyes, and the importance of regular eye care.



Stress can aggravate dry eye, said Dr. Aizuss, noting that several studies have reported an association between dry eye and psychiatric disorders. Raised cortisol levels due to stress can also affect vision, leading to blurriness, distortion, and gray spots.

“We know that dry eye disease impacts quality of life as well as work productivity, and we know that dry eye disease has been worsening during the pandemic due to the hours spent on Zoom and other video display terminals,” he said.

Get the latest news on the COVID-19 pandemic, vaccines and variants, and more reliable information directly from experts and physician leaders with the “AMA COVID-19 Update.” You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version.

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Computer vision syndrome is becoming more common as people spend more time at home teleworking. All that extra screen time can lead to headaches, blurred vision, dry eyes and eye strain.

“Focusing on video display terminals results in a longer blinking interval that exacerbates tear film evaporation and increases the risk of developing dry eye disease,” said Dr. Aizuss.

But screens aren’t the only culprit of dry eye disease. An ill-fitting mask can redirect air toward the eyes, causing dry eye. Masks with a metal nose strip can prevent spectacle fogging for patients who wear glasses. This can also stop dry air from going up into the eyes.

“For those who suffer dry eye symptoms in spite of this, we recommend artificial tears from a bottle, up to about four times daily,” advised Dr. Aizuss. Hot compresses are also useful for relieving dry eyes.

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To prevent eye-related health issues, physicians should advise their patients to exercise, eat properly, get plenty of sleep, reduce screen time, and learn to manage stress. But to avoid more serious eye issues, don’t skip regular eye checkups, stressed Dr. Aizuss.

When using over-the-counter drops, choose artificial tears over products that “get the red out.” These products work “by constricting the blood vessels on the surface of the eye, which is inevitably followed by rebound dilation of those vessels and increased redness,” he said.

Patients can follow the 20-20-20 rule to alleviate computer-related eye strain. Every 20 minutes, focus on something in the distance 20 feet away for 20 seconds. This helps relieve symptoms such as spasms, headaches, and eye twitching. It also encourages regular blinking to lubricate the eyes and improves ocular comfort.

Patients with minor symptoms such as a little bit of redness should wait a day or two to see if things improve.

“More serious problems, such as significant pain, increasing blurred vision, loss of part of the field of vision, new onset of floaters, flashing lights in the vision—those should be evaluated more urgently,” advised Dr. Aizuss.

Fomite transmission is not a significant means of spreading SARS-CoV-2, but try not to rub your eyes, he said, adding “there's many cases of COVID associated conjunctivitis and the virus is cultured from the tears.”

The AMA has developed a COVID-19 resource center to give doctors a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention and the World Health Organization.