An issue that has not received a lot of attention in COVID-19 and Long COVID discussions is that the virus can cause minor or major vision changes that may be temporary or permanent. This article discusses some of these issues.

Updated February 19, 2024

Post COVID eye complications

While we continue to learn more about COVID and long COVID, researchers believe that COVID-19 causes the immune system to become overactive. Doctors are still learning how COVID affects the eyes, but there is a concern about vascular inflammation and microclots that travel through the body and reach the veins, arteries and blood vessels of the eye.

Other issues that may contribute to vision changes or damage include:

Oxygen deprivation of the eyes or optic nerve
Diabetes (high blood sugar)
Hypertension (high blood pressure)
Blood disorders
Conditions that affect the blood vessels
Hyperferritinemia (high levels of stored iron)
Inflammation of the optic nerve
Inflammation of the eye tissues
Inflammation of blood vessels restricting blood flow and oxygen supplies
Optic stroke or aneurysm
Breakdown of connective tissues from premature aging related to hormonal changes and collagen breakdown

A common symptom of Long COVID is hypoxia (blood oxygen levels under 95%). Several factors in Long COVID can cause or contribute to low oxygen levels, so it can be challenging to identify a specific cause. One of the risks of hypoxia is that it could lead to long term or permanent damage and demyelination of the nerve. Nerves are the pathways for electrical impulses to flow and initiate body functions. Every thought, behavior, action and body function is the result of electrical signaling. The optic nerve in the brain is essential to communication from the eyes to the brain.

Nerves are contained in a myelin sheath, similar to a conduit or the plastic coating on a wire. The purpose of the myelin sheath is to contain the current while the electrical impulses are on their journey, from end-to-end and or on to the next nerve. Inflammation and hypoxia caused by COVID-19 can cause demyelination, or the breakdown of the myelin sheath. Picture an old lamp cord with cracking plastic. The cracks in the plastic can allow the electricity in the cord to escape, just as the breakdown in the myelin can in the nerve shafts. And just as a lamp won't turn on with a broken cord, the nerves can fire without enough energy to activate them, resulting in ineffective function.

Inflammation of nerves can cause a wide range of symptoms, especially when the optic nerve is involved. When the nerves can't function, neither can the organs & body parts they control. It is important to get your eyes checked by an optometrist, ophthalmologist and/or a retinal specialist if you are experiencing eye problems or vision changes. If you experience sudden onset eye pain, drooping eyelid, or loss of vision, go to the nearest emergency room to be checked for a stroke or aneurysm.

As we have seen with many other long COVID challenges, doctors may not be able to visualize issues like inflammation or demyelination of the nerve, so identifying the cause and diagnosis will be focused on ruling out other issues like glaucoma, vitreal detachment (that can be repaired surgically if caught early) and infection.

Many covidCAREgroup members report vision issues including:

Changes in prescriptions
Dry eye
Excessive tearing
Blurred vision
Prism effect in one or both eyes
Appearance of looking through running water
Temporary blind spots or loss of vision
Eye pain/pressure
New or worsened color blindness
Light sensitivity
Floaters
” Lightening” flashes in the eyes
Central retinal vein occlusion
Central retinal artery occlusion

COVID's effects on the retina

People respond in different ways to COVID infections. While some people develop mild to severe respiratory problems, others experience no symptoms at all. Pink eye remains the most common sign of COVID in the eyes of children and adults.

Studies suggests that few people with COVID will develop eye problems. But when those problems occur, they can range from mild to vision-threatening. Many of these problems affect the retina — a light-sensing layer of cells in the back of the eye that plays a key role in your vision.

The four most common eye problems that may develop after COVID

"Cotton wool" spots

When blood clots prevent nutrients from getting to the retina, the tissue in the retina begins to swell and die. If the doctor examines your eye closely using a special tool called optical coherence tomography, this area looks white and fluffy like cotton wool. These spots do not typically affect a person's vision.

Eye stroke aka retinal artery occlusion

Blood clots in the arteries of the retina can block the flow of oxygen, causing cells to die. This is known as a retinal artery occlusion, or eye stroke. The most common symptom of an eye stroke is sudden, painless vision loss.

Retinal vein occlusion

When a vein in the retina becomes blocked, blood can't drain out like it should. The buildup of blood raises pressure levels inside the eye, which can cause bleeding, swelling and fluid leaks. People with this complication can develop blurry vision or even sudden, permanent blindness.

Retinal hemorrhage

This occurs when blood vessels in the retina start bleeding. It is sometimes caused by a retinal vein occlusion. A hemorrhage can lead to blind spots and gradual or sudden loss of vision.

Things you can do to help yourself

Minimizing physical & psychological stressors is essential in recovery from Long COVID.

Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein, vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

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