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 Table of Contents  
Year : 2020  |  Volume : 32  |  Issue : 2  |  Page : 216-217

The hidden ocular impact of COVID-19

Department of Ophthalmology, Karpaga Vinayaga Institute of Medical Sciences, Maduranthakam, Tamil Nadu, India

Date of Submission28-May-2020
Date of Decision29-May-2020
Date of Acceptance01-Jun-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Dr. Fayiqa Ahamed Bahkir
Department of Ophthalmology, Karpaga Vinayaga Institute of Medical Sciences, Maduranthakam, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_69_20

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How to cite this article:
Bahkir FA. The hidden ocular impact of COVID-19. Kerala J Ophthalmol 2020;32:216-7

How to cite this URL:
Bahkir FA. The hidden ocular impact of COVID-19. Kerala J Ophthalmol [serial online] 2020 [cited 2020 Oct 24];32:216-7. Available from: http://www.kjophthal.com/text.asp?2020/32/2/216/293304

Dear Editor,

I would like to bring to your attention the fact that amidst the chaos created by the COVID-19 pandemic, the ocular impact of the pandemic has gone unnoticed. Here are some ways to deal with these at home.

A frenzy of disinfection has gripped the world, handwashing and hand sanitization being the only known deterrents to the spread of infection. Overuse of these alcohol-based handrubs has resulted in what has been labeled “Sanitiser-aerosol driven ocular surface disease,” caused due to aerosolization of the liquid affecting the ocular surface.[1] The symptoms include redness, irritation, and mild lacrimation without any signs of infection.

  • Always prefer handwashing over alcohol-based handrubs, especially at a home environment, where both the resources and the time are available. This is not only economical, but is also better for your skin, as repeated exposure to alcohol-based rubs can be drying and present with symptoms of allergic or atopic dermatitis.[2]
  • When using alcohol-based handrubs, make sure to keep eyes closed while dispensing the liquid, and using them below eye level to ensure minimal exposure to eyes.[1]
  • In general, the usage of alcohol rubs over gloves by medical professionals is discouraged. This is because the reaction of latex to alcohol is not known; if wearing gloves, the person cannot be sure to have covered the entire surface area of the hand during the process.[3]
  • If the patient is a contact lens wearer, opting to wear spectacles for a few days will not only decrease symptoms caused by aerosolized handrub solutions, but will also reduce the number of contact-lens induced disorders.

The pandemic has also caused an increase in the usage of digital devices across the globe, both in the setting of working from home, online classes for students, and the general increase in mobile phone and digital device usage that has replaced going outside. Working on digital devices such as a laptop, mobile phone, iPad, or tablet is at an intermediate distance between distant vision and near vision, which puts constant undue strain on the eyes.[4] This can lead to symptoms of eye strain and musculoskeletal pain due to improper posture that automatically stems from being hunched over these devices for too long. While working on digital devices, the blink rate tends to decrease drastically from the normal fifteen times per minute to about five to seven times per minute.[5] This leads to both a qualitative[6] and a quantitative decrease in the tear production and distribution, and the benefits of a tear film protecting the corneal and conjunctival surfaces are gradually lost, ultimately presenting with dry eye symptoms. The collective term for these symptoms “Computer Vision Syndrome” is a misnomer since this can occur due to usage of all digital devices. Symptoms of computer vision syndrome include headache, redness, tearing, dryness, blurring of vision, colored halos around lights, difficulty in focusing fine printed text, foreign body sensation, heaviness of eyelids, blurring of vision, and neck pain.[7] Symptoms of computer vision syndrome can occur even with three hours of screen time per day.[4]

To alleviate these symptoms, simple techniques can be followed.

  • For people working from home, setting up a makeshift “office space” at home with a table and chair and proper lighting can improve posture and reduce stress on the neck and shoulder muscles. This setup will also discourage using laptops on the bed, which can lead to a hunched over posture while working for long hours.
  • A proper level to keep digital devices is such that the neck is straight, and the screen is 4–5 inches below eye level.[8] This keeps most of the globe covered by the eyelids and minimizes the surface area exposed to drying forces and prolongs the development of symptoms.
  • Abandon contact lenses for spectacles, as contact lenses can aggravate computer vision syndrome symptoms in addition to causing ocular surface disorders on their own
  • 20-20-20 rule.[8] After every 20 minutes of working on digital devices, look at an object situated twenty feet away for 20 seconds.
  • Consciously correct posture every 20 minutes.
  • Though blue light has not been proven to be harmful to the eyes in any conclusive way, it is widely accepted that blue light interferes with circadian rhythm.[9] To keep this to a minimum, try not to use digital devices at least for an hour before bed, or if their use cannot be avoided, keep the device's inbuilt blue light filters on from 7:00 pm. This, however, does not reduce symptoms of digital eye strain.
  • Consciously blinking frequently while using screens is a way to keeping the natural barrier of the eyes functional
  • Every hour while working on devices, close eyes, and rotate them in a full circle while keeping the lids closed.
  • A lukewarm fomentation followed by a lid massage (with the index fingers, gently massage above downwards for the upper lid; and below upwards for the lower lid) helps with healthy tear film formation.
  • For mild symptoms, an artificial tear solution can be used as and when needed while working on digital devices.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Shetty R, Jayadev C, Chabra A, Maheshwari S, D'Souza S, Khamar P, et al. Sanitizer aerosol-driven ocular surface disease (SADOSD) – A COVID-19 repercussion? Indian J Ophthalmol 2020;68:981.  Back to cited text no. 1
Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent hand washing for COVID-19 prevention can cause hand dermatitis: Management tips. Cureus J Med Sci 2020;12:e7506.  Back to cited text no. 2
Services AC. Eczema, Hand-Washing and the New Coronavirus (COVID-19): Protecting Yourself and Your Skin. Asthma Allergy Foundation of America. Available from: https://community.aafa.org/blog/eczema-wash-hands-coronav. [Last accessed on 2020 May 28].  Back to cited text no. 3
Computer Vision Syndrome. Available from: https://www.sankaranethralaya.org/patient-care-cvc.html#a. [Last accessed on 2020 May 28].  Back to cited text no. 4
Computers, Digital Devices and Eye Strain – American Academy of Ophthalmology. Available from: https://www.aao.org/eye-health/tips-prevention/computer-usage. [Last accessed on 2020 May 28].  Back to cited text no. 5
Kanski, J. and Bowling, B., 2016. Kanski's Clinical Ophthalmology. [Edinburgh]: Elsevier.  Back to cited text no. 6
Mdel MS, Cabrero-García J, Crespo A, Verdú J, Ronda E. A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol 2015;68:662-73.  Back to cited text no. 7
Computer Vision Syndrome. Available from: https://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome. [Last accessed on 2020 May 28].  Back to cited text no. 8
Should You Be Worried about Blue Light? American Academy of Ophthalmology; 2017. Available from: https://www.aao.org/eye-health/tips-prevention/should-you-be-worried-about-blue-light. [Last accessed on 2020 May 28].  Back to cited text no. 9


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