The COVID-19 pandemic introduced the public to a wide range of symptoms that extend far beyond the typical respiratory illness, including discomfort in the eyes. While cough, fever, and fatigue are widely known, many people experience non-traditional manifestations. This has created confusion, especially when symptoms like watery eyes overlap with common ailments such as seasonal allergies or the common cold. Understanding whether excessive tearing is truly a sign of a SARS-CoV-2 infection requires a closer look at the virus’s ability to affect the ocular surface.
Is Tearing a Recognized COVID Symptom?
Excessive tearing is a recognized manifestation of COVID-19, often occurring as part of viral conjunctivitis, or “pink eye.” Ocular symptoms, including tearing, redness, and discharge, are present in a measurable percentage of confirmed cases. The overall prevalence of eye-related issues varies across different research, with reports ranging anywhere from 2% to 32% of patients experiencing some form of ocular involvement.
In a large meta-analysis, the pooled prevalence for tearing specifically was reported to be around 12.8% among patients who had COVID-19. While this is not as common as systemic symptoms like fever or cough, it is a clear indication that the virus can affect the eyes. Conjunctivitis itself is frequently cited as the most common ocular disorder associated with the infection, which often includes increased tear production as a primary feature.
Why COVID Can Affect the Eyes
The SARS-CoV-2 virus is capable of causing eye symptoms because the ocular surface possesses the necessary structures for viral entry. The clear membrane covering the eye, called the conjunctiva, contains the Angiotensin-Converting Enzyme 2 (ACE2) receptor. This ACE2 receptor serves as the main entry point that the virus uses to invade human cells.
When viral particles from respiratory droplets land on the eye’s surface, they can bind to these ACE2 receptors, initiating an infection. The resulting viral activity triggers an inflammatory response in the conjunctiva. This localized inflammation leads directly to the noticeable symptoms, such as redness, irritation, and overproduction of tears.
The virus may also reach the eye through an indirect route via the nasolacrimal duct. This duct connects the eye’s surface to the nasal cavity and throat, creating a pathway for respiratory secretions to potentially carry the virus to the ocular surface from within. The presence of viral genetic material, or RNA, has been detected in the tear fluid of some patients, confirming the virus’s ability to localize in this area.
Comparing Eye Symptoms to Allergies and Colds
Differentiating COVID-19-related tearing from symptoms caused by allergies or the common cold relies on identifying other key features. Tearing and redness caused by seasonal allergies are almost always accompanied by itching, a symptom that is generally much less prominent in COVID-related conjunctivitis. Allergies are an immune response and do not cause a fever, which is often present with a COVID-19 infection.
A common cold can also cause watery eyes due to inflammation, but the sudden loss of taste or smell is a strong indicator pointing toward COVID-19. The quality of any discharge can also offer clues, as viral conjunctivitis, including that caused by SARS-CoV-2, typically involves a clear, watery discharge. Bacterial conjunctivitis, by contrast, usually involves a thicker, stickier discharge.
If watery eyes are accompanied by systemic symptoms like fever or body aches, testing for COVID-19 is the definitive step to determine the cause. Allergies tend to respond quickly to antihistamine medications, whereas viral symptoms will not. Consulting a healthcare provider is advisable if any ocular symptoms are severe or if they occur alongside other symptoms associated with a viral infection.