Delirium in older patients with COVID-19 presenting to the emergency department. HHS Vulnerability Disclosure, Help Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment. Some coronavirus patients just happen to have unrelated eye issues, so don't immediately assume you have COVID-19 if your eyes hurt, burn or itch. This is a multicenter case series of patients with severe respiratory failure due to COVID-19 with prolonged unconsciousness after cessation of sedatives. Symptoms of COVID-19. The National Institutes of Health is also funding a National Eye Institute study on long COVID-19, which seeks to understand the symptoms that may develop in many organ systems, including the eye. Factors such a long use of sedatives and the presence of severe generalized muscle weakness (present in all our cases) complicate assessment of the level of consciousness. BMJ Open Ophthalmology. Vaira LA, et al. Symptoms include if your eyes are: If you have conjunctivitis, it doesnt necessarily mean you have COVID-19. COVID-19: Testing. Think of the movie The Diving Bell and the Butterfly about Jean-Dominique Bauby, the editor of the French fashion magazine Elle. Thanks for reading Scientific American. Conjunctivitis is inflammation or an infection of the conjunctiva, a thin membrane that covers the whites of the eyes (sclera) and the inside of the eyelids. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. 7 strange symptoms of COVID-19, including rashes, COVID toes and hair loss, Post-COVID syndrome: common symptoms and how to know if you have it, Can COVID affect your eyes? AskMayoExpert. Mayo Clinic; 2021. Rarely, it also can cause an eye infection called conjunctivitis. Check with your insurer to see if you can refill glaucoma drops and other essential prescriptions in advance. The most common symptoms of COVID-19, including cough, fatigue, fever, headache, muscle aches and loss of taste or smell, are not eye-related. 2020 May 31;14(5):447-449. doi: 10.3855/jidc.12792. Thanks for reading Scientific American. All About Vision and AllAboutVision.com are registered trademarks of AAV Media, LLC. He suspects that as many as one third of people with COVID have some type of eye issueeven if it is just red eyes that do not bother them. Cholankeril G, et al. Symptoms of viral conjunctivitis such as that caused by the coronavirus may include: Like any viral conjunctivitis, a COVID eye infection should be considered very contagious. J Infect Dev Ctries. One well-known case was that of Rom Houben. Consciousness is often underestimated; much more is going on in the brains of newborns, animals and coma patients than we think. We describe how the protracted recovery of unconsciousness followed a similar clinical sequence. Patel and his colleagues are working on a study, not yet submitted for publication, that he says will be among the first to report that the virus can cause inflammation in the tissue behind the eyeball. It's important to note that an eye issue in a person with coronavirus could actually be caused by something other than the virus. She was admitted to the hospital for oxygen therapy. Symptoms may include: It's important to note that while eye symptoms have been reported in relation to positive COVID-19 cases, it is uncommon for it to be the only symptom. FOIA This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. A research paper in Nature lists ocular symptoms of Covid, including foreign body sensation, floaters, blurry vision and pain. Investigators led by a team at Massachusetts General Hospital (MGH) now . COVID toes appear to be more common in children and young adults. Then there are cases in which the brain says, Move! but the motor neural pathways have been severed. Record performance in each category after each subscale exam. However, swollen, discolored fingers or toes could also be chilblains, an inflammatory skin condition. Centers for Disease Control and Prevention. Its most common symptoms are a fever, coughing, and breathing problems. Washin your hands before putting them in, or taking them out -. -, Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. Like everyone, be sure to wash your hands often and stay home whenever you can. More guidelines and information on Disputes & Debates, Involvement of Type I Interferon Signaling in Muscle Stem Cell Proliferation During Dermatomyositis, Neurology | Print ISSN:0028-3878 If I stimulate this region of the brain, the patient may hear and understand what I say. American Academy of Ophthalmology: Coronavirus Eye Safety, Coronavirus and Your Eyes, Quick Home Remedies for Pink Eye., CDC: Coronavirus Disease 2019 (COVID-19).. So the difference. 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. Motor reactions with the limbs occurred in the last phase. Findings In this case series including 38 patients with COVID-19, 12 patients had ocular manifestations, such as epiphora, conjunctival congestion, or chemosis, and these commonly occurred in patients with more severe . Methods A case series of patients who were admitted to the intensive care unit due to COVID-19related acute respiratory failure is described. Conclusion Prolonged unconsciousness in patients with severe respiratory failure due to COVID-19 can be fully reversible, warranting a cautious approach for prognostication based on a prolonged state of unconsciousness. It is important to take into account the possible reversibility of prolonged unconsciousness in patients with COVID-19 admitted to the ICU, which warrants watchful waiting in such cases. Learn more. In patients with coronavirus disease 2019 (COVID-19) who are admitted to the intensive care unit (ICU) for respiratory distress, an encephalopathy, most notably in the form of delirium, occurs in up to 84%.1 Brain MRI studies in patients in the ICU with COVID-19, including those with prolonged comatose state, reported varying degrees of MRI abnormalities, although few to no details were reported on the clinical picture, course, and prognosis of prolonged unconsciousness in such patients.2 Here, we report a case series of patients with COVID-19 admitted to the ICU for respiratory failure who, after cessation of sedatives, remained unconscious for longer than expected periods. But of course, in clinical practice we need unambiguous criteria. The physician says, Squeeze my hand. Or we observe whether the patient responds to sounds or touch. Locked-in patients cant move either, but they are completely conscious. Mice are not natural hosts for RNA viruses, so the commonly used lab rodents do not work particularly well as a stand-in for SARS-CoV-2 infection. 2020; doi:10.1136/bmjophth-2020-000632. Doctors are still learning about COVID-19 and eye problems, so it's too early to know whether coronavirus actually can cause chemosis. The clinical pattern from unconsciousness to awakening occurred in a similar sequence in all patients. Although consciousness does not reside in our muscles, stimulating patients may enable them to move muscles consciously. High prevalence of concurrent gastrointestinal manifestations in patients with SARS-CoV-2: Early experience from California. PMC October 2020. Minimally conscious patients can barely move and are not completely aware of their surroundings. As a physician, it is my aim to translate this knowledge into practice. If your eye problem isn't an emergency, you might need to wait to visit an eye doctor. 2020 Sep;103(3):1162-1165. doi: 10.4269/ajtmh.20-0680. Go to Neurology.org/N for full disclosures. Although pulmonary manifestations are more common, patients with severe disease may present with neurological symptoms such as in our case. We examine what happens during deep sleep, when people temporarily lose consciousness. But there are a couple of tricks. Investigators led by a team at Massachusetts General Hospital now describe a . Most often, eye symptoms are associated with systemic symptoms of COVID, including the typical features of the respiratory illness we're familiar with including cough, fever, and fatigue." When the eyes are exposed to the virus, a person can develop conjunctivitis symptoms, often appearing like pink eye. In this article, we will discuss the pathogenesis, imaging findings, and differentials of this disease. Steven Laureys greets me with a smile as I enter his office overlooking the hills of Lige. Research is ongoing, including right here in Omaha. Chemosis is the swelling of the conjunctiva, the thin membrane that covers the front of the eye and the insides of the eyelids. Weve also been working with Buddhist monks because we know that meditation can trigger alterations in the brain; connections that are important in the networks involved in consciousness show changes in activity. If they still don't respond, then you can presume they're unresponsive. BOSTON - Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. That was not surprising to scientists. People with severe infections can develop pneumonia and die from this lung illness. When blood clots prevent nutrients from getting to the retina, the tissue in the retina begins to swell and die. This may be the case with eye flashes and floaters, two common eye issues that have been reported by some coronavirus patients. One small study of 38 patients found that some patients with COVID-19 also had chemosis. In some cases, a patient has been able to communicate transiently for the first time after a 20-minute stimulationby, for example, making a simple movement in response to a question. Based on data so far, doctors believe that 1%-3% of people with COVID-19 will get conjunctivitis, also called pinkeye. Anouk Bercht is a science writer based in the Netherlands. Eye involvement may be a portal for COVID in addition to being just a symptom, he says. Share this information and remember: Widespread vaccination is key to ending the pandemic. And if youre caring for someone ill, don safety glasses or goggles. These problems have developed in people who were very sick with COVID as well as people who were apparently healthy and lacked symptoms. Disclaimer. Patients with unresponsive wakefulness are technically awake, as the name implies. Some studies have found that COVID-positive patients report certain eye problems at close to the same rate that patients without coronavirus do. Thanks for reading Scientific American. The brain is so heavily damaged that neither of the networks functions correctly anymore. Most patients who awaken from a coma soon recuperate. As our case series shows, it is conceivable that neurologists could be faced with the dilemma to prognosticate on the basis of a prolonged state of unconsciousness, all with the background of a pandemic with the need for ICU capacity exceeding available resources. How older drivers can improve their driving at night, Schedule an appointment with an eye doctor, Blurry vision and the COVID-19 coronavirus, Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states. The case of 1 patient is provided, and characteristics of 6 cases with a similar clinical pattern are summarized in table 1 and supplementary table e-1 (available on Dryad, doi.org/10.5061/dryad.866t1g1pb). Submissions should not have more than 5 authors. With different brain scanners, I can find out where brain damage is located and which connections are still intact. -, Bohmwald K, Galvez N, Ros M, Kalergis AM. Mayo Clinic Minute: How dirty are common surfaces? How Long Do Coronaviruses Live on Surfaces. ), and Radiology (F.J.A.M. Patel knows of two cases in which COVID-patients have lost sensation in their corneas, which can cause those corneas to break down, even with minor trauma. The first feature was opening of the eyes after acoustic or tactile stimuli within 1 to 12 days after sedatives were stopped. How can minimal consciousness be distinguished from locked-in syndrome? Learn about causes, symptoms, and treatments. What processes in the brain create consciousness? However, COVID-19 may cause neurological symptoms in some patients. Earlier in the pandemic, many doctors temporarily closed their offices except for emergency care. Next, 5 to 12 days later, all patients started to follow objects spontaneously with their eyes, which was still not accompanied by obeying commands. Scores should reflect what the patient does, not what the clinician thinks the patient can do. It is sometimes caused by a retinal vein occlusion. Mao L, et al. A recent study of 83 people by BMJ Open Ophthalmology reports the most common COVID-19 eye symptoms were photophobia (18 percent), sore eyes (16 percent) and itchy eyes (17 percent). Go to Neurology.org/N for full disclosures. Your organization or institution (if applicable), e.g. Doctors are still learning how COVID affects the eyes. Itchy eyes caused by COVID is "unlikely to occur in isolation," he said. She had been on high-dose sedatives since intubation. Submissions must be < 200 words with < 5 references. Get ophthalmologist-reviewed tips and information about eye health and preserving your vision. In the future, it may be possible to read brain signals using scalp electrodes and a brain-computer interface. It may be frustrating that we currently lack the tools to measure the hundreds of billions of synapses with their tangled mass of neurotransmitters. 'MacMoody'. Instructions: Administer stroke scale items in the order listed. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. Fourteen days after the sedatives were stopped, she started following people with her eyes for the first time. Symptoms of conjunctival chemosis include red eyes, itchy eyes, watery eyes, puffy eyes, swollen eyelids and feeling like you have something in your eye (foreign body sensation). . 0 8600 Rockville Pike Doctors still are learning about how the coronavirus affects the eyes. Commonly described as "goopy" or runny eyes, eye discharge is made up of mucus, oil and skin cells. With those tissues, the team was then able to show that two types of inner ear cells have the genes for making proteinsincluding ACE-2 receptorsthat allow SARS-CoV-2 to get into cells. 2020; doi:10.1001/jamaneurol.2020.112. For example, we can tell the patient, If you want to say yes, imagine that you are playing tennis. It happens when the virus infects a tissue called conjunctiva, which covers. "While COVID case numbers have improved over time, vigilance and precautions are needed to protect one's health from COVID and other viruses such as influenza," says Dr. Yeh. Although damage to sight and hearing still appear to be less common than loss of smell and tastewhich can affect 40 percent or more of people with COVIDstudies on eyes and ears lend insight into the many and often still mysterious ways that the virus can go to work inside the human body, experts say. Chilblains develop in response to repeated exposure to cold air. And know that your eye doctor may take extra precautions, such as checking your temperature before you can enter the building and using a special plastic breath shield when examining your eyes. This content does not have an Arabic version. This is why diagnosis is so difficult. The data are growing to suggest that there are more neural consequences of this infection than we originally thought, says Lee Gehrke, a molecular biologist at the Massachusetts Institute of Technology. and transmitted securely. Contact an eye doctor if you need medical attention. The authors declare that they have no conflict of interest. The virus could also invade a barrier between the bloodstream and inner ear. Kandemirli SG, Dogan L, Sarikaya ZT, Kara S, Akinci C, Kaya D, Kaya Y, Yildirim D, Tuzuner F, Yildirim MS, Ozluk E, Gucyetmez B, Karaarslan E, Koyluoglu I, Demirel Kaya HS, Mammadov O, Kisa Ozdemir I, Afsar N, Citci Yalcinkaya B, Rasimoglu S, Guduk DE, Kedir Jima A, Ilksoz A, Ersoz V, Yonca Eren M, Celtik N, Arslan S, Korkmazer B, Dincer SS, Gulek E, Dikmen I, Yazici M, Unsal S, Ljama T, Demirel I, Ayyildiz A, Kesimci I, Bolsoy Deveci S, Tutuncu M, Kizilkilic O, Telci L, Zengin R, Dincer A, Akinci IO, Kocer N. Radiology. All they can move is their eyessomething that neither the patient nor the physician is aware of at the beginning. According to a 2022 review, blepharitis-associated eyelid problems that have been reported with COVID-19 include: swollen eyelids irritated, dry, or itchy eyelid skin Meibomian gland dysfunction. During this pandemic, an emergency radiologist should be well acquainted with various neurological manifestations of COVID-19. This content does not have an English version. If the results show that there is no hope whatsoever, we then discuss difficult topics with the family, such as end-of-life options. These spots do not typically affect a person's vision. Submit only on articles published within 6 months of issue date. Signs and symptoms (adult). Are you experiencing sore eyes or itchy eyes or a sensitivity to light and worry that your symptoms might be a sign of COVID-19? She subsequently developed several episodes of high fever with constantly negative blood and sputum cultures with improving infection parameters (C-reactive protein, ferritin, procalcitonin, cell counts) and was treated with antibiotics. Investigators led by a team at Massachusetts General Hospital (MGH) now describe . Create your free account or Sign in to continue. Two days later, she was transferred to the ICU due to worsening of respiratory status and was intubated the same day. If there is no response to commands, sounds or pain stimuli, this does not necessarily mean that the patient is unconscious. Research also indicates it may be more common in people with severe cases of COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. Ive heard that Houben was eventually able to type words with the help of his communication facilitator. This is a major philosophical and ethical problem that will be answered differently by different people. Signs and symptoms of COVID-19 may appear 2 to 14 days after exposure. READ NEXT: Blurry vision and the COVID-19 coronavirus. NIH launches database to track neurological symptoms associated with COVID-19. Lines and paragraphs break automatically. Occasionally we see much more brain activity than anticipated, and then we can initiate treatment aimed at rehabilitation. During this pandemic, an emergency radiologist should be well acquainted with various neurological manifestations of COVID-19. The hands, wrists or ankles also can be affected. doi: 10.1002/jmv.25728. This difficult problem causes the patients to concentrate, and their pupils will dilate slightly as a result. All About Vision does not provide medical advice, diagnosis or treatment. The findings are highly suggestive that, indeed, SARS-CoV-2 patients might have hearing loss associated with virus infection due to infection of the hair cells, Gehrke says. JAMA Dermatology. November 2020. This pattern of awakening did not fit the regular patterns seen in patients in the ICU in whom eye opening is frequently accompanied or quickly followed by motor reactions to (painful) stimuli and an encephalopathy with an active delirium, as was also shown in the great majority of patients with COVID-19 in the ICU.1 Our findings corroborate a recent case report showing intact functional connectivity in the default mode network using fMRI in a patient with prolonged unconsciousness admitted to the ICU for respiratory failure due to COVID-19.7 One of the main drawbacks of our study is the selection bias that is inherent to case series. BioMed Research International. Mayo Clinic; 2021. JAMA Neurol. Pardhan S, et al. This network is located deep within the cingulate cortex and in the precuneus. Burning eyes is one of the most common symptoms of conjunctivitis (pink eye), which can be a sign of COVID-19. Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. There's some evidence that the potentially fatal coronavirus infection can also cause red eyes or pink eye. Center for Disease Control and Prevention. You must ensure that your Disclosures have been updated within the previous six months. 2020;413:116832. doi: 10.1016/j.jns.2020.116832. Encased in bone and located deep inside the head, it is inaccessible, and animal models do not always help. Vision, smell and tastethese are all connected.. A 50-year-old man who was unresponsive with acute hypoxic respiratory failure. Web page addresses and e-mail addresses turn into links automatically. Nine of these patients (which amounted to 0.8%) did have "congestion," which sounds a bit like a traffic jam in your eyes but instead refers to some combination of the earlier-mentioned eye . Case Report: COVID-19-Associated Bilateral Spontaneous Pneumothorax-A Literature Review. ), Prolonged Unconsciousness Following Severe COVID-19. Herman A, et al. You should still contact your doctor if you notice eye symptoms, especially if you have: Contact your doctor if you have any COVID-19 symptoms or if youve had contact with people who are sick. Thats right. Just as under anesthesia, the connections between certain brain areas are less active under hypnosis. The burning sensation is often accompanied by redness and swelling caused by the . 2020; doi:10.1038/s41591-020-0916-2. American Academy of Dermatology Association. Based on data so far, doctors believe that 1%-3% of people with COVID-19 will get conjunctivitis, also called pinkeye. A long ICU course in severe COVID-19 is not unusual. A patient can be intermittently awake, continue to breathe on his or her own, spontaneously open his or her eyes, and look around in a non-purposeful way. But if you start showing signs of other cold-like symptoms alongside itchy eyes, it's worth taking a test to see if you've . Wondering if an awkward eye twitch might be due to COVID-19? Wear glasses. The sedative midazolam was stopped on ICU day 10, and the sedative propofol was stopped on ICU day 14. She had been on thyroid supplementary medication during her entire ICU stay, and free thyroxine levels were measured within normal range several times. Epub 2020 Aug 21. People on ventilators often develop a type of eye irritation called chemosis, a swelling or bulging of the eye membranes and eyelids, Patel says. It is possible that he experienced emotions over all those years. Lechien JR, et al. Some eye discharge is normal in fact, it plays an important part in eye health because it removes debris and helps to keep the eye healthy. People respond in different ways to COVID-19 infections. The most common symptom of an eye stroke is sudden, painless vision loss. The same small study mentioned above found that some coronavirus patients experience overly watery eyes (epiphora), but wasn't able to definitively conclude they are a symptom of coronavirus. An analysis of 121 patients dating back to the beginning of the pandemic unveils COVID's most common effects on the eye. But if you also have a fever, cough, or shortness of breath, ask your doctor what, if anything, you should do. a, Corresponding apparent diffusion coefficient (ADC), Corresponding apparent diffusion coefficient (ADC) map did not reveal any abnormality suggesting pseudo-normalization, MeSH Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, 4 formas en las que el COVID-19 deja huella en sus ojos, International Society of Refractive Surgery, Eye Care During the Coronavirus Pandemic (COVID-19), Other conditions that affect the blood vessels. Sources used at the time of publication are provided in the Notes and References section. Copyright 2020 The Author(s). It is a complex case that the media has failed to report adequately. Symptoms may include: Tearing or watery eyes Thats right. The clinician should record answers while administering the exam and work quickly. But when those problems occur, they can range from mild to vision-threatening. Since this is thought to be a minor route of infection, getting COVID-19 through your eyes is unlikely. They can range from mild to severe. Anzalone N, Castellano A, Scotti R, Scandroglio AM, Filippi M, Ciceri F, Tresoldi M, Falini A. J Neurol. Using scalp electrodes, we can stimulate particular regions of the brain. We believe that a physical barrier to the deposition of . At most, a coma lasts for a few days or weeks. Is pink eye a symptom of COVID-19, a cold or the flu? What do the numbers on your eyeglass frames mean? Limiting close physical contact is key to helping reduce the spread of the coronavirus. Smell and taste recovery in coronavirus disease 2019 patients: A 60-day objective and prospective study. Terri Janos 617-726-0954 tjanos@partners.org. Do not go back and change scores. sharing sensitive information, make sure youre on a federal She tested positive on the oropharyngeal swab test for severe acute respiratory syndrome coronavirus 2. 2023 Scientific American, a Division of Springer Nature America, Inc. Call or go online to find out whether your doctors office is accepting routine visits. JAMA Network Open. This inflammation can cause blood clots to form. Real-time tracking of self-reported symptoms to predict potential COVID-19. Although we are still learning how the virus may affect the eyes, we know that some people experience inflammation which can cause mild to severe problems in numerous areas of the body. The research also illustrates how intertwined our sensory organs are. Consciousness is not all or nothing. We can be more or less awake, more or less conscious. Spectacles acting as a barrier to eye touching was hypothesised to help prevent SARS-CoV-2 transmission. If someone is not responding to you and you think they are unresponsive, ask loudly: 'Are you alright?' or 'Open your eyes'. Your email address, e.g. Accessed Feb. 7, 2022. Additional anonymized data not available within the article or supplementary material are available to qualified researchers on reasonable request. National Library of Medicine The clinical pattern of awakening started with early eye opening without obeying commands and persistent flaccid weakness in all cases. Over the pandemics first year and a half, accumulated data have established that about 11 percent of people with COVID develop some kind of eye issue, according to a review of multiple studies. Cureus. He and his colleagues reported ocular signs and symptoms in nearly 10 percent of 400 patients hospitalized in Michigan in March and April 2020. How do you determine whether they are conscious? 2023 Scientific American, a Division of Springer Nature America, Inc. The clinical course in our case series, normal CSF analyses, and spontaneous improvement without any corticosteroids most likely support a critical illnessrelated encephalopathy, although a clear distinction is difficult to make. Subsequently, 1 to 17 days later, patients started to obey commands for the first time, which always began with facial musculature such as closing and opening of the eyes or mouth. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. In this article, we will discuss the pathogenesis . What does it mean that some people feel they are leaving their bodies, whereas others suddenly feel elated? ), Neurology (A.A.A.C.M.W. Moistening drops may help ease itchiness. Neurologic alterations due to respiratory virus infections. Li died from his illness early in 2020, but his case was not the only early clue that eyes might play a role in the viruss spread. They may perceive subtle changes in facial expression or notice slight movements that escape the physicians attention. There was no funding agency/sponsor involved. Please enable it to take advantage of the complete set of features! WebMD does not provide medical advice, diagnosis or treatment. Neuroradiologic manifestations of COVID-19: what the emergency radiologist needs to know. In that setting, everyone needs to know what we mean by an unconscious patient. Avoid touching your face, especially the mucous membranes in your mouth, nose, and eyes. From conjunctivitis to vertigo, coronavirus infections can affect disparate senses. Hair cells, which are important for both hearing and balance, can also be infected by the virus, the researchers reported in Nature in October. These may include peer-reviewed scientific research, data from government health authorities, and other trusted sources of information. Front Cell Neurosci. As a neurologist, I see the consequences of brain damage every day. The buildup of blood raises pressure levels inside the eye, which can cause bleeding, swelling and fluid leaks. Signs and symptoms of COVID-19 may appear 2 to 14 days after exposure. Eye problems.