Practice Policy Update Regarding COVID-19

Shared from the American Academy of Ophthalmology

Written By: Reena Mukamal Reviewed By: Andrew G Lee MD Edited By: Anni DelfaroApr. 20, 2020

As doctors use ventilators to treat the sickest patients with COVID-19, some patients are being placed on their stomachs to boost the amount of oxygen in their blood. But eye experts warn that facedown positioning, also called prone positioning, could put patients with coronavirus at risk for vision loss.

Coronavirus and the risk of vision loss

The risk is likely low, says ophthalmologist and Academy spokesperson Dr. Andrew Lee. So far, there are no reports of vision loss due to COVID-19.

But about 2 of every 1,000 patients who lie their stomachs for hours during spinal surgery wake up with permanent vision loss. The longer a patient remains in prone position during surgery, the greater their risk of blindness. That’s worrisome when it comes to patients with COVID-19, who may be placed on their stomachs for days or weeks while hooked up to a breathing machine.

“Vision problems in these individuals may not have surfaced yet,” says Dr. Lee. “We are still in the early days of understanding the impacts of both COVID-19 and the treatments being used to fight it.”

Laying facedown raises eye pressure

When a person lies on their stomach with their head resting lower than their heart, pressure can build in the eyes and cut off the oxygen supply to the optic nerve. This can trigger an eye stroke, or ischemia, and cause irreversible blindness in one or both eyes.

The risk is highest in men, patients with diabetes or high blood pressure and those who experience blood loss or complications during surgery. Whether these same risk factors apply to patients with COVID-19 is unclear.

Doctors could reduce the risk of vision loss by keeping prone patients’ heads above, or at the same level as, their hearts while hooked up to breathing machines, Dr. Lee says.

Patients who have recovered from COVID-19 after receiving lung treatment in facedown position should immediately report any changes in vision to their doctor.

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