How the SARS-CoV-2 coronavirus behaves and how to combat it seems to be a moving target. The role eyes play in the disease is still under investigation, with some research showing that ocular symptoms of the disease are common.1 Now, one researcher suggests that, just as the eye can provide an entryway for the virus to invade, it may also be amenable to topical therapy that might reduce risk following exposure.2

“The eye and its adnexae represent a large surface area directly exposed to airborne viral particles and hand contact,” wrote the speculative paper’s author, Minas Theodore Coroneo, MD, of the University of New South Wales Department of Ophthalmology in Sydney. “The virus may bind to corneal and conjunctival angiotensin converting enzyme 2 (ACE2) receptors and potentially to the lipophilic periocular skin and superficial tear film.”

The piece, published in The Ocular Surface, explains that this route provides the virus with access to the lungs and gut. However, the author notes, “the portals that make us susceptible to coronavirus attack and invasion can be used to provide protection that is likely to be safe, extensive, convenient and at low cost. The researchers add that “this pathway is accessible with eye drops or aerosols containing drugs which appear efficacious” based on systemic use studies.

For instance, an as-yet untested combination of drugs such as hydroxychloroquine, azithromycin and zinc—all of which can be used topically in the eye and work by blocking ACE2 receptors—could in theory be reformulated for topical use to blunt the ocular pathway of viral transmission.2,3

 “At this point, clinical studies are needed expeditiously to investigate the safety and efficacy of local prophylactic regimens following exposure to SARS-CoV-2,” Dr. Coroneo concluded in his paper.


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1. Hong N, Yu W, Xia J, et al. Evaluation of ocular symptoms and tropism of SARS-CoV-2 in patients confirmed with COVID-19. April 26, 2020 [Epub ahead of print].

2. Coroneo M. The eye as the discrete but defensible portal of coronavirus infection. The Ocular Surface. May 21, 2020. [Epub ahead of print].

3. Chowdhury M, Rathod J, Gernsheimer J. A rapid systematic review of clinical trials utilizing chloroquine and hydroxychloroquine as a treatment for COVID-19. Acad Emerg Med. May 2, 2020. [Epub ahead of print].