By Consultant Ophthalmologist P. Kanthamani
What is conjunctivitis?
Inflammation of the conjunctiva is called conjunctivitis. To recapitulate the conjunctiva is the mucus membrane lining the white part of the front of the eyeball and the inner aspects of the eyelids. Conjunctivitis can be caused by viruses, bacteria, chlamydia, allergens and irritants such as chemicals, fumes etc. The viral conjunctivitis is ‘flu’ or ‘cold of the eye’.
What is ‘Madras Eye’?
Conjunctivitis caused by adenoviruses is an epidemic type of conjunctivitis. It may also be caused by picorna and entero viruses. It is highly contagious and many people in the same locality get affected at the same time. This is not confined to Chennai. It can be widespread and global. Then it goes by various names such as ‘Delhi eye’, ‘Bombay eye’ etc., depending on where it is prevalent.
What are the symptoms and signs?
- One eye gets affected first followed by the second eye later at times
- Redness especially at the inner corners of the eye and the inner aspects of the lids,
- Discharge – watery or mucous or pus-like with glueing of lids and inability to open on waking up
- Swelling of lids
- Sandy, foreign body or gritty sensation, irritation and heaviness of eyes
- Sensitivity to light
- Red spots small to big
- Swelling of glands in front of the ears
- Fever and common cold with pain in the throat can be associated in a subtype of viral conjunctivitis.Vision is not affected usually.
How does it spread?
That‘Madras eye’ is highly contagious is a well-known fact. But the common myth is it spreads by looking at the affected person’s eyes. This is a totally wrong concept to be done away with because it actually spreads by fomites [objects used by the affected person] and occasionally by droplet infection
People pay attention to the former and ignore the latter and this could be one of the important reasons for the fast spread of the viral infection.
What is the treatment?
Patient education on the preventive aspects will help a long way for controlling the exponentially spreading disease.
- The person affected should stay confined to the home; avoid crowded places or attending work, school, or college as the case may be. This also gives rest to the patient. Since it is caused by a virus, one’s own immunity helps in hastening recovery. It is our social responsibility not to spread the infection to others and meticulously follow necessary precautions even though difficult.
- Personal belongings like tissue, cosmetics, soap, towel, pillowcase must consciously be kept separate and not mixed with others.
- It is best to avoid hankie or towel to clean eyes and instead use a tissue and dispose of followed by washing of hands immediately. While cleaning eyes do not rub eyes but gently dab the tears at the corners to prevent haemorrhagic spots.
- Do not sleep on the unaffected side.
- Antibiotic eye drops as per the recommended dosage can be used
- Antibiotic ointment at bed time will ease opening of eyes in the mornings
- Tear substitutes and lubricants can also be used
- General safe pain killers and anti-inflammatory drugs [with due caution in children, pregnant women, those having drug allergies or acidity] can be used because they reduce the hand-eye contact in addition to alleviating the pain and swelling.
Why use antibiotic drops when it is viral? What is the role of steroids?
Topical antibiotic drops are used by doctors to prevent secondary infection by bacteria.
Steroids can be used only by an ophthalmologist and only after confirming it is the epidemic variety and not due to herpes simplex virus or bacteria. Besides not all red or pink eyes is viral conjunctivitis. There can be a foreign body or acute glaucoma etc which has to be ruled out by careful history and slit lamp examination by the eye specialist.
What are the general tips?
- Cold compressions can appease.
- Dark goggles for minimising involuntary hand-eye contact and to reduce glare.
- Avoid stress and visual work
- Listening to good music can be of help to while away time.
- There is no restriction on healthy food.
Is there no specific antiviral drug?
Cidofovir [vistide] is a specific antiviral for adenoviral conjunctivitis.
How long does it last?
Generally, it is self-limiting and disappears in few days to about 3- 4 weeks depending on one’s own resistance without any sequel. In children, it vanishes in about two days.
When can one resume duty?
One should go by cessation of watering and discharge. The chance of infecting others is reduced by then. Redness particularly under the lids takes a longer time to disappear.
What are the complications?
It is only more of a nuisance disrupting one’s routine and constraining his/her activities.
Seldom it can cause dryness of eyes. Cornea when affected in the second or third week in a few also heals well
What is the best prevention?
In our eagerness to prevent we tend to use the same drops in the unaffected eye and also in the unaffected persons. This surely will enable the spread of the virus from the contaminated bottle. So the best thing to prevent is
‘Wash our hands before touching our eyes during an epidemic’