Conjunctivitis epidemic has struck again this November 2006. This highly contagious eye disorder is called Madras Eye. Chennai is remembered with its historical name 'Madras' due to this epidemic. 'Madras Eye' now goes around Chen'eye' (Chennai) and the southern parts of India with people wearing highly fashionable goggles. People fear to come near you and even fear to gaze at your eye while speaking. This immediate development of untouchability arises due to fear of having this highly contagious Madras Eye. Red eye and irritation can make anyone sense the development of conjunctivitis. Even though vision will remain unaffected, fear of losing pending jobs spreads panic.
Eye is a sensitive sensory organ providing vision to the body for handling the environment smoothly. Wind wipers – eyelids, protect it from dust and spreads tears throughout the eyeball to prevent drying up with wind and temperature. Tears provide lubrication for free eye movement against lids without any friction. Conjunctiva is a thin mucous membrane lining the inner aspect of eyelids and outer surface of eyeball. Conjunctivitis medically is meant for the infection and inflammation of the conjunctiva. It presents itself as redness of conjunctiva with engorged reddish blood vessels and muco purulent discharges.
Types of conjunctivitis Conjunctivitis can be classified as acute and chronic conjunctivitis. It can also be classified as bacterial, viral and allergic, depending upon the causative factors. Further, it is classified as catarrhal or muco purulent, purulent and membranous conjunctivitis. Most of the purulent conjunctivitis cases are bacterial in origin whereas viral conjunctivitis is more serious (watery). The bacterial infection usually comes in milder form than severe form of the viral infections. As a self-limiting disease in maximum number of cases bacterial conjunctivitis usually lasts 3-5 days whereas the viral one is 5-7 days or more.
Incidences Usually, it comes as an epidemic from time to time infecting thousands and thousands of people irrespective of sex and age. People would be susceptible to it with its highly contagious nature. It spreads rapidly with contact. Usually, it is less virulent in children unless otherwise the eyes are rubbed more. It subsides on its own within 3-4 days.
Causes Conjunctivitis can be caused by virus or bacteria or by allergic reaction. The violent-spreading conjunctivitis is mainly due to bacteria or virus. Sometimes a mixed infection or added infection can occur as a complication. The most common viral infection is caused mainly by Adeno virus or Entero virus or Koch week's bacillus. The other bacteria are Pneumococcus, Streptococcus, Staphylococcus, etc.
Both viral and bacterial conjunctivitis are very contagious. They spread violently through contact of streaming down tears, purulent discharges, nasal discharges, aerosol of sneezing or cough, etc. Also with towels, bed covers / pillows, furniture, phones, commodities which are used by (or had the contact of) infected person (secretions). Hand is the main culprit for spreading, i.e. while wiping the tears or secretions it gets contaminated quickly to spread further. Incubation period may be 1-3 days.
Symptoms Usually, conjunctivitis starts in one eye and follows to the other. It is difficult to control the spread to the other. The common symptoms are
- Infiltraion, irritation & itching of the eye(s) with redness
- Redness more markedly occur in fornix and inner aspect of eyelids
- Excessive lachrymation (especially in initial stages)
- Muco purulent discharges (especially in initial and middle phase)
- Sensation of foreign body in the eye (like sand or irritants) - gritty feeling
- Swelling of eyelids – sometimes puffiness of face
- Sensitive to touch and light with glaring and blurring vision (photophobia)
- Eyelids get glued in the morning due to drying up of sticky purulent discharges
- Heaviness of eyes with headache
In case of severe infection
- Toxic symptoms may follow – temperature may shoot up with profound weakness
- Suppuration follows with more purulent discharges
- Fibrinous exudates occur causing scarring of conjunctiva and opacities of lenses
- Exfoliations or granulations may follow
- Sub-conjunctival bleeding may occur rarely in spots
Complications
Mostly, there won't be any complications at all, as it resolves spontaneously within a week's time (at the most). But if it is not cared-for properly with proper hygienic measures, it may persist and cause complication. Most of the time, complication comes from manipulations, home remedies and steroidal drugs. The commonest complications are dryness of eyes and chronic conjunctivitis. Scarring of conjunctiva / cicatrisation / deposit of concretions may occur after prolonged intensified infection and inflammation (chronic conjunctivitis). The other complications are Trachoma, Trichiasis, Ptosis, etc. Also, one should be cautious when they have diabetes or hypertension or both. The complications of using steroidal drugs are not usually immediate, but often follow later. They are temporary suppression of the disease with recurring nature, glaucoma, cataract and retinal bleeding.
Diagnosis
Opthalmologists can easily diagnose the complaint with simple eye examination. To rule out risk factors in case of prolonged persistent infections, following tests can be done.
- Culture and sensitivity tests
- Routine blood tests to rule out sugar and any other infection and inflammations
- Maintaining blood pressure and sugar level is very essential to control violent infection and other complications
Prevention & management
Keeping eyes clean with hygienic measures will always prevent Madras Eye. Isolation or staying away from the affected persons is the most effective preventive step.
Dos
- Give rest to eyes periodically by closing it completely for some time
- Blink 2-3 times to revive normal tears flow / spread while feeling dryness or irritation
- Wash eyes 4-5 times a day or as required with cool water
- Wear dark goggles to protect eyes from glaring lights / dry wind / hot sun
- Wipe secretions / tears with clean kerchief or towel (different one for each eye)
- Wash hands often with soap or disinfectant to keep clean and avoid spread
- Keep hands away from the infected eye
- Consult your health professional or ophthalmologist immediately, if your condition gets worse.
Avoid
- Touching / picking / rubbing / squeezing the eyes
- Chlorine water for washing eyes
- Dispose wipe tissues or clothes properly and immediately
- Sharing towels, tissues, cloths, pillows, eye drops, cosmetics, etc.
- Going to office / school to avoid spreading further to others
- Hot (water) compress since it may cause increased blood flow to cause more redness
- Contact lenses
- Hair driers
- Watching TV / working in computer for a long time
- Exposure to smoke, wind, dust, chemical fumes, strong soaps, shampoos, etc.
- Smoking, snuffing, drinking
- Steroidal drugs to avoid complications
- Self-medication and home remedies
General treatment
Actually, with the advice of rest, cool compress and hygenic measures, ''wait and watch' is the commonly provided treatment for conjunctivitis. As it is a self-limiting disease and since most of the times the epidemic occurs with virus and there is no effective anti-viral drug / drops, it is generally left untreated or allowed to run its course. Artificial tear drops only will be provided to soothe irritations. In case of severe infection, antibiotic eye drops will be prescribed to control bacterial infection or to avoid added infection. Further, for the most severe cases, topical steroid drops are prescribed to cut down the inflammatory process, complications and irritations. Even though they can soothe the situation, it commonly brings complications like chronic conjunctivitis or opacities or retinal bleeding, etc., so, it is prescribed only in emergency conditions
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