Madras eye outbreak in India: Why should we foster a better understanding of acute conjunctivitis?

Dear Editor, In November 2022, the Health Minister of Tamil Nadu, India, alerted the people and health professionals about acute conjunctivitis (AC) outbreak, with more than 150,000 cases affected since the onset of the monsoon.[1] The epidemic outbreak of acute viral conjunctivitis was first identified in the City of Chennai, then Madras, in India. Hence, AC is colloquially known as “Madras Eye” in India.[2,3] Human adenoviruses (serotypes 3, 4, 7, 8, 9, 11, 19a, 21, 35, and 37), enterovirus 70 (EV70), and coxsackie virus A24 variant (Cox.A24v) are the common etiological agents of acute viral conjunctivitis.[2,3] AC may co-occur with or masquerade as other clinical entities such as COVID-19-associated conjunctivitis, allergic conjunctivitis, chlamydial conjunctivitis, and acute congestive glaucoma.[3] Hence, using the terminologies such as pink eye, red eye, and eye flu to refer to “Madras Eye” in the media makes people vulnerable to misconceptions.[1] In this perspective, The Lancet Global Health Commission on Global Eye Health emphasized that “There is a need for standard terminology and robust definitions to measure the magnitude of eye disease that does not impair vision.”[4] Lack of evidence does not justify neglect. Considering the self-limiting nature of acute viral conjunctivitis and the consequent lack of clinical evidence, we should not underrate its repercussions. This notion is augmented by the fact that there is no update on the status of the AC outbreak thereafter.[1]Although viral conjunctivitis accounts for 80% of infectious conjunctivitis cases, misdiagnosing viral conjunctivitis as bacterial conjunctivitis and irrational use of antibiotics may exacerbate the burden of antimicrobial resistance (AMR).[5] The high prevalence (53.57%) of self-medication practice in India compounds the AMR menace. Lack of disease awareness and increased screen time on mobile phones are additional concerns. Besides, inappropriate treatment may worsen the clinical scenarios of epidemic keratoconjunctivitis, acute hemorrhagic conjunctivitis, and pharyngoconjunctival fever and may affect visual acuity [Table 1].Table 1: Salient features of various types of epidemic conjunctivitis, their etiology and differential diagnosisThe government should collaborate with major eye care hospitals and provide extensive teleophthalmology-based healthcare services (through mobile telemedicine vans with satellite connectivity and mobile apps) to the population in rural and remote areas and quickly contain the spread of infection by restricting patients’ mobility. Besides, the deployment of allied health professionals, including pharmacists and nurses (especially in the resource-constraint areas), should be encouraged to liaise between the patient/caregiver and the healthcare practitioners. Extensive PCR-based DNA sequencing should be performed to augment epidemiological surveillance and public health.[2] It is imperative to remember that the laxity of the government, health authorities, and lack of awareness among the general public during the “preventable” conjunctivitis outbreak not only impacts the well-being of the patients and their caretakers but also poses a high socio-economic burden and prevents accomplishing universal health coverage. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.