As temperatures soar, so do cases of conjunctivitis, commonly known as pink eye. There is a seasonal spike, driven by heat, humidity, dust, and infections that spread more easily during this time. Since most cases resolve on their own, recent research strongly recommends moving away from routine, one-size-fits-all antibiotic use, which is often unnecessary and can lead to long-term issues such as resistance.
Conjunctivitis is the inflammation of the transparent membrane, lining the eyeball and inside of eyelids, causing red, itchy, watery, and gritty eyes. Also called pink eye colloquially, the causes could be bacterial, viral, allergic, dry eyes, and environmental factors such as dust and wind exposure. But if you look at the prevalence of bacterial conjunctivitis across the globe, it differs, depending on factors such as hygiene practices, environmental conditions, and healthcare infrastructure.
While the infection can occur in all age groups, it mostly affects children and young adults. And though it may seem like a minor irritation, experts warn that ignoring early symptoms or self-medicating can lead to complications. And the standard care is shifting away from immediate, one-size-fits-all antibiotic use to a more tailored approach such as antiseptics and steroids for severe viral cases, and supportive care or delayed antibiotics for milder cases.
Viral vs bacterial conjunctivitis
Viral conjunctivitis is commonly caused by viruses like adenovirus and herpes simplex, while bacterial conjunctivitis is caused by bacteria such as Staphylococcus, Streptococcus, and Haemophilus, with certain types affecting newborns.
There have been changes over time with many different viruses and bacteria evolving. "Adenovirus mutates gradually over time. These changes are not dramatic. Bacterial conjunctivitis has faced antibiotic resistance. What hasn't changed much include that most cases resolve on their own and hygiene is still important," says Dr. Preetha.
Doctors say it can be difficult to distinguish between viral and bacterial conjunctivitis based on symptoms alone. “Viral conjunctivitis is milder, it usually results in clear, watery or thin mucus irritation and minimal discomfort due to eyelid swelling, whereas bacterial conjunctivitis is often associated with thick purulent or mucopurulent discharge with moderate to severe swelling and eyelids stuck together when you wake up,” they say.
But there is more. According to the National Centre for Infectious Diseases (NCID), specific features of viral conjunctivitis commonly includes recent upper respiratory tract infection or contact with infected persons. It usually begins in one eye and involves the other eye a few days later.
“Adenoviral conjunctivitis is frequently associated with preauricular lymphadenopathy and pseudomembranes on the conjunctiva. Picornaviruses such as enterovirus 70 and coxsackievirus A24v typically result in subconjunctival haemorrhages (acute haemorrhagic conjunctivitis),” it states.
Eye herpes (conjunctivitis) often happens in people who have had it before. “There may be herpetic vesicles along eyelid margins or periocular skin. Dendritic corneal ulcers may be seen if the cornea is also involved,” NCID states.
In bacterial conjunctivitis, according to the NCID, one would notice continuous mucopurulent discharge at the lid margins and around the corners of the eye. “Crusting of eyelids. Neisseria species can cause hyperacute bacterial conjunctivitis, which is severe and sight-threatening and requires urgent ophthalmological consultation.” it states.
Symptoms to watch out for
“The early symptoms of pink eye that people should watch out for include red eyes, discharge, crusting on eyelids, watering, grittiness, itching, burning, and mild swelling of lids,” says Dr. Preetha Rajasekaran, who is a consultant ophthalmologist at Dr Agarwals Eye Hospital, Chennai.
In more severe cases of dry eye, it may also cause blurring of vision, according to Dr Kalpana R, who is a senior consultant ophthalmologist at SIMS Hospital, Chennai. “Patients often report a gritty sensation, as if a foreign body is present in the eye,” she says.
Can it affect vision?
While your chance of getting pink eye today is generally low, it becomes much higher if you are exposed to an infected person and touch your eyes.
Most cases resolve without long-term effects, doctors warn that complications can arise if not treated properly. “Most conjunctivitis resolves without long-term effects, but when the cornea becomes involved, there is a risk of permanent vision damage. If the infection is not adequately treated, it can cause scarring and can affect vision,” says Dr. Preetha.
Prevention and care
Maintaining eye hygiene and avoiding triggers is key during summer months. “There are a few dos and don’ts that patients can follow to prevent the spread of pink eye. The dos include washing hands frequently, cleaning the discharge from the eyes, washing the linen and towels with hot water, seeking medical care, and wearing protective eye wear,” says Dr. Preetha.
The ongoing research, she adds, is focused on developing broad spectrum antiviral drugs, testing antiseptic antiviral combinations and exploring immune modulating drugs to reduce inflammation, faster and more accurate diagnosis, advanced drug delivery systems, designing better hygiene guidelines and outbreak control.
Moreover, the medicines being developed include antiviral drops, combination therapies of antiseptic anti-inflammatory drops, broad spectrum next-gen eye drops against multiple viruses and bacteria, smarter drug delivery systems.
“To prevent conjunctivitis, it is important to avoid touching or rubbing the eyes frequently, as this can increase the risk of infection and inflammation. Maintaining good eye hygiene is essential,” adds Dr. Kalpana.
Doctors also caution against common mistakes. The don’ts include not wearing contact lenses, not touching the eyes frequently, not sharing personal things with others, not using makeup around the eyes, and not self-medicating, but consulting a healthcare professional for management.
Treatment depends on the underlying cause. In some cases, over-the-counter lubricating eye drops may help relieve symptoms. However, it is always advisable to consult an ophthalmologist to accurately diagnose the cause and receive appropriate treatment.
Simple measures can also help ease discomfort. “For relief, warm or cold compresses can be applied over closed eyelids. It is important to avoid splashing tap water directly into the eyes and to refrain from rubbing them,” Dr Kalpana says, adding that wearing protective eyewear and sunglasses can help shield the eyes from dust, wind, and harmful UV rays.
With conjunctivitis cases on the rise this summer, doctors say it is important to get diagnosed early, proper hygiene, and avoiding common triggers. What may start as mild redness or irritation can quickly worsen if left untreated, making awareness and timely care crucial to protecting eye health.