From pink eye to blindness

Two news stories about eye health are very hot these days. One about ‘red/pink eye’ which is ravaging our country, and the other about an injection meant to improve vision in diabetic patients which became the reason for severe complications and, in some cases, complete vision loss. Today, we will discuss both issues.

For more than a month, different cities in Pakistan have been reporting an outbreak of ‘Pink Eye’ or conjunctivitis. This started in Karachi, then Lahore, and now Rawalpindi and Islamabad are in their grip. Eyes could become red due to many reasons, including allergic conditions and pollution, but when an outbreak starts, it is commonly caused by bacteria or viruses. In Pakistan, most cases in an outbreak setting are caused by viruses, which is why they spread very quickly from one person to another. Viral conjunctivitis starts with one eye, and then the other one gets infected. Eyes become red and teary with yellow or white discharge, which sometimes sticks to eyelids (more in bacterial than viral). Eyes are itching and, in extreme cases, have burning sensations, including blurred vision.

Viral conjunctivitis spreads like wildfire. This is spread by contact (shaking hands, using the same towels, touching infected surfaces) and in close proximity, where a patient coughs and sneezes. In the early days of Covid-19, we instituted control measures for droplet infection, which are very valid for conjunctivitis too. So wash your hands with soap and water as much as you can. Avoid shaking hands or touching surfaces and then touching your face or eye.

You don’t need any specific medicines, as you will recover in a week or two. In case you need anything for your itchy or burning eyes, just use ‘natural tears’, which are marketed under different brand names. Use cold compresses (clean water and cloth) to get relief. Do not wear contact lenses until you are fully recovered. What about ‘vitamin eye drops’ or even eye drops containing antibiotics? Though vitamin eye drops are a big business these days because of their popularity, I have not seen much scientific data on their effectiveness. However, having a balanced diet with naturally occurring vitamins in fruits and vegetables is good for overall health and eye health too. Unless your doctor thinks that this is a bacterial infection, using eye drops with antibiotics could not give you any benefit but increase the chances of anti-microbial resistance (AMR), a major global health challenge at this moment. Remember, anything you are putting in your eye, you need to ensure that it is safe, as the eye is a sensitive organ of our body.

If your eyes become more red and painful and you start having a feeling of ‘something in the eye’, or still have blurred vision even after wiping your eyes, then see your doctor immediately. People with weakened immune system (cancer, HIV and other medical conditions requiring long-term treatment) should also consult their doctor early.

There are also news reports of blindness after patients were treated with eye injections. This injection is used to treat diabetic patients who have advanced eye disease and has been shown to be effective in reducing the decline in vision in diabetic patients. This injection is used globally for diabetic vision loss and is a cheap alternative to very expensive drugs. However, it is originally a cancer drug, so it comes in a big vial, and then it is repacked in different hospitals to be used in the eyes. So any lapse in sanitisation from manufacturing, repackaging, or at the time of injection could cause a serious eye infection. Due to lapses in repackaging, similar outbreaks have been reported from many countries, including a similar outbreak last year in Lahore. According to news reports, 12 patients in Lahore, Kasur and Jhang who received these injections got severe eye infections, including some with irreversible vision loss.

A scientific outbreak investigation is required to ascertain the actual problem in these steps, and we need to fix it. Pakistan has a huge disease load of diabetes, and halting vision loss is critical for patients’ wellbeing. Outright banning the drug will take away a cheaper solution from the hands of our patients.

Published in The Express Tribune, September 28^th, 2023.

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