Conjunctivitis : A Major Health Risk Following Floods

By Dr. Chulalak Tangmanakorn, Ophthalmologist.

Thailand is a tropical country. The period from July to October is the rainy season, and this year, Thailand experienced heavy rainfall due to the influence of a typhoon, causing a flood crisis in many provinces. After the flood, the most common eye disease found to be spreading is an epidemic of conjunctivitis (pink eye), which can affect people of all ages. Lately, Ubon Ratchathani province reported that the number of conjunctivitis patients during this year's flood reached 3,608 people.

Symptoms of Conjunctivitis

Patients will experience eye irritation, itching, and eye pain. The whites of the eye will appear red, with tearing, light sensitivity, and excessive sticky discharge. Sometimes, severe symptoms of the disease can lead to reduced vision.

Findings upon Examination

• It usually starts in one eye first and then follows in the other eye.
• The eyelids may be swollen and red.
• The conjunctiva (whites of the eye) turn red, with small bumps on the conjunctiva, a watery eye, yellow mucous membrane on the conjunctiva, and excessive tearing.
• There may be cloudiness (infiltrates) on the clear cornea.
• May also be accompanied by a sore throat, cough, sneeze, or a cold.

Bumps on the conjunctiva

The whites of the eye turn red

White cloudiness on the cornea, causing reduced vision

Corneal staining with a special dye by an ophthalmologist

What Causes Conjunctivitis?

Most conjunctivitis found after a flood crisis is most often caused by a virus, followed by bacteria.

The type of virus most commonly found in Thailand and the Southeast Asian region is Adenovirus, which usually spreads during the rainy season and is found to be endemic in communities, schools, or nurseries.

The Most Common Symptoms of This Viral Infection are in 2 Forms :

1. Pharyngoconjunctival fever is caused by Adenovirus strains 3, 4, and 7. Patients infected with this type of virus will have a sore throat, fever, cough, runny nose, enlarged lymph nodes in the neck, and may also have diarrhea. After infection, there is an incubation period in the body of 5–14 days before the conjunctivitis symptoms appear in both eyes, and it can spread to others for up to 2 weeks.
2. Epidemic keratoconjunctivitis is caused by Adenovirus strain 8. The symptoms are relatively more severe than the first form, often starting with conjunctivitis in one eye first, accompanied by itchy bumps, red eye, shedding of the conjunctiva, and most severely, causing white cloudiness on the cornea, leading to blurred vision and seeing rainbows around lights.

Another virus that made headlines many years ago, associated with a female celebrity who had a red eye and blood-colored tears, is caused by a virus in the Piconavirus group, which leads to a condition called Acute Hemorrhagic Conjunctivitis. Symptoms include swollen and red conjunctiva, subconjunctival hemorrhage (blood under the conjunctiva), and when crying, the tears are red like blood.

Diagnostic Examination

Currently, there are portable diagnostic tools that can be used to confirm viral conjunctivitis, such as the Adenoclone test and RPS Adeno Detector, but they are not yet available for sale in Thailand due to the relatively high cost per kit. In most cases, diagnosis can be made from the patient's history and eye examination.

Transmission

1. Through contact with the patient's secretions, such as tears, nasal discharge, coughs, or sneezes.
2. Through sharing objects with the patient, such as handkerchiefs, towels, children's toys, or cosmetics.
3. Through contact with contaminated water containing the virus, such as in swimming pools or ponds.
4. From carrier animals, such as houseflies.

Therefore, it often spreads in families, communities, and schools due to close contact with conjunctivitis patients.

It can be seen that since this virus can be contaminated in water sources and dirty, stagnant water, it is considered an epidemic disease that occurs after floods. Due to the flooding, people are forced to relocate and live together in close proximity, increasing contact and sharing items, which makes it easy for the infection to spread to others.

Treatment

• Since viral conjunctivitis usually heals on its own within 1–2 weeks (unless there is a secondary bacterial infection) and generally does not cause serious complications like bacterial or other viral infections, the goal of treatment is to prevent the spread to others and alleviate eye symptoms. It is recommended to see an ophthalmologist for diagnosis and treatment and strictly follow the advice.
• Avoid rubbing the eyes when they are itchy or irritated. Instead, a cold compress on the eyelids should be used, which can help reduce itching and irritation.
• Sunglasses should be worn to help reduce light sensitivity.
• Eye rest is advised. Avoid prolonged use of the eyes, such as using a computer for long periods.
• Do not buy medication from a pharmacy to use on your own. You should consult an ophthalmologist.

Prevention

Guidelines for Conjunctivitis Patients

1. Conjunctivitis patients should be separated from others, such as by taking 1–2 weeks off from school and work to prevent the spread of infection to others, especially avoiding close proximity to young children.
2. Conjunctivitis patients should be advised to avoid contact with others through coughing, sneezing, or various secretions.
3. Conjunctivitis patients should wash their hands more often, especially after touching their eyes.
4. Paper or cotton used to wipe the eyes should be disposed of in a tightly closed trash can.

Guidelines for the General Public

1. Refrain from sharing items with conjunctivitis patients, such as towels, handkerchiefs, or pillowcases.
2. Wash hands thoroughly and frequently, and avoid rubbing the eyes with hands.
3. If dirty water gets into the eyes, they should be immediately washed out.

References

1. Krachmer. Cornea 3rd edition
2. Birthe Meyer et al. REVIEW ARTICLE : Epidemic Keratoconjunctivitis; The Current Situation and Recommendations for Prevention and Treatment