Amid conjunctivitis surge, doctors warn against irrational use of steroid eye drops

Amid a surge in conjunctivitis and eye flu cases in the national capital, doctors have warned against the irrational use of steroid eye drops, saying it may bring temporary relief but can do more harm in the long run.

Early detection and use of appropriate therapies are key to expeditious resolution of the disease and can help minimise potential harmful effects or transmission of untreated conjunctivitis, Dr J S Bhalla, a senior consultant eye surgeon at the DDU hospital said.

Conjunctivitis in the present epidemic is a self-limiting disease and does not require antibiotic treatment in all cases, he said, adding that hand and facial hygiene are very important to prevent its spread. There is no approved treatment but topical corticosteroids may be helpful in a subgroup of patients with adenoviral conjunctivitis and may prevent scarring in severe cases.

"It should be noted, however, that treatment guidelines suggest caution in the use of corticosteroids because they can potentially prolong infection," Bhalla said.

Dr J S Titiyal, chief of the RP Centre at AIIMS, said the condition is usually caused by viruses, which are highly contagious and spread quickly. He said the RP Centre found adenovirus to be the causative agent in all cases tested.

Among these, nearly 20-30 per cent of cases have a positive bacterial culture as well, pointing towards superadded bacterial infection, Titiyal added.

"The viral infection of the eyes is self-limiting and one can recover in one to two weeks. However, secondary bacterial infection may rarely occur and delay recovery," he said. "In such cases, use of antibiotic eye drops is advised." However, Bhalla said primary or urgent care physicians may prescribe antibiotics without making an informed differential diagnosis, adding that misdiagnosis of viral etiologies as bacterial conjunctivitis and the resulting inappropriate use of antibiotics can occur in as much as 50 per cent of cases.

This can lead to inappropriate antibiotic prescriptions and the risk of antibiotic resistance, the doctor added.

Both Bhalla and Titiyal warned against the indiscriminate use of steroid eye drops, saying over-the-counter steroids should not be used unless advised by an ophthalmologist for specific indications.

"Since it provides rapid relief of symptoms due to its anti-inflammatory properties, patients feel symptomatically better. But there are risks associated with steroid use without recommendations of your eye doctors," Bhalla, the secretary of the Delhi Ophthalmological Society, added.

He warned that patients who use corticosteroids over a long term are at risk of developing glaucoma (which is a potentially blinding condition) and cataracts.

Titiyal said two of the major symptoms experienced are itching and grittiness. Lubricating drops are soothing to the eyes and provide symptomatic relief, and cold compresses also decrease ocular irritation and itching, he said, adding people with active conjunctivitis can use of dark goggles to help reduce photophobia and prevent frequent touching of eyes.

Bhalla, a member of the Scientific Committee of All India Ophthalmological Society, further said topical steroids increase eye pressure more frequently, severely and rapidly among children as compared to adults.

Corticosteroids are a predisposing factor for bacterial conjunctivitis and can lead to suppression of the immune response, with the consequent risk of secondary ocular infections, he said.

Adenoviral conjunctivitis is a major cause of acute infectious conjunctivitis cases among adults, Bhalla said, adding bacterial conjunctivitis is responsible for the majority of cases among children.

"Topical steroids and their mixtures must be sold as 'prescription-only' medications. Physicians should refrain from irrational use of steroidal eye drops," he suggested.