Dr. C.V. Alert, MB BS, DM.
It seemed like a normal working day. My receptionist phoned to say that there was a new patient outside, sent by his company after some of his co-workers were ‘making some noise’, about his eye that looked pink.
II remembered hearing on the news that “red/pink eye” seemed to be stirring in another Caribbean island: it has apparently taken the short trip across to Barbados. According to reports on the radio, it also affected one ward of a District Hospital here, a sub-population vulnerable to contagious diseases.
It was easy to make a ‘spot’ diagnosis [with apologies to the ophthalmologists] once the patient came into the room: the pink/red eye was immediately obvious. In fact, the patient himself came up with the diagnosis: “Doc, I have the red eye”. He noted that the eye was ‘a bit itchy’, and he had the redness, but there was no discharge nor pain. He also had no constitutional symptoms. The clinical diagnosis was acute conjunctivitis, although he did not recall being around anyone that had it.
Acute conjunctivitis can be separated into viral and bacterial categories, depending on the etiological agent. A not uncommon scenario seems to be an initial viral conjunctivitis also becoming affected by bacteria, presenting with features of both viral and bacterial conjunctivitis.
Viral conjunctivitis is a common, self-limiting condition caused by a small number of viruses. It is also highly contagious, a fact not lost on his co-workers, who were the ones in fact who ‘forced’ the boss to send this worker to me in the first place. Symptomatic treatment was offered in the form of decongestant eye drops, and the patient was advised about personal hygiene. He then asked about a sick-leave certificate.
The medical literature suggests that viral conjunctivitis is highly contagious, usually for 10-12 days from onset as long as the eyes are red. At a primary care level there is no test to determine whether a patient with a pink or red eye is no longer contagious, once the eye clears up. Should all working adults be automatically offered a 14 day sick leave certificate? If we allow an adult with viral conjunctivitis to return to work while they are still potentially contagious, can we be complicit in putting the work colleagues at risk? If we observe a 14 day period, we can be accused as offering ‘excessive’ sick leave, which in turn has a negative effect on national productivity. [(Some of) our politicians, without offering any supportive evidence, from time to time accuse (some) doctors of offering excessive sick leave to (some) adult workers. This obviously has a negative effect on productivity.)
Both the prevention and the treatment of viral conjunctivitis stress the importance of personal hygiene. At a community level, however, strict hygienic practices are challenged by erratic garbage collection, irregular water distribution in some areas, frequent floods – and on parts of the south coast, if homeowners, business persons and those pedestrians who walk there after rainfall are to be believed, the flood water contaminated by fecal material. This makes ‘community sanitation’ extremely challenging, and provides ideal media for communicable diseases to thrive. Viral conjunctivitis, and even bacterial conjunctivitis, are diseases that treasure such an environment. Attention to these ‘community hygiene’ issues is important because many diseases, many with more severe personal consequences than acute conjunctivitis, can flourish in such an environment. Unfortunately the red-eye outbreak is occurring at the precise time that our service providers are challenged to consistently provide us with a clean, healthy environment.
With due sympathy to those affected by pink/red eye, we will be lucky if Barbados comes out of our current set of environmental challenges with not-so-few cases of acute conjunctivitis. More severe contagious diseases lurk in the background; some, like leptospirosis, are already endemic here. But the disruption that contagious diseases cause to the home and the workplace, and to national productivity, can bring more than just ‘tears to one’s eyes’.