How best to treat Apollo —Expert

allergic conjunctivitisWATCHING from a distance, it was obvious the little girl was not finding it easy playing with her doll because intermittently she stops to scratch her red eyes. Her mother was told that she had allergic conjunctivitis and with time, the itching will stop.

Pink eye, or conjunctivitis, is a common eye infection. It can make your eyes itchy and teary, with a watery discharge, and swollen, crusty eyelids. There are three types: viral, bacterial, and allergic conjunctivitis.

For the past few months, there has been an increase in cases of a red and itchy eye. But the thought of red-eye causes anxiety in most parents. However, it is not an uncommon dilemma because it has various causes or precursors, including allergies, chemicals, dust and germs.

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An allergy is defined as an abnormal sensitivity to a substance normally tolerated and generally considered harmless such as pollen, dust mites, food, drugs or insect stings. This means that while some allergens are tolerated by most people, they can induce an allergic reaction in others.

Allergic conjunctivitis affects a large number of people, with a great majority developing red, itchy eyes, which affect their performance at work. It is usually a mild disease that can be easily treated. However, other forms of eye allergies can be dangerous enough to threaten eyesight.

Ironically, “allergic conjunctivitis is the second most common eye disease that affects children in Nigerian environment,” said Professor Ayotunde Ajaiyeoba, a paediatric ophthalmologist consultant, University College Hospital (UCH), Ibadan, Oyo State.

According to Professor Ajaiyeoba, allergic conjunctivitis was preventable, though one out of every four children with allergic conjunctivitis turns out to develop asthma later in life.

Usually, eye doctors can determine what is the cause of a red eye by the way the eye looks and the symptoms produced.  This also determines its mode of treatment.

Amazingly, many people resort to using self-prescribed antibiotics to treat all red eyes. Some use things like sugar water, urine, battery water or other local remedies to treat the discomforting eye problem.

However, experts have continued to caution on the use of many of these remedies, including some eye drops. Although it is common for people to resort to the use of antibiotics, for some red eye, antibiotics usually don’t help. In fact, they can do more harm than good.

In 2017, for instance, a study suggests that most people with pink eye are getting the wrong treatment. About 60 per cent of patients got prescription antibiotic eye drops, even though antibiotics are rarely necessary to treat this common eye infection. About 20 per cent received an antibiotic-steroid eye drop that can prolong or worsen the infection.

Professor Charles Bekibele, head, Department of Ophthalmology, UCH, Ibadan, stated that when the redness of the eye has a sudden onset and without pain, it may be viral in origin and as such an antibiotic may not be necessary.

He declared: “If it is viral, it goes through its natural course and the body overcomes it. It does not cause pain, but it may cause some irritations like redness, sticky discharge, watery eye and puffy eye. Due to the sticky discharge, the affected eye is stuck together in the mornings.”

Moreover, the commonest infection that causes sudden onset of red eye that is not associated with pain is Apollo, which is medically termed viral conjunctivitis.

Apollo occurs commonly in school children because their body immunity is not fully matured. They get it through infection from other people in school, nurseries and other places where people aggregate a lot. It thrives easily where there is overcrowding.

Other children and their parents later contract the infections when the macro environment at home is conducive for the germ to spread.

Although Apollo is a self-limiting disease that without any drug will go on its own, Professor Bekibele said medicines such as eye drops are only recommended to prevent another bacterial infection that might want to worsen the eye problem.

He declared: “Ordinarily, it does not need treatment but we have to give patients something to assure them and also maybe for comfort because it could feel uncomfortable because it is like you have sand in your eye. So you may have to relieve them of some discomfort and if there is a risk of a secondary re-infection, you may want to give eye drops.

“And usually we advice that patients should not use home remedies like urine, sugar water, cow urine, salt water, brake fluid, battery water, breast milk and other funny remedies that people prescribe. These are common things that people apply. They will cause more damage.”

He cautioned against the use of steroidal eye drops in treating Apollo.

“Many people abuse steroids and we usually discourage it. Steroids are dangerous because they cause cataracts, glaucoma, and other eye problems. Steroids ideally should be prescription drugs and by experts who know the effects and side effects, not just everybody,” he added.

Some other antibiotic eye drops and ointments can cause problems. Antibiotics can cause itching, stinging, burning, swelling, and redness. They can cause more discharge. And they can cause allergic reactions in some people.

However, he said that many other things can cause red eyes and as such, every case needs to be seen at the hospital to determine it really causes and proffer appropriate treatment.

“Redness or pink eye that may also be of sudden onset that is associated with pain and blurring of vision could also be due to what is called acute closure glaucoma. Acute closure glaucoma is not common; we do not often see it.

“Some redness or pink eye may be due to inflammation in the eye as a result of a minor injury or trauma, an allergic reaction, fungal infection and so on.”