This was a prospective observational study conducted in a tertiary care hospital in Dehradun, Uttarakhand, India over a period of three months, from June 1, 2023, to August 31, 2023. Ethical approval was obtained from the Institutional Ethics Committee with IEC number SGRR/IEC/46/28. The study adhered to the tenets of the Declaration of Helsinki.

Inclusion and Exclusion criteria: The inclusion criteria were patients diagnosed with viral conjunctivitis, while the exclusion criteria involved patients with any other cause of conjunctivitis or corneal ulcers.

A total of 586 patients were diagnosed with viral conjunctivitis after visiting the eye OPD and were enrolled after providing their informed consent. Following inclusion, the patients underwent a detailed history and ocular examination. The demographic and clinical profiles were tabulated and analysed. The treatment of referred or already treated cases was also analysed.

Categorical variables were presented as numbers and percentages (%). The data were entered into an MS Excel spreadsheet, and the analysis was conducted using Statistical Package for Social Sciences (SPSS) 26.0 software.

A total of 586 cases of viral conjunctivitis were encountered over a period of three months. Out of these, 263 were newly diagnosed, while 323 cases were already under treatment from elsewhere. Among the 323 cases already under treatment, 16 were treated by general practitioners. The maximum number of cases occurred in the 10-20 years age group, with 172 (29.35%) cases, followed by the 20 years age group, which had 126 (21.50%) cases [Table/Fig-1]. The present study included 341 (58.19%) males and 245 (41.81%) females.

Pain, redness, and watering were presenting symptoms in 100% of the cases. Diminution of vision was reported by 68 (11.60%) cases out of the total 586 cases [Table/Fig-2]. Follicles and conjunctival congestion were uniform clinical signs present in all cases (100%). Lid swelling was the second most common sign, observed in 373 (63.65%) cases, while the least common sign was subepithelial infiltrates, which were seen in 7 (1.19%) [Table/Fig-3]. Clinical images showing petechial haemorrhages and pseudomembranes are shown in [Table/Fig-4,5].

[Table/Fig-4]:

Clinical image showing petechial haemorrhages in case of epidemic viral conjunctivitis.

[Table/Fig-5]:

Clinical image showing pseudomembrane in case of viral conjunctivitis.

An analysis of the treatment for the 323 referred or already treated cases showed that the majority of patients, 148 (45.82%), were treated with a combination of topical antibiotic drops, topical steroids, and topical artificial tear drops, followed by 65 (20.12%) cases treated with a combination of topical antibiotic drops and topical steroid drops. Only eight patients (2.47%) were using only artificial tear drops out of the total 323 referred cases [Table/Fig-6].

The current study involved 586 cases of viral conjunctivitis over a period of three months, of which 263 were newly diagnosed and 323 cases were already under treatment from elsewhere.

In the year 2023, there were numerous reports about an outbreak of acute conjunctivitis. It has different names in India, such as Madras Eye and Joy Bangla [9,10]. The sudden rise in the number of cases is certainly attributed to changes in weather conditions. The damp and increasingly humid environment during the monsoon provides an ideal breeding ground for microorganisms to multiply and spread the infection rapidly. Areas with high population density, such as relief camps, suburban areas, and housing societies, are at a significantly greater risk for the quick transmission of infections [11,12].

The data in the present study were compiled to examine the demographic and clinical trends at the beginning of this recurrent clinical entity. The study highlighted that the disease primarily affected children under 20 years of age. The reason for this occurrence could be attributed to a poor understanding of hygiene among school children. Therefore, raising awareness at the school level is of utmost importance to educate them about hygiene and the isolation of infected students. A lower threshold for absenteeism and increased provisions for medical leave through proper medical documentation should be encouraged. Another affected age group was the working population between 21 and 30 years. The male and female distribution was 58.19% and 41.81%, respectively.

All the patients presented with typical features of pain, redness, and watering. The results were in concordance with another study by Madurapandian Y et al., as seen in [Table/Fig-7] [13]. The lack of a correct diagnosis and the initiation of erratic medications is one of the largest issues; if revisited and corrected, this could lead to a decrease in recalcitrant cases of conjunctivitis. Most patients exhibited typical clinical signs of viral conjunctivitis. The clinical signs have been compared to the study by Pinto RD et al., in [Table/Fig-8] [14]. Differentiating between follicles (viral, bacterial, or toxic) and papillae (allergic), as well as the type of discharge, will certainly aid in achieving a correct diagnosis in most cases of conjunctivitis. A history of any upper respiratory tract infection or a tender preauricular lymph node [2] will further support the diagnosis of viral conjunctivitis. The presence of multiple haemorrhagic spots on the conjunctiva will help establish a diagnosis of epidemic conjunctivitis [15]. Furthermore, the presence of vesicles and corneal involvement should prompt consideration of a herpetic lineage. Thus, these sequelae should be kept in mind while managing such cases.

Out of the 323 cases who were already being treated elsewhere, 45% were on a combination of eye drops, including antibiotics, steroids, and lubricating agents. This is not in accordance with the treatment guidelines. Such erratic treatments have been highlighted in the literature [16]. Counselling patients and demonstrating patience by the treating ophthalmologist are crucial roles in this scenario. Topical artificial tear drops can be used with varying frequency. From a broader perspective, it is established that topical steroids can cause prolonged viral shedding and increase the duration of conjunctivitis [15]. Unfortunately, due to the easy availability of topical steroids, the prevalence of self-medication in society, and the non judicious use of steroids, various complications arise, leading to an increase in refractory cases of viral conjunctivitis. Therefore, proper awareness campaigns can help patients better manage their condition and reduce the rate of recurrences. The 16 cases treated by practitioners other than ophthalmologists should also be considered, and awareness campaigns or sensitisation policies should include a broader segment of the medical fraternity.

The present study had a small sample size and a short duration. The main limitations of the study include a small cohort, being a single-centre study, and a lack of follow-up with the patients.

To conclude, present study found that 4.95% of cases were treated by general practitioners, and 46% of the cases involved the use of a combination of medications, including topical steroids. Although viral conjunctivitis is a very common ophthalmic condition, the irrational and non specific use of medications leads to prolonged duration of the disease, increases the risk of corneal involvement, and ultimately affects visual acuity. This situation contributes to an increased mental, social, and economic burden on society. Proper sensitisation of practitioners and the public is urgently needed. Patients diagnosed with conjunctivitis of presumed adenoviral etiology must undergo further investigation to identify the type of viral strain, and this information should be communicated to a government nodal agency to help identify the types and patterns of outbreaks in the population.