Are We Equipped or Still Unprepared to Act Early to Avoid Misuse or Overuse of Resources: A Perspective in View of Recent Conjunctivitis Surge

Dear Editor, The escalating prevalence of acute conjunctivitis, a pervasive ocular malady, has engendered a nationwide concern. Esteemed medical institutions are inundated with approximately 100 cases daily, prompting an introspection into our preparedness and diagnostic acumen. Conjunctivitis, colloquially known as "red eyes", is a frequent cause for clinical visits, with antibiotic eye drops being prescribed to nearly 60% of the afflicted individuals. However, it is noteworthy that a significant proportion of these prescriptions are made by nonophthalmologist physicians.1 A comparative analysis reveals that only 36% of patients consulting an ophthalmologist were prescribed antibiotics, as opposed to 68% who sought help from a general physician.2 This discrepancy underscores the importance of accurate diagnosis in treating "red eyes", which could be symptomatic of severe conditions like acute angle closure glaucoma, uveitis, endophthalmitis, carotid-cavernous fistula, cellulitis, and anterior segment tumors. While antibiotics are the standard treatment for conjunctivitis, it is crucial to remember that bacterial pathogens are isolated only in 50% of the cases. Moreover, bacteria were found in up to 52% of suspected viral conjunctivitis cases. Therefore, an accurate diagnosis is paramount to prevent mismanagement and ensure effective treatment.3 The frequency of microbiological evaluations in conjunctivitis cases is not universally standardized and is largely contingent on the severity of the condition, the response to initial empirical treatment, and the clinician's discretion. Conjunctival discharge samples can indeed be collected for microbiological analysis to confirm the etiology.4 Gram staining and culture are instrumental in delineating bacterial characteristics, while Giemsa stain can be utilized for Chlamydia screening. Rapid antigen testing is available for confirming probable viral causes of conjunctivitis, thus circumventing redundant antibiotic use. One study reported that this method has a sensitivity of 89% and a specificity of up to 94% when juxtaposed with polymerase chain reaction (PCR), viral culture, and immunofluorescent staining. In cases of viral conjunctivitis, enzyme-linked immunosorbent assay and direct immunofluorescent monoclonal antibody staining are rapid and widely available detection methodologies. For virus detection, several PCR tests are available, and nucleic acid amplification techniques may be utilized to diagnose viral infection.5 The first step in managing a patient with suspected conjunctivitis is to rule out serious ocular diseases that present with "red eye" and mimic conjunctivitis. This necessitates a thorough medical history, and a comprehensive physical and ophthalmologic examination. Imaging and ancillary laboratory tests are crucial aspects of assessing these patients. Steroids and antibiotics must be used judiciously and only when indicated. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.