Rising rates of conjunctivitis in Pakistan: epidemic, challenges, solutions, and recommendations

Highlights A delay in diagnosing and treating conjunctivitis can cause pain and eye loss, and access to healthcare facilities and adequate treatment is problematic owing to disparities in healthcare provision between urban and rural locations. The temperature and environment of Pakistan have a significant impact on the occurrence of eye infections like conjunctivitis, and as these illnesses may have a detrimental effect on one's quality of life and mental health, it is imperative that steps be taken to address the pandemic. Conjunctivitis is an inflammation or infection of the conjunctiva1. It might either be contagious or not1. There are two subtypes of conjunctivitis: acute and chronic. In contrast to chronic conjunctivitis, which is defined as lasting more than 4 weeks, acute conjunctivitis is characterized by beginning within 3–4 weeks after presentation1. The occurrence of conjunctivitis varies depending on age, season, and the underlying reason2. Allergic conjunctivitis affects between 15% and 40% of people, with adenovirus being the most prevalent cause3. Instances of conjunctivitis caused by viruses range from 20% to 70%, with adenovirus being the most common cause2. In children, bacterial conjunctivitis is most prevalent from December to April4. At least three to four instances of conjunctivitis were seen at one outpatient clinic each day, according to the leading ophthalmologist at Hashmanis Hospital, who also stated that the patient flow had been mostly constant for more than a week5. Although bacterial and viral conjunctivitis are both present in some instances, the former is somewhat more common5. According to the Provincial Health Department, conjunctivitis, often known as pink eye, is becoming more prevalent in the metropolis and surrounding metropolitan areas6. One of the city's most known hospitals, Jinnah Hospital, handles 50 daily patients in its outpatient department. Half of these are unique to red eye infections, which affect both adults and children7. Conjunctivitis is one of several eye ailments that people must contend with; it is very infectious and can spread in crowded settings. Sharing personal objects is one cultural habit that may help spread eye diseases. Delay in diagnosis and treatment might result in discomfort and vision damage. It can also prevent access to healthcare facilities and appropriate treatment. Timely diagnosis and treatment are challenging because of the disparity in healthcare availability between urban and rural areas. Symptoms may worsen due to a lack of ophthalmologists and other eye care professionals and poor cleanliness procedures. The prevalence of eye infections like conjunctivitis is greatly influenced by the climate and environment in Pakistan. Eye infections can also have a negative impact on quality of life and mental health. Those who have apparent symptoms may also experience social stigma or prejudice. Antibiotic resistance can be caused by overusing antibiotics, especially eye drops; hence, better prescribing procedures are required. Treatment can be expensive, especially for those without access to cheap healthcare or health insurance. People who are malnourished have weakened immune systems, which makes them more vulnerable to eye illnesses. Conjunctivitis-affected kids could have to miss school, which would interfere with their education and academic growth. Pakistan, a low-middle-income nation, struggles to monitor eye illnesses such as conjunctivitis because its data collection and surveillance methods are insufficient. Investing in comprehensive programs is challenging due to the limited resources available for public health efforts. Budget restraints and competing healthcare goals make it difficult to consistently provide appropriate financing for healthcare services and research into eye infections. Conjunctivitis typically goes away on its own, and permanent vision loss is extremely rare1. It's important to rule out any other red eye diseases that might be dangerous to one's vision1. Primary care doctors need to be aware of the typical differential diagnoses for the causes of red eyes, which include conjunctivitis, episcleritis, and scleritis; corneal ulcers, abrasions, or foreign bodies; iritis; glaucoma; subconjunctival hematomas; chemical/flash burns; dry eye; and blepharitis1. It is crucial to make a choice on a referral to an ophthalmologist quickly in order to provide high-quality patient treatment1. Contact lens wearers, individuals with mucopurulent discharge and eye discomfort, probable instances of chlamydial and gonococcal conjunctivitis, and patients with previous ocular surface illnesses are typically advised to have treatment with topical antibiotics4,8. Early illness resolution9, prompt return to work or school4,10, and the potential for fewer conjunctivitis complications are all benefits of using antibiotics4. Seasonal allergies cause the majority of occurrences of allergic conjunctivitis11. For the treatment of allergic conjunctivitis, antihistamines, mast cell inhibitors, and topical steroids (in some circumstances) are recommended12. A multifaceted strategy, including the cooperation of people, communities, healthcare professionals, and public health authorities, is necessary to prevent a conjunctivitis epidemic. Conjunctivitis may be prevented by maintaining good hand cleanliness. It inhibits self-infection, prevents transfer from person to person, and lowers pollution. By eliminating possible germs from the hands, effective handwashing with soap and water can break the chain of transmission. Regular handwashing lowers the risk of indirect transmission by decreasing environmental contamination. Encourage thorough handwashing with soap and clean water when possible, and use alcohol-based hand sanitizers in the absence of soap and water. Encourage people to wash their hands frequently throughout the day, especially before touching their faces, eyes, or things that might potentially contact them. Promote excellent conduct via role models and run educational efforts. It's important to advise people to keep their distance from those who are exhibiting conjunctivitis symptoms. Isolation or separation of infected persons should be taken into consideration in educational and professional contexts until they are no longer infectious. To discover lasting solutions, it is advised to invest in sanitation infrastructure, promote healthy hygiene habits, foster community involvement, enforce sanitation standards, and fund research and innovation. In order to maintain clean communities, it is vital to implement public awareness programs, establish regulatory organizations, and promote community engagement. Several initiatives may be used to enhance access to eye care services in order to solve the lack of eye care professionals. Expanding training programs, rewarding experts, putting telemedicine and teleophthalmology programs into place, building accessible eye clinics, and encouraging public–private collaborations between healthcare providers are all necessary. These actions will boost the number of eye care professionals and enhance rural and isolated regions' access to services. At this time of epidemic, it's imperative to make sure that medical institutions have enough eye drops and drugs for treatment. Conjunctivitis should be diagnosed and treated as soon as possible to minimize the danger of the infection spreading. The strategy should include raising public healthcare expenditure, promoting health insurance, maintaining budget transparency, luring private investment, looking for alliances and foreign help, and funding health systems research to maximize resource use. Additionally, it stresses the significance of health insurance, encourages budget transparency, and ensures private sector investment in healthcare infrastructure. The necessity for foreign assistance and cooperation with international healthcare organizations for programs aimed at improving healthcare should also be emphasized in the strategy. It will be beneficial to start public awareness campaigns on conjunctivitis, its symptoms, transmission, and treatment options. It might be crucial to use numerous media outlets, such as radio, television, social media, and neighborhood activities, to reach a large audience. Delay in conjunctivitis diagnosis and treatment can cause discomfort and damage to eyesight, and access to medical facilities and adequate care is challenging due to the gap in healthcare accessibility between urban and rural locations. The climate and environment of Pakistan have a significant impact on the occurrence of eye infections. Conjunctivitis normally resolves without treatment, but it's crucial to screen out any other red eye conditions that might be hazardous to one's vision. Ethical approval This article does not involved human beings. No ethical approval was needed. Consent None. Sources of funding The authors have not received any funds. Author contribution A.H., T.A., Z.N., and A.A.: conception of study, major drafting of work, literature search, and final approval and agreeing to the accuracy of work. Conflicts of interest disclosure The authors stated no conflicts of interest. Research registration unique identifying number (UIN) None. Guarantor Ashna Habib, Zainab Nazir, Tooba Ali, and Aymar Akilimali. Provenance and peer review Not commissioned, externally peer-reviewed. Data availability statement None.