In April this year, eye health screening will be carried out across all primary schools in the country, with the aim of detecting eye problems among young children. Organised by the Ministry of Health (MoH) and other partners, the screening is part of RDF (Rwanda Defence Force) citizen outreach programme, that normally takes place annually. This, according to organizers, is because refractive error is only priority for many but it is not the most prevalent for people aged 6 to 39. The efforts are part of implementing the National Strategic Plan for eye health running from 2018 to 2019. Meanwhile, data from the Rwanda Health Management Information System (RHMIS, 2016) showed that in health centres, eye diseases are the forth cause of morbidity with a total of 638,080 consultations. In Rwanda, the major causes of blindness are untreated cataract, glaucoma, age-related macular degeneration, and other posterior segment causes. Dr John Nkurikiye, an ophthalmologist and associate professor of ophthalmology, says viral conjunctivitis is among the common eye infections that affect many people. What to know about the condition Dr Nkurikiye says viral conjunctivitis is an infection of the outer membrane of the ocular surface and the inner eyelid (the membrane is called conjunctiva). It is highly contagious and is caused by a virus called adenovirus. The transmission of the disease, he says, is by direct contact with the secretions from the sick eye. “Usually the sick person touches the secretions and touches a common surface like doorknobs, tables, but also by a handshake. It is part of what is called ‘Dirty Hands Diseases’,” he says. Dr Nkurikiye notes that this is the reason why this type of infection is common in schools as it spreads quickly. “It can also be a complication of other viral infections like a common cold or flu.” He notes that one is also at increased risk for viral conjunctivitis if they wear contact lenses, especially if they’re extended-wear lenses. And that’s because bacteria can live and grow on the lenses. When it comes to the symptoms and signs, Dr Nkurikiye says there are different ways to indicate one is suffering from viral conjunctivitis. He says they include; acute episode of red-eye, watery discharge, discomfort especially intolerance of bright light (photophobia). He notes that the watery discharge can become purulent with time (like pus). The ophthalmologist goes on to add that the presence of a lymph node (small painful swelling) in front of the ear is more in favour of a viral conjunctivitis than any other type. “There is swelling of the conjunctiva (the thin layer that lines the white part of the eye and the inside of the eyelid) and/or eyelids as well,” he says. Other signs, he says, include increased tear production, feeling like a foreign body is in the eyes or an urge to rub the eyes, among others. On examination, he points out that there are signs that are specific, like follicles on the inner surface of the eyelids. Who is at risk and what are the complications? Dr Pascal Ngiruwonsanga, the director of Gakoma Hospital located in the small zone with five health centres in Gisagara District, says everyone who gets in contact with the ocular secretions can get infected. This, he explains, is so because viral conjunctivitis is highly contagious, and that most viruses that cause conjunctivitis spread through hand-to-eye contact by hands or objects that are contaminated with the infectious virus. He says that the infection usually resolves spontaneously within two to four weeks. In some instances, however, he says symptoms can persist even longer. In addition, Dr Ngiruwonsanga says the condition can accompany common viral upper respiratory infections, such as measles, the flu or the common cold. “Viral conjunctivitis usually produces a watery discharge, typically, the infection starts in one eye and quickly spreads to the other eye,” he says. He says it can be self-limiting and minor and can heal without any medication. Besides, he points out that viral conjunctivitis can also be severe, especially the epidemic type with the formation of pseudo-membranes and invasion of the cornea. Dr Ngiruwonsanga adds that it can as well lead to severe dry eye, irregular astigmatism, corneal ulceration with persistent keratoconjunctivitis (inflammation of cornea and conjunctiva), corneal scarring, and chronic infection. The way forward Christian Mudenge, an ophthalmologist at Galien Clinic in Kimironko, Kigali, says the treatment of this disease is symptomatic to reduce the inflammation with eye drops. In severe cases, he mentions that antibiotic drops are added to treat superimposed bacterial infection. Whereas, antiviral therapy is added if the cornea is involved while in case of severe inflammation, strong anti-inflammatory drops like steroids are cautiously used. When it comes to prevention, he says from the sick person, the main prevention is to avoid touching the eye with fingers. This, he explains, can end up spreading the disease to other people, especially in the family and to other school children if they are in schools. “Avoid touching your face and eyes, if you must apply medicine to the area around the eyes, then it’s ideal to wash your hands before and after the application,” he says. Dr Nkurikiye says once you are in contact with someone with conjunctivitis, whether at home or at work, washing hands or using hand sanitisers very often is important to keep the infection at bay. He says that washing hands when one comes from a public place before doing anything else when they reach home is vital as far as keeping the infection at bay is concerned. This, he says, is a general hygiene principle that everyone should adopt. Another important point people should be aware of, Dr Nkurikiye says, is to avoid rushing to buy medicine in pharmacies before seeing an eye doctor. “This is a common practice for whatever eye problem anyone has,” he says.
