Red, sticky eyes this monsoon? What 'Madras eye' is, what helps, and what can harm

Every year, as the rains settle over Hyderabad, eye clinics see the same thing. For a few weeks in August and September, many people arrive with one red, watery, sticky eye, and very often the second eye has joined in by the time they are seen. It tends to move through families: a child first, then a parent, then a grandparent.

This is viral conjunctivitis, the “Madras eye” your parents warned you about. It is extremely common, it is usually harmless, and it is also one of the conditions where well-meaning home treatment can do damage. Here is what you need to know.

Why it spreads so fast in the monsoon

Conjunctivitis is an infection of the thin, transparent skin that covers the white of your eye and lines your eyelids. The monsoon version is almost always caused by a virus, most often an adenovirus, and the weather does it two favours. Humidity lets the virus survive longer on surfaces, and the rains push everyone indoors, closer together, sharing towels, pillows, door handles and phones.

It does not spread by looking at someone’s red eye. That is a myth. It spreads through hands. Someone rubs their infected eye, touches a lift button or a shared handkerchief, and the next person touches that and then touches their own face.

How to recognise it

The typical picture is:

• One eye turns pink or red, then the other follows within a day or two.
• The eye waters a lot and feels gritty, as if there is sand in it.
• The lids are stuck together on waking, with a watery or slightly sticky discharge.
• Eyelids may be puffy, and a small tender lump may appear in front of the ear. That is a lymph node doing its job.
• Often there has been a cold or sore throat in the house a few days earlier.

Vision is usually fine, apart from a watery blur that clears with a blink. It runs its course in one to two weeks, and, like a common cold, there is no medicine that shortens a straightforward viral infection. The aim is to keep you comfortable, stop it spreading, and watch for the small number of cases that become something more.

What helps at home

• Cold compresses. A clean cloth soaked in cold water, wrung out and held over closed lids for a few minutes, several times a day. This eases the burning.
• Lubricating eye drops. Plain artificial tears, used four to six times a day, soothe the grittiness and wash the surface. Buy a fresh bottle and do not share it.
• Clean the lids gently. Use cotton dipped in cooled boiled water to wipe the discharge, from the nose outward, one clean swab per eye.
• Hand-washing, relentlessly. This is the single most effective thing you can do for your family. Soap and water every time you touch your face.
• Separate towels, pillowcases and handkerchiefs for the affected person, changed daily. Wipe phone screens and spectacles.
• No contact lenses until the eye has been completely white and comfortable for a couple of days. Discard the lenses you were wearing when it started.
• Stay home from school or office for the first few days, while the eye is watering heavily. That is when you are most infectious.

Dark glasses are for comfort in bright light; they do nothing to stop the spread, but wear them if they help.

The mistake that can cause real harm

This is the part most worth remembering.

A common mistake is to describe a red eye at a medical shop and walk out with a steroid eye drop or a steroid-antibiotic combination. The eye feels much better within a day, and that is the trap. Steroid drops can switch off the eye’s defences, let a hidden bacterial or herpes infection flare, raise the pressure inside the eye, and, used repeatedly, speed up cataract. Used without supervision, they can cause permanent damage.

Please do not put anything in a red eye that a doctor has not looked at and prescribed. Leftover drops from a previous illness belong in the bin, not in your eye.

Antibiotic drops, by the way, do nothing against a virus. They are prescribed only when there is a clear sign of bacterial infection, typically thick, yellow-green pus that keeps returning minutes after you wipe it.

When to see an eye doctor the same day

Most conjunctivitis is a nuisance, not a danger. But a handful of other conditions also present as a “red eye”, and some of them can threaten sight. See an eye doctor without waiting if you notice any of these:

• Pain: a real ache, not just grittiness.
• Blurred vision that does not clear with blinking.
• Sensitivity to light strong enough that you want the curtains drawn.
• A white or grey spot on the black of the eye.
• A red eye in someone who wears contact lenses. This can become a corneal ulcer quickly.
• A red eye in a newborn or very young infant.
• Symptoms that are getting worse after five days, or not gone after two weeks.

And one more: if the blur lingers for weeks after the redness has cleared, that is worth a look too. Some adenoviral infections leave tiny spots on the cornea that cause haze and glare; they are treatable, but they need to be seen.

The short version

Monsoon conjunctivitis is common, spread by hands, and usually settles on its own in a week or two. Cold compresses, plain lubricating drops and careful hand-washing are enough for most families. What you must not do is self-medicate with steroid drops from the chemist. And if there is pain, light-sensitivity or blurred vision, or if the person wears contact lenses, that is a same-day visit, not a wait-and-see.

If you are unsure, have an eye doctor confirm it is nothing more.