Why is red eye disease on the rise in Uganda?

Red eye disease, scientifically known as conjunctivitis, is the swelling or redness (inflammation) of the thin, clear layer that covers the white surface of the eye and the inner eyelid. The white part of the eye has a fine blood vessel (pathway) within it. When the outer layer that covers the white surface becomes inflamed, these blood vessels enlarge and become more prominent, thus making the eye appear red.

How did we end up where we are?

According to information from the Ministry of Health, there are three main types of conjunctivitis: infectious, allergic and chemical. The assessment of patients by the ministry during this outbreak shows that many patients present with symptoms such as red eyes, itching, tearing, swelling, grainy sensation, headache and fever.

The first cases of red eye disease were detected in Kassanda and Kaweeri prison facilities on February 26, information from the Health ministry shows.

Two days later, Lira Main and Erute prisons also detected the cases among the inmates and this was followed by reports of cases in Kampala remand prisons on March 3, according to official records from the ministry.

By March 6, the total reported cases had shot up to 314 and information about the outbreak reached Kampala Capital City Authority on March 7. The ministry explained it was at this point that epidemiologists and laboratory scientists were deployed to investigate the causes of the outbreak and recommend control strategies.

The ministry also revealed that since the disease in the prisons was reported among new inmates, it was believed to have originated from communities. The ministry then issued the first statement about the disease outbreak on March 14 after many parents in Kampala had raised concerns about the disease in schools and communities.

Since then, the number of infections reported to the ministry from communities, schools and prisons across the country has been rising, raising questions about the effectiveness of the containment strategies prescribed by the scientists and whether the recommendations were implemented.

Figures from the ministry put the cumulative total of cases at 7,596 by April 6. This is a spike from the 314 cases reported to the ministry by March 6. However, the above number may not be a true reflection of the extent of the spread in the communities as many people have embarked on self-medication and other self-care approaches and so do not go to facilities that send data to the ministry.

What should someone afflicted with the disease do?

Patients have been tasked to seek medical help. Eye specialists have warned that the use of some non-recommended self-care approaches increases the risk of disease spread and could cause loss of sight.

“This is a viral infection which has gone in the community and probably we are not doing well to control it so it is spreading from one person to another,” Dr Dan Bwonya, an ophthalmologist (eye specialist) at Mengo Hospital, told Saturday Monitor.

“Unfortunately, people are using all types of medicines and making the infections go further. You find others putting urine, others putting tea leaves. The eye is a very sensitive organ, you cannot keep putting anything you think of,” he added.

If the disease is not treated and cured, the patient will keep spreading it to other people like their family members, workmates and friends.

Dr Bwonya’s concern about the use of non-recommended methods to treat the disease is reinforced by Dr Daniel Kyabayinze, the director of public health at the Ministry of Health.

“People should not put other things on their eyes because the eye has a very fine membrane that can be injured, causing blindness. Only clean water will do. Some people are using very unconventional things—they will put herbs and other things and that can damage the eye. The eye is so delicate,” he said.

The disease, which the Health Ministry described as “self-limiting” and “not life-threatening” can significantly affect the workplace productivity of a person and the learning of children who are infected, amid the cost incurred in treatment. 

What else do we know about the red eye disease outbreak in Uganda?

The analysis of the samples collected from the patients showed that the disease was caused by a virus. This was done by the Uganda Virus Institute, according to information from the Health ministry.

A 2024 report by Hidayat Namuddu and Adonia Kyakulaga for a study conducted between September 2022 and May 2023 in Jinja Hospital, shows that viral conjunctivitis is common in the population.

“From … 100 respondents that were randomly selected, the study established that viral conjunctivitis was more prevalent in the age group of 25-40 years,  50 percent (50), more in females, 52 percent (52) than males 48 percent (48) and also had chances of recurrence twice 51 percent (20),” the researchers wrote.

“Viral conjunctivitis was associated with upper respiratory tract infection, 29 percent (29), more in urban places, 71 percent (71), and was also associated with systemic conditions mostly in diabetes mellitus, 20 percent (20),” the report reads further.

The researchers also learnt that 56 percent patients used eye drops and ointments while around 44 did not use eye drops—meaning some could be using non-recommended methods.

What are the prevention and control measures around the disease?

The researchers recommend thus: “There should be massive sensitisation by the government to increase people’s awareness of the risk factors for acquiring viral conjunctivitis—isolation of people from endemic places to prevent the rapid spread because viral conjunctivitis is too contagious. And finally, the government should establish more specialised hospitals (eye clinics) to increase accessibility to eye care services.”

However, according to Dr Bwonya, “there is only one major thing to minimise the spread of the disease: Avoid touching your eyes with contaminated hands or objects.”

“If you are busy touching your eyes when your hands are not clean then you are spreading infection. If you are to touch there [your eyes], your hands have to be clean first. That is the most important thing,” he further told Saturday Monitor.

He added: “Anything that your eyes come into contact with when they are contaminated, you will get red eyes—things like towels, handkerchiefs that you use and put in your pocket and mix with money in your pocket that you don’t know where it is coming from. It is just like Covid control measures.”

On his part, Dr Kyabayinze said the government is already doing a lot of work with the leaders of Kampala Capital City Authority (the most affected area), and Uganda Prison Services (UPS) to contain the outbreak.

“As of April 7, 2024, UPS has registered at least 4,853 recoveries, whereas 1,044 cases were under isolation. Schools and private healthcare facilities are mounting a response to community cases,” Dr Kyabayinze said.

Health ministry said it has employed strategies, including activation of the National Public Health Emergency Operation Centre to boost coordination during the response to the outbreak, activation of school health taskforce, and improved community sensitisation, and enhanced surveillance in prisons and police cells.

The ministry, in the statement, urged the public to adhere to the following preventive measures, which include maintaining high sanitation standards and washing hands frequently with clean water and soap.

The ministry also advised people to avoid direct contact with infected individuals, particularly touching the eyes and shaking hands, and refrain from sharing items with infected persons, such as pillows, washcloths, towels, eye drops, or eyeglasses. Sick people are also advised to seek treatment to minimise the spread.

Treatment options

Dr Kyabayinze says treatment can be done using creams if it is viral conjunctivitis, adding, “but we know this infection is not life-threatening in that it will heal over time. Within two to three days you will get relieved and within a week you will be completely healed.”

According to information from the American Academy of Ophthalmology (eye care), viral conjunctivitis (red eyes) is like a common cold in the eye.

“There is no treatment for the virus and usually you just have to let it heal on its own. Viral pink eye should go away within a week or two without treatment,” information from the academy’s website reads.

To reduce the symptoms of viral conjunctivitis, the academy advises that one can take ibuprofen or another over-the-counter pain killer and or use over-the-counter lubricating eye drops (artificial tears).

One can also put a warm, damp washcloth over your eyes for a few minutes.

“To make this warm compress: Soak a clean washcloth in warm water then wring it out so it’s not dripping. Lay the damp cloth over your eyes and leave it in place until it cools. Repeat this several times a day, or as often as is comfortable,” information from the website reads.

The academy also advises that one should use a clean washcloth each time so you don’t spread the infection and also use a different washcloth for each eye if you have infection in both eyes.

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