Madras Eye

Madras Eye is the popular term used in India for viral conjunctivitis, an acute and highly contagious inflammation of the conjunctiva — the thin, transparent membrane that covers the white part of the eyeball and lines the inside of the eyelids. Although the name originated in southern India, particularly in Chennai (formerly Madras), the condition occurs worldwide and is most common during humid or rainy seasons. It is caused primarily by adenoviruses, though other viruses and bacteria can also trigger the infection.

Origin of the Name

The term Madras Eye came into common usage in India during outbreaks of viral conjunctivitis reported in and around Madras (now Chennai) several decades ago. Due to the scale of these outbreaks, the name became locally synonymous with the infection. Despite the regional association, Madras Eye is not restricted to Chennai or South India and has no special variant linked to the region; it is simply a colloquial name for a viral eye infection.

Causes and Transmission

The most common cause of Madras Eye is infection by the adenovirus group, particularly adenovirus type 8, type 19, and type 37. Occasionally, enteroviruses, herpes simplex virus, or bacteria such as Staphylococcus aureus and Streptococcus pneumoniae may cause similar symptoms.
Transmission occurs easily through:

• Direct contact with infected eye secretions (by handshakes, towels, or eye cosmetics).
• Contaminated objects such as pillowcases, handkerchiefs, or contact lenses.
• Respiratory droplets from coughing or sneezing.
• Swimming pools, where shared water facilitates spread during outbreaks.

The infection spreads rapidly in schools, offices, and crowded places, especially in warm and humid environments.

Symptoms and Clinical Features

Madras Eye typically affects one eye first, with the second eye becoming infected within one to two days. Symptoms develop within one to three days after exposure and may include:

• Redness and irritation of the eye.
• Watery discharge or tearing.
• Itching or burning sensation.
• Swelling of the eyelids and conjunctiva.
• Sensitivity to light (photophobia).
• Gritty or foreign-body sensation.
• Mild pain and blurry vision (due to tearing or inflammation).

In severe cases, especially those caused by adenoviruses, small lymph nodes in front of the ear may swell, and corneal involvement (keratitis) may occur, temporarily affecting vision.

Types of Conjunctivitis

Madras Eye, or viral conjunctivitis, is one of several types of conjunctival inflammation:

• Viral Conjunctivitis: Caused mainly by adenoviruses; highly contagious and self-limiting.
• Bacterial Conjunctivitis: Characterised by thick, yellowish discharge; responds to antibiotics.
• Allergic Conjunctivitis: Triggered by allergens such as pollen or dust; causes intense itching.
• Chemical or Irritant Conjunctivitis: Due to exposure to smoke, chlorine, or pollutants.

Viral conjunctivitis is distinguished by its watery discharge and the rapid spread among close contacts.

Diagnosis

Diagnosis of Madras Eye is primarily clinical, based on symptoms and physical examination by a doctor. Typical signs include redness, watery discharge, and swollen eyelids. Laboratory tests are rarely needed but may include:

• Conjunctival swab or scraping to identify the virus or bacteria in severe or atypical cases.
• Fluorescein staining to check for corneal involvement.

Because it is a viral infection, antibiotic eye drops are not usually necessary unless a secondary bacterial infection develops.

Treatment and Management

Madras Eye is generally self-limiting, resolving within 7 to 14 days without specific antiviral treatment. Management focuses on symptom relief and preventing spread.
Treatment recommendations include:

• Cold compresses to reduce redness and swelling.
• Artificial tears or lubricating eye drops to soothe irritation.
• Antihistamine or decongestant drops to relieve itching.
• Avoiding contact lenses until complete recovery.
• Antibiotic drops or ointments only if bacterial infection is suspected (on doctor’s advice).
• Steroid drops should be avoided unless prescribed by an ophthalmologist, as improper use may worsen infection.

Rest, proper hygiene, and refraining from touching or rubbing the eyes are crucial for recovery.

Prevention and Hygiene Measures

Since Madras Eye spreads rapidly, maintaining strict hygiene is vital to prevent outbreaks. Recommended precautions include:

• Avoid touching or rubbing the eyes.
• Wash hands frequently with soap and water.
• Use a clean handkerchief or tissue to wipe tears or discharge.
• Avoid sharing towels, pillows, or eye cosmetics.
• Do not use contact lenses or eye makeup during infection.
• Disinfect common household items such as doorknobs, spectacles, and mobile phones.
• Stay away from swimming pools during outbreaks.
• Individuals with infection should avoid close contact and take leave from school or work until recovery.

Complications

Although Madras Eye is usually mild and self-limiting, complications can occur in some cases, particularly if the infection affects the cornea. Possible complications include:

• Keratitis (inflammation of the cornea).
• Subepithelial corneal infiltrates, leading to temporary visual blurring.
• Secondary bacterial infection.
• Chronic conjunctivitis if hygiene measures are neglected.

Permanent vision loss is extremely rare, but prompt medical consultation helps avoid complications.

Epidemiology and Seasonal Occurrence

In India and other tropical regions, outbreaks of Madras Eye are common during the monsoon season, when humidity and close contact facilitate viral transmission. Urban overcrowding and increased use of common water sources such as swimming pools contribute to its rapid spread.
Although people of all ages can be affected, children and young adults tend to be more susceptible due to close social interaction.

Public Health and Social Aspects

Madras Eye has social and public health implications due to its contagious nature. In many communities, myths persist — such as the belief that looking at an infected person can spread the disease, which is untrue. The virus spreads only through direct or indirect contact with infectious material, not by visual exposure.
Public health campaigns during outbreaks focus on education about hygiene, prompt diagnosis, and isolation of infected individuals to control spread.