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

Every year, as the rains settle over Hyderabad, the same thing happens in my clinic. For a few weeks in August and September, nearly every third patient walks in with one red, watery, sticky eye — and very often, by the time I see them, the second eye has joined in. Families come together: 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 does the most damage. So let me tell you what I tell patients across the desk.

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 I still have to correct every week. 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. What we do is keep you comfortable, stop it spreading, and watch for the small number of cases that become something more.

What genuinely 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 better than anything in a bottle.
• 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 causes real harm

Here is the part I most want you to remember.

Almost every monsoon I see patients who went to a medical shop, described a red eye, and walked out with a steroid eye drop or a steroid-antibiotic combination. The eye feels wonderfully better within a day — and that is precisely 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. I have seen permanent damage from a bottle that cost less than a cup of coffee.

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. We prescribe them 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 come in 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. Come in 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 one can become a corneal ulcer fast.
• 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 obsessive hand-washing will carry most families through it. 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 your family has caught it this season, we are happy to see you quickly, confirm it is nothing more, and send you home with a plan that is safe for your eyes.