The remedies that cost people their sight

This article is written without judgement and with a specific purpose. Traditional and improvised eye remedies are used widely, they are usually applied by people acting out of care, and they are a recurring cause of avoidable blindness in Nigeria. It is worth explaining precisely why, because "don't do that" without a reason persuades nobody.

Why the eye is different

The cornea — the clear window at the front — has no blood supply of its own. Blood vessels would interfere with transparency, so it is nourished by diffusion from the tears and the fluid behind it.

Two consequences follow. First, the immune response to an infection there is slower and weaker than almost anywhere else in the body, so an infection that would be trivial on the skin can advance rapidly on the cornea. Second, the cornea heals by scarring, and a scar on the visual axis is opaque tissue sitting exactly where you need to see through. The eye may be saved and the sight still lost.

So the eye tolerates less and forgives less than other tissue. That is the whole argument.

What is commonly used, and what it does

Plant saps and herbal preparations. Many are directly caustic to the corneal surface, stripping the epithelium and leaving the eye open to infection. Others are simply non-sterile and introduce bacteria and fungi directly onto damaged tissue. Fungal keratitis following plant-derived remedies is well documented in Nigeria and elsewhere in the region, and it is among the hardest eye infections to treat.

Breast milk. Frequently used for a newborn's sticky eye, and offered in good faith. It is not sterile, it has no antimicrobial effect useful in the eye, and a sticky eye in the first month of life can be a serious infection requiring urgent treatment. The remedy substitutes for the visit that was needed.

Sugar or salt solutions. Made with unsterile water, and the concentration is wrong for eye tissue in either direction — drawing fluid out of the cornea or into it. The water itself carries organisms including Acanthamoeba.

Urine. Not sterile once it has left the body, and introduces bacteria onto a compromised surface.

Borrowed or leftover prescription drops. The most dangerous category, because it looks like proper medicine. Steroid drops in particular: used on a herpes simplex corneal infection they can cause devastating progression, used on a fungal infection they accelerate it, and used long-term they raise intraocular pressure — producing steroid-induced glaucoma — and bring on cataract. Steroid drops are genuinely useful medication, prescribed for the right condition and monitored. They are not something to pass between relatives.

"Eye whitening" drops bought over the counter and used daily. They constrict blood vessels and treat nothing; stopping causes rebound redness worse than the original, which prompts more use.

The pattern that recurs in clinic

A minor problem — a bit of grit, a mild conjunctivitis, a small abrasion. A remedy is applied, sometimes several over days. The eye becomes more painful and more red. More remedies follow. By the time the person reaches a clinic, a week or two has passed, and what was a self-limiting irritation is now a corneal ulcer requiring intensive treatment, with a scar likely regardless of outcome.

The delay is usually the larger part of the harm. The remedy adds to it.

What to do instead

For a foreign body: blink, and try clean water once. If it does not come out, have it removed properly — it takes a practitioner a few minutes under magnification.

For a chemical splash: irrigate immediately with a large volume of clean water for at least twenty minutes, then go to hospital. This is the one situation where water is exactly right, and where speed matters more than anything else.

For redness with pain, light sensitivity or reduced vision: see someone the same day.

For a sticky eye in a newborn: see someone the same day.

For anything else that has not settled within a couple of days: have it examined.

A word to families

The people who apply these remedies are almost always trying to help, often a parent or grandparent with real authority in the household. Arguing about tradition is rarely productive. The more effective line is the practical one: the eye scars, the scar is permanent, and an examination costs very little compared with what is at stake. Most people, offered that reasoning, take it.