Background: Eye infections such as stye (hordeolum), blepharitis and keratitis are common yet often misunderstood conditions that can lead to serious ocular complications if left untreated. These infections, though preventable and manageable with early intervention, remain under-recognized due to limited public awareness-especially in low-resource settings. This study aims to assess the knowledge, attitudes and practices related to these infections among the general population of Himachal Pradesh, India, to identify existing gaps and inform future eye health education strategies. Materials and Methods: A descriptive cross-sectional study was conducted from October to December 2024 using a structured, validated online questionnaire. The survey included 400 adult participants (aged >18 years) from both urban and rural regions of Himachal Pradesh. The questionnaire covered socio-demographic details, awareness of symptoms and causes, preventive practices and healthcare-seeking behavior related to stye, blepharitis and keratitis. Responses were scored and categorized into four knowledge levels: Very Good (>80%), Good (60-79%), Fair (41-59%) and Poor (<40%). Data were analyzed using SPSS version 26.0, with descriptive statistics and chi-square tests applied to explore associations. Results: Of the 400 participants, 51.8% were male and 48.3% female, with a majority aged 26-45 years. Rural residents comprised 59.5% of the sample. While 80.3% correctly identified a stye and 72.0% understood the cause of blepharitis, only 59.8% were aware of vitamin A’s role in preventing eye infections. Although 88.5% recognized keratitis as contagious and 87.3% correctly identified ophthalmologists as the appropriate specialists, fewer respondents identified specific symptoms of these infections. Overall, 40.8% of participants demonstrated Very Good knowledge, 36.8% Good, 15.5% Fair and 7.0% Poor. Lower knowledge scores were significantly associated with rural residence and lower educational attainment. Conclusion: The study reveals a moderately high level of general awareness regarding eye infections among the population of Himachal Pradesh. However, notable gaps exist in the recognition of symptoms, understanding of risk factors and adoption of preventive measures-especially in rural and less-educated communities. Targeted, culturally appropriate educational interventions are urgently needed to bridge these gaps, promote early treatment and reduce the preventable burden of eye infections.
The human eye, a vital yet delicate organ, is highly susceptible to various infections that, if left untreated, can lead to discomfort, impaired vision, or even long-term complications. Among the most common ocular infections are stye (hordeolum), blepharitis and keratitis-conditions that affect different parts of the eye and eyelid but often present with overlapping symptoms such as redness, irritation, swelling and discharge. Despite their frequency, public knowledge and awareness of these infections, their causes, symptoms and appropriate treatment methods remain limited [1-4].
A stye is an acute, localized bacterial infection of the eyelid’s oil glands, often caused by Staphylococcus aureus. Blepharitis, on the other hand, is a chronic inflammatory condition affecting the eyelid margins, typically resulting from bacterial colonization, seborrheic dermatitis, or dysfunction of the meibomian glands. Keratitis-an infection or inflammation of the cornea-can be more severe, potentially leading to corneal scarring or vision loss if not treated promptly. These conditions vary in severity, yet they share a common thread: most are preventable and manageable with early detection, good hygiene and timely medical intervention [5-8].
In developing countries like India, limited access to specialized eye care services, combined with poor hygiene practices and widespread self-medication, often leads to delayed diagnosis and mismanagement of these infections. Rural populations and individuals with lower health literacy are particularly vulnerable, as they may not recognize early warning signs or understand when to seek professional help. Misconceptions about the contagiousness of these infections, inappropriate use of antibiotics or home remedies and a general lack of awareness further compound the problem [9,10].
Given the importance of early identification and proper care, raising public awareness about eye infections is critical for preserving vision and reducing avoidable complications. This study aims to assess the level of public knowledge, attitudes and practices related to common eye infections-specifically stye, blepharitis and keratitis-among residents of Himachal Pradesh, India. By identifying knowledge gaps across different socio-demographic groups, the research seeks to inform future educational campaigns and strengthen community-based eye health interventions.
Research Design
A descriptive cross-sectional study was conducted to assess public knowledge, awareness and practices related to common eye infections-specifically stye, blepharitis and keratitis-among residents of Himachal Pradesh, India. The study utilized a structured online questionnaire to facilitate widespread data collection across diverse demographic groups in both rural and urban settings.
Study Area and Population
The study was carried out across multiple districts of Himachal Pradesh, a state characterized by varied topography, healthcare accessibility and population literacy levels. The target population included adults aged 18 years and above, representing a mix of educational, occupational and socio-economic backgrounds. Special emphasis was placed on including individuals from rural regions, where awareness and access to ophthalmic care are often limited.
Sample Size and Sampling Technique
A sample size of 400 participants was determined using a 95% confidence interval and an estimated 50% awareness level regarding common eye infections, with a 5% margin of error. A 10% buffer was included to account for incomplete responses. Convenience and purposive sampling techniques were employed to ensure inclusion of participants from various demographic segments. The survey was disseminated through digital platforms such as WhatsApp, Facebook and local community networks.
Inclusion and Exclusion Criteria
Inclusion Criteria
Exclusion Criteria
Data Collection Instrument
The questionnaire was developed with input from ophthalmologists, optometrists and public health experts. It was reviewed for content validity and piloted on a small group prior to full deployment. The final version consisted of four main sections:
The questionnaire was made available in both Hindi and English for accessibility and clarity.
Scoring and Knowledge Classification
Each correct answer in the knowledge and awareness section was awarded one point. Based on the total score, participants were categorized into four levels of knowledge:
Data Collection Procedure
The survey was conducted over a three-month period (October to December 2024) via Google Forms. Participants received the survey link through community leaders, educational institutions and social media groups. Prior to beginning the survey, participants were briefed on the purpose of the study, assured of confidentiality and asked to provide informed consent.
Data Analysis
Collected data were cleaned, coded and entered into Microsoft Excel. Descriptive and inferential statistics were analyzed using SPSS (version 26.0). Frequencies, percentages and cross-tabulations were used to summarize findings.
Ethical Considerations
The study protocol was reviewed and approved by the institutional ethics committee. All participants were informed of the voluntary nature of the survey and confidentiality of responses was strictly maintained. Participants retained the right to withdraw from the study at any time without any consequence.
The socio-demographic analysis of the 400 participants revealed a fairly balanced gender distribution, with males accounting for 51.8% and females 48.3%. The majority of respondents were in the age groups of 26-35 years (34.3%) and 36-45 years (29.0%), indicating a predominance of individuals in their productive years. Education levels varied, with a combined 67.9% having completed secondary school or higher education (34.5% secondary, 33.5% undergraduate). A small portion (4.0%) reported having no formal education. Occupationally, homemakers (24.8%) and office workers (24.0%) made up the largest groups, followed by teachers (17.0%) and healthcare professionals (11.5%). Students accounted for 12.8% of the sample. The rural population formed the majority (59.5%), emphasizing the need for awareness initiatives in non-urban areas where access to specialized eye care may be limited (Table 1).
Table 1: Socio-Demographic Characteristics of Participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18–25 | 94 | 23.5 |
26–35 | 137 | 34.3 | |
36–45 | 116 | 29.0 | |
46 and above | 53 | 13.3 | |
Gender | Male | 207 | 51.8 |
Female | 193 | 48.3 | |
Education Level | No formal education | 16 | 4.0 |
Primary school | 61 | 15.3 | |
Secondary school | 138 | 34.5 | |
Undergraduate degree | 134 | 33.5 | |
Postgraduate degree | 51 | 12.8 | |
Occupation | Homemaker | 99 | 24.8 |
Office Worker | 96 | 24.0 | |
Teacher | 68 | 17.0 | |
Healthcare Professional | 46 | 11.5 | |
Student | 51 | 12.8 | |
Other | 40 | 10.0 | |
Residential Setting | Urban | 162 | 40.5 |
Rural | 238 | 59.5 |
Assessment of awareness and knowledge related to eye infections-specifically stye, blepharitis and keratitis-showed encouraging but varied results. A high percentage (80.3%) correctly identified a stye as a painful lump on the eyelid and 72.0% recognized eyelid bacterial inflammation as a cause of blepharitis. While 65.8% correctly identified the cornea as the affected area in keratitis, only 59.8% were aware of the role of vitamin A in preventing eye infections. An impressive 88.5% knew that infections like keratitis could spread and 87.3% identified ophthalmologists as the appropriate specialists for treatment. However, fewer respondents recognized specific symptoms: 64.8% associated red, swollen eyelids with styes and 66.5% correctly linked blepharitis with crusty or itchy eyelids. Preventive behaviors such as regular handwashing (81.5%) and avoiding eye rubbing (77.8%) were well understood, yet awareness of serious complications like corneal scarring from untreated keratitis was moderate (62.8%). These findings highlight both strengths in general awareness and the need for improved education regarding specific symptoms and risks.
Table 2: Awareness and Knowledge of Eye Infections (Stye, Blepharitis, Keratitis) Among the General Population
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What is a stye? | a) Ear infection, b) Painful lump on the eyelid, c) Throat swelling, d) Skin rash | 321 | 80.3 |
2 | What is a common cause of blepharitis? | a) Loud noise, b) Poor diet, c) Eyelid inflammation from bacteria, d) Dry air | 288 | 72.0 |
3 | What part of the eye is affected by keratitis? | a) Lens, b) Retina, c) Cornea, d) Optic nerve | 263 | 65.8 |
4 | Can eye infections like keratitis spread to others? | a) Yes, b) No, c) Only if chronic, d) Only in children | 354 | 88.5 |
5 | Which nutrient supports eye infection prevention? | a) Vitamin B12, b) Vitamin A, c) Vitamin K, d) Iron | 239 | 59.8 |
6 | What should someone do if they suspect an eye infection? | a) Ignore it, b) See a doctor, c) Rub eyes, d) Wait a week | 316 | 79.0 |
7 | What is a common symptom of a stye? | a) Hearing loss, b) Sore throat, c) Red, swollen eyelid, d) Fever | 259 | 64.8 |
8 | Which symptom requires urgent medical attention? | a) Mild redness, b) Severe eye pain with vision loss, c) Occasional itching, d) Tiredness | 303 | 75.8 |
9 | Can blepharitis be caused by poor hygiene? | a) Yes, b) No, c) Only in the elderly, d) Only from injury | 271 | 67.8 |
10 | What is a common treatment for bacterial keratitis? | a) Ear drops, b) Antibiotic eye drops, c) Painkillers, d) Sugar syrup | 293 | 73.3 |
11 | What is a risk of untreated keratitis? | a) Corneal scarring, b) No risk, c) Hair loss, d) Joint pain | 251 | 62.8 |
12 | Can a stye resolve without medical treatment? | a) Yes, b) No, c) Only if severe, d) Only with surgery | 317 | 79.3 |
13 | How does blepharitis typically present? | a) No effect, b) Crusty or itchy eyelids, c) Improved vision, d) Ear pain | 266 | 66.5 |
14 | What can cause keratitis in contact lens wearers? | a) High humidity, b) Improper lens hygiene, c) Loud noise, d) Spicy food | 256 | 64.0 |
15 | Can warm compresses help treat a stye? | a) Yes, b) No, c) Only for keratitis, d) Only in youth | 262 | 65.5 |
16 | What habit helps prevent eye infections? | a) Rubbing eyes, b) Sharing towels, c) Washing hands regularly, d) Using old makeup | 326 | 81.5 |
17 | What should you avoid during an eye infection? | a) Drinking water, b) Touching or rubbing eyes, c) Resting, d) Bright lights | 311 | 77.8 |
18 | Which of these is NOT a symptom of blepharitis? | a) Crusty eyelids, b) Redness, c) Itching, d) Sore throat | 243 | 60.8 |
19 | What is the first step if you notice a painful eyelid lump? | a) Rub eyes, b) Apply cold, c) Avoid touching and see a doctor, d) Ignore it | 258 | 64.5 |
20 | What type of doctor treats eye infections? | a) Cardiologist, b) Neurologist, c) Ophthalmologist, d) Dentist | 349 | 87.3 |
The knowledge score classification further underscored these trends. Of the participants, 40.8% achieved a “Very Good” score (>80%), reflecting a strong grasp of eye infection basics. Additionally, 36.8% scored within the “Good” range (60-79%), indicating moderate awareness with room for improvement. However, 15.5% fell into the “Fair” category (41-59%) and 7.0% demonstrated “Poor” knowledge (<40%), revealing knowledge gaps among a notable portion of the population. These lower scores were more common among individuals with limited formal education and rural residents, emphasizing the importance of targeted awareness campaigns and health education programs to improve recognition, prevention and timely management of eye infections.
Table 3: Knowledge Score Classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 163 | 40.8 |
Good | 60%–79% | 147 | 36.8 |
Fair | 41%–59% | 62 | 15.5 |
Poor | <40% | 28 | 7.0 |
This study provides comprehensive insights into the public’s awareness, knowledge and practices concerning common eye infections-stye, blepharitis and keratitis-among residents of Himachal Pradesh. With a focus on identifying knowledge gaps across demographic segments, the findings reveal both encouraging trends and critical areas for public health intervention, particularly in regions with limited access to eye care services.
The demographic composition of participants was notably diverse, encompassing individuals from various educational, occupational and age backgrounds. The predominance of respondents in the 26-45 years age bracket suggests that a large portion of the surveyed population is in its most productive phase of life, making awareness about eye infections especially relevant, given the potential impact of vision issues on daily functionality and economic productivity.
Educationally, while a majority had completed secondary or undergraduate education (67.9%), a significant 19.3% of participants had only primary education or none at all. This variation underscores the need for differentiated communication strategies-where more nuanced, scientific explanations may be appropriate for educated groups and simple, visual, or community-based awareness programs are vital for those with lower literacy levels. Similarly, the occupational diversity, with homemakers, office workers, teachers, healthcare professionals and students fairly represented, highlights the potential reach of targeted awareness campaigns through schools, workplaces and healthcare centers.
Importantly, the study revealed a rural majority (59.5%), reinforcing the urgent need to strengthen outreach and healthcare access in non-urban areas. Rural communities often face infrastructural limitations, delayed diagnosis and a higher reliance on home remedies or informal health advice. These factors may exacerbate the consequences of seemingly minor infections, such as styes or blepharitis, if left untreated or mismanaged.
The assessment of awareness and knowledge levels yielded promising yet uneven results. High response accuracy on basic identification questions-such as recognizing a stye as a painful eyelid lump (80.3%) or associating bacterial eyelid inflammation with blepharitis (72.0%)-suggests a general awareness of these infections in the population. The fact that 88.5% of participants understood that keratitis could be contagious indicates a heightened sensitivity toward disease transmission, likely bolstered by increased public health communication post-COVID-19.
However, this general awareness was not consistently reflected in deeper knowledge or symptom-specific understanding. For instance, while 87.3% correctly identified ophthalmologists as the appropriate specialists, only 64.8% recognized red, swollen eyelids as a symptom of a stye and just 66.5% associated blepharitis with crusty or itchy eyelids. These gaps suggest that while the population is aware of the existence of these infections, many may not recognize their onset-potentially delaying timely consultation and treatment.
Nutritional awareness also posed a concern. Only 59.8% correctly linked vitamin A to eye infection prevention, indicating a disconnect between general health knowledge and ocular health specifics. Infections like keratitis, particularly among contact lens users, are strongly associated with poor hygiene, yet only 64% identified improper lens care as a contributing factor. This calls for stronger educational efforts targeted at specific behavioral risks, such as lens hygiene, eye makeup safety and towel sharing.
Encouragingly, a strong understanding of preventive behaviors was evident. Over 81% acknowledged that handwashing helps prevent infections and 77.8% knew to avoid eye-rubbing during infections. These findings can serve as a foundation upon which to build more comprehensive educational programs, leveraging existing behavioral awareness while addressing knowledge deficiencies around symptoms and treatment.
The knowledge classification revealed a stratified awareness landscape. Nearly 41% of participants demonstrated “Very Good” knowledge (>80% correct responses) and 36.8% fell into the “Good” category. While these numbers are encouraging, the remaining 22.5% with “Fair” or “Poor” scores represent a substantial minority that may be vulnerable to misdiagnosis, mistreatment, or inaction during early stages of infection.
The skewed distribution of lower knowledge scores among rural residents and less-educated individuals highlights systemic disparities in access to health information. These gaps likely stem from reduced healthcare infrastructure, fewer eye health outreach efforts and limited exposure to preventive education. The challenge, therefore, lies not only in disseminating knowledge but in doing so through culturally and linguistically appropriate formats-such as visual infographics, local health volunteers, or audio-visual media in regional languages.
Public Health Implications and Future Interventions
The findings of this study underscore a crucial public health imperative: to bridge the gap between general awareness and actionable knowledge. Infections like stye, blepharitis and keratitis may initially appear minor but can lead to significant discomfort or vision loss if neglected. Hence, timely recognition and treatment are essential [8,9].
Health authorities should consider integrating eye infection awareness into broader vision care and hygiene programs. School health programs, especially in rural and semi-urban areas, can serve as entry points to educate children and parents about hygiene and early signs of infections. Campaigns focusing on safe makeup practices, proper contact lens usage and eye hygiene could be implemented in collaboration with opticians and beauty professionals [10,11].
Community health workers and ASHA personnel can be empowered to conduct door-to-door awareness drives, especially targeting populations with limited education. Training them to identify signs of common eye infections and refer cases early to ophthalmologists would ensure a proactive approach to vision health. Additionally, eye screening camps could include brief sessions on infection prevention, first aid for eye issues and when to seek medical help [9-11]
Moreover, digital platforms-already used for the dissemination of the survey-can be leveraged to share informative videos, posters, and short health messages. Social media channels and messaging apps are powerful tools in spreading awareness among the tech-savvy youth and working-age populations, who made up the bulk of this study’s respondents [11,12].
In summary, while there is encouraging general awareness about eye infections among the Himachal Pradesh population, significant knowledge gaps persist-particularly regarding symptoms, risk factors and treatment approaches for stye, blepharitis and keratitis. The disproportionately lower knowledge among rural and less-educated populations points to the urgent need for targeted, accessible and sustained educational interventions. By addressing these disparities through community engagement, school involvement, healthcare provider training and mass media outreach, the burden of preventable ocular infections can be significantly reduced, thereby safeguarding vision and enhancing quality of life for the affected populations.
Arvind, Ritvi et al. “Knowledge of ocular infections among the dental practitioners across India: a cross sectional survey.” BMC Research Notes, vol. 17, no. 1, February 2024. https://link. springer.com/article/10.1186/s13104-023-06656-w.
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