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Corneal ulceration in South East Asia. I: A model for the prevention of bacterial ulcers at the village level in rural Bhutan

K Getshen¹, M Srinivasan², M P Upadhyay³, B Priyadarsini², R Mahalaksmi² and J P Whitcher⁴

¹ Jigme Dorji Wangchuk National Referral Hospital, Thimpu, Bhutan
² Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, 1 Anna Nagar, Madurai 625020, Tamil Nadu, India
³ B P Eye Foundation, G PO Box 2126, Kathmandu, Nepal
⁴ Francis I Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, CA 94143-0944, USA

Correspondence to:
Correspondence to:
John P Whitcher
MD, MPH, Francis I Proctor Foundation, UCSF Box 0944, 95 Kirkham Street, San Francisco, CA 94143-0944, USA; nepal{at}itsa.ucsf.edu

Aim: To prove that antibiotic distribution by grassroots volunteer village health workers (VVHWs) in Bhutan is an effective and efficient public health intervention for the prevention of post-traumatic corneal ulceration.

Methods: 55 villages in two districts in Bhutan were selected for the study. A defined population of 10 139 individuals was followed prospectively for 18 months by 31 VVHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria.

Results: During the 18 month period 135 individuals reported to VVHWs with an ocular injury and 115 were found to have a corneal abrasion. All 115 were treated with 1% chloramphenicol ointment three times a day for 3 days and all healed without sequelae

Conclusions: Corneal ulcers that occur following traumatic corneal abrasions can be effectively prevented, even in the setting of isolated rural conditions such as those that exist in villages in Bhutan, by using relatively simple preventative measures that local VVHWs can easily be taught to employ.

Keywords: corneal blindness; corneal ulceration; corneal abrasion; ulcer prevention; Bhutan

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