SCIENTIFIC REPORT

Corneal ulceration in South East Asia. II: A strategy for the prevention of fungal keratitis at the village level in Burma

N Maung¹, C C Thant¹, M Srinivasan², M P Upadhyay³, B Priyadarsini², R Mahalakshmi² and J P Whitcher⁴

¹ Trachoma Control and Prevention of Blindness Programme, Department of Health, Yangon, Burma
² Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, 1 Anna Nagar, Madurai 625020, Tamil Nadu, India
³ BP Eye Foundation, GPO Box 2126, Kathmandu, Nepal
⁴ Francis I Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, CA, 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; jack.whitcher{at}ucsf.edu

Aim: To prove that topical antifungal and antibiotic prophylaxis distributed by grass roots village health workers (VHWs) in Burma is an effective public health intervention for the prevention of post-traumatic microbial keratitis in a population where the majority of ulcers are fungal.

Methods: Three villages in Bago District with a combined population of 16 987 were selected for the study. This defined population was followed prospectively for 12 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria.

Results: During the 12 month period 273 individuals reported to VHWs with an ocular injury and 126 were found to have a corneal abrasion. All 126 were treated with 1% chloramphenicol and 1% clotrimazole ointment three times a day for 3 days, and all healed without sequelae.

Conclusions: Both fungal and bacterial ulcers that occur following traumatic corneal abrasions can be effectively prevented in a village setting by using relatively simple measures that local volunteer public health workers can easily be taught to employ.

Abbreviations: VHWs, village health workers

Keywords: corneal blindness; corneal ulceration; ulcer prevention; fungal keratitis; Burma

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