Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics

Br J Ophthalmol. 2006 Dec;90(12):1472-5. doi: 10.1136/bjo.2006.103028. Epub 2006 Aug 17.

Abstract

Aim: To determine whether topical antifungal prophylaxis distributed by paid village health workers (VHWs) in south India is necessary after corneal abrasion to prevent fungal keratitis in a population where half of the ulcers are fungal.

Methods: Two panchayaths (village administrative units in Madurai district with a combined population of 48 039 were followed prospectively for 18 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions. Patients fulfilling the eligibility criteria were randomised into two groups and treated with either 1% chloramphenicol and 1% clotrimazole ointment or 1% chloramphenicol and a placebo ointment three times a day for 3 days. Patients, doctors and VHWs were blinded to treatment.

Results: During the 18-month period, 1365 people reported to VHWs with ocular injuries, of whom 374 with corneal abrasions were eligible for treatment. Of these, 368 (98.5%) abrasions healed without complications. Two patients had mild localised allergic reactions to the ointment, two dropped out and two patients in the placebo group developed microscopic culture-negative corneal stromal infiltrates that healed in 1 week with natamycin drops.

Conclusions: Both fungal and bacterial ulcers that occur after traumatic corneal abrasions seem to be effectively prevented in a village setting using only antibiotic prophylaxis.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Antifungal Agents / therapeutic use*
  • Child
  • Chloramphenicol / therapeutic use
  • Clotrimazole / therapeutic use
  • Community Health Workers
  • Corneal Injuries
  • Corneal Ulcer / etiology
  • Corneal Ulcer / prevention & control*
  • Double-Blind Method
  • Drug Combinations
  • Eye Infections, Fungal / etiology
  • Eye Infections, Fungal / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • India
  • Male
  • Middle Aged
  • Ointments
  • Prospective Studies
  • Sex Distribution

Substances

  • Antifungal Agents
  • Drug Combinations
  • Ointments
  • Chloramphenicol
  • Clotrimazole