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Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics
  1. M Srinivasan1,
  2. M P Upadhyay2,
  3. B Priyadarsini1,
  4. R Mahalakshmi1,
  5. J P Whitcher3
  1. 1Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
  2. 2B P Eye Foundation, Kathmandu, Nepal
  3. 3Francis I Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to: J P Whitcher Francis I Proctor Foundation, UCSF Box 0944, 95 Kirkham Street, San Francisco, CA 94143-0944, USA;jack.whitcher{at}


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.

  • VHWs, village health workers

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  • Published Online First 17 August 2006

  • This study was supported by a grant from the World Health Organization/South East Asia Regional Office in New Delhi, and by material, logistical, technical and human resources from the Aravind Medical Research Foundation, Aravind Eye Care System and Lions Aravind Institute of Community Ophthalmology in Madurai.

  • Competing interests: None declared.