Management of corneal ulcers in rural area

Dr Rakhi Kusumesh
Associate Professor
Cornea and Ocular Surface services
Regional Institute of Ophthalmology
Indira Gandhi Insstitute of Medical Sciences
Patna, Bihar
• Corneal ulceration is a leading cause of visual impairment globally

• Disproportionate burden in developing countries.

• It is expected that the number of corneal blind people in India will increase to 10.6 million by
2020.

• “Silent Epidemic”

Lim AS. Mass blindness has shifted from infection (onchocerciasis, trachoma, corneal ulcers) to cataract. Ophthalmologica 1997;211:270.

 
Poor rural area
Causes of corneal ulcers
 • Reducing the delay
in starting
• Poor socioeconomic status antimicrobial therapy
following a corneal
• Agricultural trauma abrasion

• Delay in presentation

• Late Initiation of antimicrobial

therapy

• Lack of infrastructure
 Corneal ulcer prevention programme

• To test the efficacy of highly organized and stratified healthcare system in preventing
corneal ulcers at village level

• Studies have employed community health workers to provide prompt administration of

antimicrobials after corneal abrasions to prevent infections

• 1% chloramphenicol ointment (Chloromycetin Kaps,Pfizer, India)

1% itraconazole ointment to be applied three times daily for 3 days.

• Pregnant women are given 1% azithromycin ointment

They showed that corneal abrasion can be prevented at village level by simple public health strategy
 Management at primary level

• Apply antibiotic drops or • Don't give systemic antibiotics;

ointment.
• Instruct patients to apply
drops frequently
• Instruct patients persons to
avoid traditional medicines
Refer to higher center
they are not helpful.
• Don't use steroid drops and/or
ointment
• Don't routinely patch the eye
if pain and redness persist for 3 days
if there is severe corneal ulcer.
Management of microbial keratitis
• Need for health promotion strategies-

• Increasing awareness about risk and consequences of corneal ulceration

• Possible safety and preventive measures

THANKYOU
Corneal blindness in developing countries

• corneal trauma About 65% of infective keratitis of nonviral origin develops following
corneal injuries. 

Corneal trauma
• contact lens wear -  this factor is less than 2% in India
Stromal infiltration

Corneal scarring

Vision loss
 Stepwise approach
Monitoring of
response

Microbiological
work-up

Institute
empirical
Nature of therapy
infection
Clinical
evaluation
 Management at secondary level
• A corneal scraping should be taken, if diagnostic microbiology services
are available to look for fungal hyphae
• Specific treatment