title: Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics.
abstract: OBJECTIVE
  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.
authors.affiliation: Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Srinivasan
authors.forename: M P
authors.initials: MP
authors.lastname: Upadhyay
authors.forename: B
authors.initials: B
authors.lastname: Priyadarsini
authors.forename: R
authors.initials: R
authors.lastname: Mahalakshmi
authors.forename: J P
authors.initials: JP
authors.lastname: Whitcher
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002701:Chloramphenicol / Q000627:therapeutic use; D003022:Clotrimazole / Q000627:therapeutic use; D003150:Community Health Workers; D065306:Corneal Injuries; D003320:Corneal Ulcer / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D004338:Drug Combinations; D015821:Eye Infections, Fungal / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009824:Ointments; D011446:Prospective Studies; D017678:Sex Distribution
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D009824:Ointments; D002701:Chloramphenicol; D003022:Clotrimazole