Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics.
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.
Srinivasan
M
M
Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
Upadhyay
M P
MP
Priyadarsini
B
B
Mahalakshmi
R
R
Whitcher
J P
JP
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
D000935:Antifungal Agents; D004338:Drug Combinations; D009824:Ointments; D002701:Chloramphenicol; D003022:Clotrimazole