title: Demographic pattern, predisposing factors and management of ulcerative keratitis: evaluation of one thousand unilateral cases at a tertiary care centre.
abstract: OBJECTIVE
  To determine the predisposing factors, special clinical manifestations and the management of presumed microbial ulcerative keratitis.
  
  
  METHODS
  A retrospective study was performed in 1000 eyes of 1000 patients with presumed microbial keratitis. Information was recorded on patients' age and gender, risk factors, seasonal presentation, number of days since initiation of ulcer, prior therapy, clinical presentation, microbiological work-up and case management.
  
  
  RESULTS
  Fifty per cent of the patients with corneal ulcers were aged between 36 and 65 years and 13.3% were in the paediatric age group (1 month to <16 years). The male : female ratio was almost 1.6:1. Only 11.4% of patients reported to the authors during the first week of initiation of ulcer. Trauma was the cause in 47.6% of eyes, and ocular surface diseases accounted for 16.6%. Forty-two per cent of eyes received topical antibiotics alone (either one or more) prior to hospital visit and 42.2% of eyes were on topical antibiotics and antifungals. Another 8.2% were on topical corticosteroids along with antibiotics and 4.6% were receiving some unidentified drop. Only 3% of the eyes did not receive any therapy prior to visit. Contact lens use as a risk factor could be identified only in 8.2% of eyes. Ulcers were central in location in 48%. Ulcer size 6-9 mm was observed in 51.7% of eyes. Medical therapy alone was effective in 61.0% of eyes and another 9.7% eyes responded to paramedian tarsorrhaphy along with topical antimicroboial drugs.
  
  
  CONCLUSIONS
  Corneal ulcers are a frequent problem in this part of the world. The ulcers seen at this tertiary referral hospital present late in the natural history of the disease and are clinically severe. Despite the severity a majority of the eyes could be saved anatomically, but almost 65% of eyes were left with a visual acuity of <6/120. Considering the high magnitude of visual loss, public education about the potential for loss of sight and the importance of timely and appropriate treatment is recommended.
authors.affiliation: Cornea service, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India. anitap49@yahoo.com
authors.forename: Anita
authors.initials: A
authors.lastname: Panda
authors.forename: Gita
authors.initials: G
authors.lastname: Satpathy
authors.forename: Niranjan
authors.initials: N
authors.lastname: Nayak
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
authors.forename: Abhiyan
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003320:Corneal Ulcer / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D005143:Eyelids / Q000601:surgery; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D017678:Sex Distribution; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents