Fungal keratitis: Mechanisms of infection and management strategies.

Fungal corneal ulcers are an uncommon, yet challenging, cause of vision loss. In the United States, geographic location appears to dictate not only the incidence of fungal ulcers, but also the fungal genera most encountered. These patterns of infection can be linked to environmental factors and individual characteristics of fungal organisms. Successful management of fungal ulcers is dependent on an early diagnosis. New diagnostic modalities like confocal microscopy and polymerase chain reaction are being increasingly used to detect and identify infectious organisms. Several novel therapies, including crosslinking and light therapy, are currently being tested as alternatives to conventional antifungal medications. We explore the biology of Candida, Fusarium, and Aspergillus, the three most common genera of fungi causing corneal ulcers in the United States and discuss current treatment regimens for the management of fungal keratitis.

Alternativas terapéuticas de la úlcera corneal infecciosa / Therapeutic alternativesfor the infectious corneal ulcer

Introducción: La úlcera corneal infecciosa es una afección frecuente en la consulta de oftalmología. Su resolución es un problema de salud a resolver, pues los tratamientos convencionales no siempre garantizan una evolución favorable de los casos diagnosticados debido a la resistencia microbiana, por lo que se siguen buscando alternativas terapéuticas. Objetivo: Describir las alternativas de tratamiento en la úlcera corneal infecciosa para minimizar sus secuelas y disminuir la ceguera por esta enfermedad. Desarrollo: La administración tópica de antibióticos de amplio espectro sigue siendo el método preferido para el tratamiento farmacológico de las úlceras corneales infecciosas, a pesar de los informes de fracasos clínicos por la resistencia a los antibióticos, por lo que se investiga acerca del uso de nuevas alternativas terapéuticas que minimicen las secuelas de esta enfermedad.Se realizó una revisión sistemática de la evidencia científica en los últimos diez años en diversos artículos, en los que se constató la aplicación de diferentes sustancias como tratamiento alternativo. Conclusiones: En la úlcera corneal infecciosa el tratamiento protocolizado combinado con sustancias alternativas, que tienen en común una actividad de amplio espectro, resultaría ser ventajoso por ser productos económicos y seguros, que han demostrado un gran poder bactericida. Se propone generalizar el uso de estos compuestos, dada la resistencia de los microorganismos al tratamiento convencional; lo que hace que la úlcera corneal sea un problema de salud a resolver.

Introduction: The infectious corneal ulcer is a frequent disorder in the ophthalmology outpatient department, its solution is a health problem to be solved, as the conventional treatments don't always guarantee a favorable clinical course of the diagnosed cases. Because of the microbial resistance, so that therapeutic alternatives are still looked for. Objective: To describe the treatment alternatives in the infectious corneal ulcer for minimizing their sequelae and to decrease blindness due to this disease. Development: The topical administration of wide spectrum antibiotics continues being the favorite method for the pharmacological treatment of the infectious corneal ulcers, in spite of the clinical failures reports caused by the resistance to antibiotics, that is why the use of new therapeutic alternatives minimizing the sequels of this disease is investigated. Method: A systematic review of the scientific evidence in the last ten years was carried out on several works, in which it was evidenced the use of different substances as alternative treatment. Conclusions: In the infectious corneal ulcer the protocolized treatment combined with alternative substances which have in common a wide spectrum activity would turn out to be advantageous as they are economic and sure products which have demonstrated a great power against bacteria. The use of these compounds could be generalized, given the resistance of organisms to the conventional treatment; what makes the corneal ulcer a health problem to be solved.

Proteus mirabilis Keratitis: Risk Factors, Clinical Features, Treatment Outcomes, and Microbiological Characteristics.

PURPOSE: To characterize the risk factors, clinical presentations, management choices, and outcomes of Proteus mirabilis keratitis. METHODS: In this retrospective study, 26 culture-proven cases of P. mirabilis infections were diagnosed and treated between 1998 and 2019 at the University of Pittsburgh Medical Center. Medical records were available for 14 keratitis cases and were reviewed for demographic information, ocular risk factors, and treatment outcomes. RESULTS: Sixteen eyes of 14 patients were included in the study. The average age was 47.8 ± 19.3 years, with a median follow-up time of 6 months. The most common ocular risk factors were poor ocular surface and contact lens use in 57.1% and 42.9% of cases, respectively. Eleven of the 14 patients (78.6%) had positive corneal cultures, and 13 of the 14 patients (92.9%) had positive conjunctiva or eyelid cultures. All isolates were susceptible to ciprofloxacin, ofloxacin, moxifloxacin, gatifloxacin, and cefazolin. Surgical intervention was required in 4 patients (28.6%). Average LogMAR visual acuity was 1.3 ± 1.0 at presentation and 0.9 6 ± 1.0 at the most recent follow-up visit. CONCLUSIONS: Proteus mirabilis is an uncommon cause of microbial keratitis. Patients with poor ocular surface and those who use contact lens are at increased risk for developing this cause of keratitis. Empiric treatment with fortified antibiotics or fluoroquinolones seemed to provide effective coverage for P. mirabilis.

Accelerated collagen cross-linking in the management of advanced Acanthamoeba keratitis / Cross-linking acelerado de colágeno no controle da ceratite por Acanthamoeba avançada

ABSTRACT Purpose: To report our initial experience in the treatment of Acanthamoeba keratitis with accelerated corneal collagen cross-linking. Methods: Retrospective chart review of patients diagnosed with Acanthamoeba keratitis with progressive corneal melting who were treated with accelerated collagen cross-linking. Results: A total of 6 eyes (5 patients) were reviewed. All the patients received adjuvant therapy with moxifloxacin and chlorhexidine. In 4 cases, the ulcer healed with a mean interval to epithelialization of 108.8 days (range 59-217). In 2 eyes, there was a persistent neurotrophic ulcer. The melting was not progressive in any case, nor did any eye required emergency penetrating keratoplasy. Conclusion: This study suggests a beneficial effect of accelerated collagen cross-linking in cases of Acanthamoeba keratitis with corneal melting. Thus, collagen cross-linking may be considered as adjuvant treatment for Acanthamoeba keratitis.

RESUMO Objetivo: Relatar nossa experiência inicial no tra tamento da ceratite por Acanthamoeba com reticulação acelerada de colágeno corneano. Métodos: Revisão retrospectiva de prontuários de pacientes diagnosticados com ceratite por Acanthamoeba, com deformação progressiva da córnea, tratados com reticulação acelerada de colágeno. Resultados: Seis olhos (5 pacientes) foram incluídos. Todos os pacientes receberam terapia adjuvante com moxifloxacina e clorexidina. Em 4 casos, a úlcera cicatrizou com uma média de epitelização de 108,8 dias (amplitude de 59-217 dias). Em dois pacientes, a úlcera apresentou um comportamento neurotrófico. A deformação não foi progressiva em nenhum dos pacientes e nenhum dos olhos exigiu ceratoplastia penetrante de emergência. Conclusão: Este estudo sugeriu um efeito benéfico da reticulação acelerada de colágeno em casos de ceratite por Acanthamoeba infecciosa com deformação corneal. A reticulação de colágeno parece ser uma alternativa coadjuvante possível para casos de ceratite por Acanthamoeba.

Accelerated collagen cross-linking in the management of advanced Acanthamoeba keratitis.

PURPOSE: To report our initial experience in the treatment of Acanthamoeba keratitis with accelerated corneal collagen cross-linking. METHODS: Retrospective chart review of patients diagnosed with Acanthamoeba keratitis with progressive corneal melting who were treated with accelerated collagen cross-linking. RESULTS: A total of 6 eyes (5 patients) were reviewed. All the patients received adjuvant therapy with moxifloxacin and chlorhexidine. In 4 cases, the ulcer healed with a mean interval to epithelialization of 108.8 days (range 59-217). In 2 eyes, there was a persistent neurotrophic ulcer. The melting was not progressive in any case, nor did any eye required emergency penetrating keratoplasy. CONCLUSION: This study suggests a beneficial effect of accelerated collagen cross-linking in cases of Acanthamoeba keratitis with corneal melting. Thus, collagen cross-linking may be considered as adjuvant treatment for Acanthamoeba keratitis.

Topical insulin in neurotrophic keratopathy after resection of acoustic neuroma. / Insulina tópica en queratopatía neurotrófica tras resección de neurinoma del acústico.

CASE REPORT: A patient with a history of surgical resection of an acoustic neuroma presented with involvement of both the left facial nerve and the left trigeminal nerve. She initially consulted for exposure keratitis, but two weeks later presented with an infectious keratitis. After taking the corneal sample, she presented with persistent epithelial defect, which did not respond to medical management. Topical insulin was indicated, and a decrease in the area of the lesion was seen in the following 5 days. A therapeutic contact lens was also placed at that time and finally, two weeks after the initiation of insulin, the epithelial defect completely closed. DISCUSSION: This was a complex case due to the confluence of facial paralysis, neurotrophic keratitis, and infectious keratitis, which finally had a successful outcome. Topical insulin can be an effective adjuvant therapy in cases of neurotrophic ulcers that do not respond to standard therapy.

Plasma rich in growth factors for the treatment of rapidly progressing refractory corneal melting due to erlotinib in nonsmall cell lung cancer.

RATIONALE: Erlotinib, an antineoplastic agent, is indicated for the treatment of patients with advanced nonsmall cell lung cancer. Most common adverse events are manageable, although more severe ones require dose reduction or discontinuation of erlotinib treatment. PATIENT CONCERNS: We present a case of severe corneal ulcer treated with autologous plasma rich in growth factors. DIAGNOSES: A 76-year-old woman with stage IVB (cT2a N0 M1c) lung cancer under erlotinib treatment presented with rapidly progressing corneal ulcer. Evolution was torpid and refractory to conventional treatment. INTERVENTIONS: Surgical options were dismissed because of the poor performance status of the patient. Despite temporary discontinuation of erlotinib treatment, the corneal ulcer continued to worsen with peripheral corneal neovascularization, stromal thinning, corneal edema, and profuse inflammation of the ocular surface. OUTCOMES: Treatment with autologous plasma rich in growth factors prevented an imminent corneal perforation and improved the corneal ulcer for over a year of follow-up. LESSONS: Considering the poor results of conventional treatment, both medical and surgical, management of the inflammation of the ocular surface together with the stimulation of the healing processes through regenerative therapy such as PRGF, can be an option worth considering in these cases.

Inyección intraestromal como método novedoso en el tratamiento de úlceras corneales infecciosas / Intraestomal injection as new method in the treatment of infections corneal ulcers

Se realizó una revisión bibliográfica con el objetivo de proponer una nueva ruta de tratamiento intraestromal. Se consideró que la vía intraestromal de aplicación de medicamentos para infecciones de la córnea debería ser incorporado en oftalmología como una vía preferencial en el manejo de este tipo de patologías, por su efectividad, bajo costo y bajo número de complicaciones. La resolución de las úlceras corneales constituye un problema de salud a resolver, pues los tratamientos convencionales no siempre garantizan una evolución favorable de los casos diagnosticados, razón por la cual surge la necesidad de buscar alternativas terapéuticas para tratar a estos pacientes(AU)

The resolution of the corneal ulcers constitutes a health problem to be solved, since the conventional treatments not always guarantee a favorable evolution of the diagnosed cases, reason for which arises the necessity of looking for therapeutic alternatives to treat these patients. This bibliographical revision has the aim to propose a new way of intrastromal treatment. Doctors consider that the intrastromal way of application of medications for infections of the cornea and of the previous segment, should be incorporated in ophthalmology as a preferential way in the handling of this type of pathologies, since its effectiveness, low cost and low number of complications(AU)

Complementary treatment of contact lens-induced corneal ulcer using honey: a case report.

The aim of this study was to report the complementary use of honey for treatment of a contact lens-induced corneal ulcer. A 23-year-old contact lens user presented with a corneal ulcer in her left eye. She had visual acuity reduced to hand movement. There was a history of wearing contact lenses while swimming in a lake seven days before presentation. The cultures from corneal scrapings and contact lenses were positive for Klebsiella oxytoca, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Pseudomonas spp. The treatment with topical levofloxacin and 25% (w/v) γ-irradiated honeydew honey solution was effective and the patient achieved final best corrected visual acuity of affected eye. In addition to positive clinical outcome, honeydew honey was shown to be highly effective in vitro against ocular isolates, in particular S. maltophilia. The minimal inhibitory concentrations for honeydew honey ranged from 5% to 10%. These results demonstrate that honey is a promising antibacterial agent in management of corneal ulcers. Moreover, honey exhibits anti-biofilm and anti-inflammatory properties, and thus becomes an interesting ophthalmologic agent.

Incision-sparing management of canaliculitis.

PURPOSE: To report our results of canaliculitis treatment with our incision-sparing technique which includes dilation of the punctum and compression of the canaliculus to express the sulphur granules, curettage and irrigation of the canaliculus with antibiotic solutions, and topical antibiotic use. METHODS: The medical records of all patients treated for canaliculitis between October 2009 and March 2013 were rewiewed. The punctum of affected canaliculus was dilated under local anesthesia. Then, starting just distal to common canaliculus, the horizontal canaliculus was compressed along its entire length using either a forceps or a cotton tip applicator on the conjunctival surface and a curette on the skin. Compression was repeated until no more sulphur granules appeared and the swelling of the canaliculus disappeared. A chalazion curette was inserted into canaliculus to evacuate any residual concretions. The canaliculus were irrigated with antibiotic solutions and the patients were prescribed topical antibiotic solutions for one month Patients with follow-up less than 3 months after the intervention were excluded from the study. RESULTS: Nine patients met criteria for canaliculitis. There were 1 male and 8 female patients. Median age of the patients was 53 years (range 36-72 years). All patients had unilateral lower canaliculitis. Mean duration of the symptoms was 13.4 months (range 4-36 months). We followed up all patients for at least 3 months after the intervention. The signs and symptoms resolved completely in all patients within 1 month and recurrence was not observed in any patient. No patients reported epiphora after the procedure. CONCLUSION: Our incision-sparing technique is effective in the treatment of canaliculitis. We suggest that minimally invasive or incision-sparing techniques be attempted before canaliculotomy to decrease postoperative complications rates.

Use of amniotic membrane and autologous serum eye drops in Mooren's ulcer.

INTRODUCTION: The management of Mooren's ulcer can be a challenge for clinicians. OBJECTIVE: To report a case of Mooren's ulcer treated with amniotic membrane transplantation supplemented with autologous serum eye drops. CASE REPORT: A 22-year-old male presented with history of pain, redness, watering and diminution of vision of the right eye for one year. Examination of his eyes revealed the best corrected visual acuity ( BCVA) of 6\60 and 6\6 in his right and left eyes respectively. Slit -lamp examination of the right eye showed a peripheral ulcer extending from 2'0 to 11'0 clock positions with peripheral thinning and the features suggestive of Mooren's ulcer. The condition did not improve with topical steroids and cyclosporine A eye drops. Therefore, 360 degree conjunctival peritomy with cauterization of the base was performed. Since there was no obvious improvement, the amniotic membrane transplantation was done with supplementation of autologous serum eye drops 20% four times a day. The patient showed symptomatic improvement in a week. There was cessation of the progression of the ulcer and decreased vascularization. One month later, a small corneal perforation was noted and was managed well with cyanoacrylate glue and bandage contact lens application. At nine months of follow up, the patient was symptomatically better, the ulcer had healed, the vascularization had decreased and the anterior chamber was well formed. CONCLUSION: Amniotic membrane transplantation showed to be promising in treatment of Mooren's ulcer refractory to immunosuppressive therapy. Addition of autologous serum eye drops seems to be an effective supplementary therapy.

Tratamento homeopático de crianças com úlcera de córnea em escudo por ceratoconjuntivite primaveril: relato de casos e aspectos bioéticos / Homeopathic treatment of children with shield ulcers of the cornea in vernal keratoconjunctivitis: case reports and bioethical dimensions

Apresentar um tratamento homeo-pático de úlcera de córnea por ceratoconjuntivite primaveril, considerando-o bioeticamente. MÉTODOS: foram usados nove casos, encami-nhados por insucesso terapêutico convencional. Escolheram-se os medicamentos de acordo com características singularizantes dos pacientes que incluíram o psiquismo. Levantaram-se os custos medicamentosos consultando-se três farmácias homeopáticas e três não-homeopáticas de Belo Horizonte. O tratamento convencional foi estimado a partir da medicação usada pelos enfermos antes do início dos cuidados homeopáticos. RESULTADOS: as cicatrizações ocorreram entre quinze e cento e oitenta dias, com custo medicamentoso médio de oito dólares, cerca de treze vezes menor do que a estimativa de custo direto de um mês da abordagem convencional. O manejo terapêutico da similitude pode minimizar preocupações bioéticas relativas à atenção à saúde de crianças com ceratoconjuntivite primaveril. CONCLUSÕES: a homeopatia pode colaborar para o tratamento desta enfermidade, aprimorando-o bioeticamente...

Present a homeopathic treatment of corneal ulcers for vernal keratoconjunctivitis and its bioethical implications. METHODS: nine cases were studied, after having been referred following the failure of conventional treatments. Medications were chosen according to the specific characteristics of the patients, including psychiatric disorders. The medication costs were gathered by consulting three homeopathic and three non-homeopathic pharmacies in Belo Horizonte. The estimate for conventional treatment cost was based on the medication prescribed for the patient prior to the commencement of homeopathic care. RESULTS: scarring occurred between fifteen and one-hundred eighty days, with an average medication cost of eight dollars, roughly one-thirteenth of the estimated direct cost of one month of conventional treatment. The similarity of therapeutic approaches should minimize bioethical concerns regarding the medical care of children with vernal keratoconjunctivitis. CONCLUSIONS: homeopathy can contribute to both the medical and bioethical aspects of treatment of this disease...

Corneal ulceration in a LASIK patient due to vitamin a deficiency after bariatric surgery.

PURPOSE: To review the case of a 41-year-old woman who underwent bariatric surgery in 2000. She subsequently underwent laser in situ keratomileusis (LASIK) surgery in 2008 and complained of dry eye since the LASIK surgery. In November 2010, she was diagnosed with a corneal melt and was treated with aggressive lubrication, followed by eventual amniotic membrane placement and a tarsorrhaphy. She then presented for consultation at the Bascom Palmer Eye Institute when she developed a corneal infiltrate. She was diagnosed with fungal keratitis with corneal xerosis. At that time, vitamin A levels were measured and were less than 2 µ/dL. The patient admitted noncompliance with nutritional supplements. METHODS: Case report. RESULTS: The patient was treated with aggressive lubrication and natamycin. Vitamin supplements were restarted, and the patient experienced dramatic improvement in symptoms with resolution of the infection. A central corneal scar with corneal thinning remains. The patient underwent a penetrating keratoplasty for visual rehabilitation. CONCLUSIONS: Patient education with emphasis on compliance with nutritional supplements is essential after bariatric surgery. Consider vitamin A deficiency in the differential diagnosis of dry eye after LASIK surgery.

In vitro efficacy of antifungal treatment using riboflavin/UV-A (365 nm) combination and amphotericin B.

PURPOSE: To demonstrate the antimicrobial properties of riboflavin/UV-A (365 nm) against fungal pathogens. METHODS: The antimicrobial properties of riboflavin/UV-A (365 nm), with or without previous treatment with amphotericin B, were tested on three groups of fungi selected from severe cases of keratomycosis: Candida albicans, Fusarium sp, and Aspergillus fumigatus. They were tested by using Kirby-Bauer discs with empty disc (control), riboflavin 0.1% alone (R), UV-A alone (UV-A), riboflavin 0.1% and additional UV-A exposure (R+UV-A), amphotericin B alone (A), amphotericin B and riboflavin 0.1% (A+R), amphotericin B and UV-A (A+UV-A), amphotericin B and riboflavin 0.1%, and additional UV-A exposure (A+R+UV-A). The mean growth inhibition zone (GIZ) was measured around the discs. RESULTS: C. albicans, Fusarium sp, and A. fumigatus did not show any increased GIZ after treatment without previous amphotericin B medication. However, GIZ was significantly greater after pretreatment with amphotericin B and riboflavin/UV-A (A+R+UV-A) for C. albicans (P = 0.0005), Fusarium sp (P = 0.0023) and A. fumigatus (P = 0.0008) compared with A, A+R, and A+UV-A. CONCLUSIONS: Amphotericin B is believed to interact with fungi membrane sterols to produce aggregates that form transmembrane channels. Given that collagen is one of the principal components of the cornea, it is also probable that amphotericin B may diffuse easily after cross-linking. Previous treatment with amphotericin B allowed riboflavin/UV-A effectiveness against C. albicans, Fusarium sp, and A. fumigatus. This schema might be used in the future for the treatment of keratomycosis.

Autologous serum application in the treatment of Mooren's ulcer.

BACKGROUND: Mooren's ulcer is a peripheral corneal ulceration of presumed autoimmune aetiology. Its clinical course and eventual prognosis is variable and usually these ulcers respond poorly to conventional therapy. HISTORY AND SIGNS: A 67-year-old male was referred to our hospital for a painful, red and tearing left eye after receiving debris. Slit-lamp examination revealed a 3.2 x 2.1 mm peripheral corneal ulcer, a diffuse thinning of the lateral limbus (between 3 o'clock and 5 o'clock) and some endothelial precipitates. The conjunctiva was severely congested. In the anterior chamber, cells (++) and fibrin were found. THERAPY AND OUTCOME: We introduced an antibiotic, corticosteroid and cyclosporin therapy to treat the marginal corneal deficit caused by Mooren's ulcer. The patient did not respond to the initial treatment, but re-epithelialisation occurred and the corneal deficit improved after the introduction of autologous serum eye drops. CONCLUSION: Autologous serum seems to be an effective supplementary therapy in Mooren's ulcer.

Severe corneal toxicity after topical fluoroquinolone therapy: report of two cases.

PURPOSE: To describe 2 cases of sterile corneal ulcers that persisted after several weeks of therapy with topical moxifloxacin 0.5% but that resolved when antibiotic therapy was changed. METHODS: Small case series. RESULTS: Both cases presented here describe corneal ulcers that persisted and showed signs of worsening during weeks of frequent topical dosing with moxifloxacin. Descemet folds and an atypically large amount of stromal edema were present in both cases, and there appeared to be possible endothelial dysfunction as well. There was no sign of bacterial, viral, or fungal infection in either case. In both cases, healing began a few days after moxifloxacin was discontinued, and topical gatifloxacin and corticosteroids were initiated. CONCLUSION: These cases suggest that moxifloxacin may interfere with the healing of corneal ulcers.

[Conservative and surgical treatment of neurotrophic keratopathy]. / Konservative und chirurgische Therapie der neurotrophen Keratopathie.

Neurotrophic keratopathy is one of the most challenging conditions among the disorders of wound healing of the ocular surface. In addition to bilateral assessment of corneal sensitivity, tear status and lid function must be analyzed and treated by unpreserved artificial tears and adequate lid surgery. Further conservative treatment options include hyaluronic acid and dexpanthenol as well as autologous serum. Application of recombinant growth factors (especially NGF) represents an interesting perspective. Concerning surgical interventions, temporary or permanent occlusion of the lacrimal punctum may be accompanied by lateral tarsorrhaphy which is easy to perform, potentially reversible, and in most cases successful. Depending on the type of wound healing disorder amniotic membrane transplantation may be helpful either as basal membrane transplant (graft) or as a patch, or in combination (sandwich). A tectonic keratoplasty a chaud should typically be combined with a simultaneous amniotic membrane patch and/or a lateral tarsorrhaphy to avoid persistent epithelial defects.

Heat treatment enhances healing process of experimental pseudomonas corneal ulcer.

We investigated the effects of hyperthermia on the healing process of experimental Pseudomonas corneal ulceration (PCU). Hartley guinea pigs were used to develop animal models of PCU. As a heat source, disposable chemical pocket warmers were applied. The healing process of PCU was compared between the heat-treated corneas and the control corneas. The severity of infection and the degree of angiogenesis were classified by a clinical scoring system. The animals were euthanized 14 days after infection and the corneas were submitted for histopathological examination. The expression of vascular endothelial growth factor (VEGF) was examined immunohistochemically. Comparative reverse transcription polymerase chain reaction was performed to measure the expression level of VEGF in the cornea. Hyperthermia significantly promoted corneal epithelization and neovascularization in the PCU model. Heat treatment significantly decreased the number of viable Pseudomonas organisms present in PCU. On immunohistochemistry, the heated cornea demonstrated more intense staining for VEGF. Comparative reverse transcription polymerase chain reaction showed upregulation of the expression level of VEGF mRNA in the heat-treated cornea. Hyperthermia accelerated the healing process of PCU with increased corneal neovascularization. Angiogenesis may play an important role in the PCU healing process, which is enhanced by the heat treatment.

Use of Traditional Eye Medicines by corneal ulcer patients presenting to a hospital in South India.

PURPOSE: To investigate the nature and frequency of use of Traditional Eye Medicine (TEM) for corneal ulcer in patients from predominantly rural background. METHODS: We documented the the use of TEM by corneal ulcer patients presenting to a tertiary eye-care centre in South India during two months of 1996. RESULTS: Of 283 patients enrolled in the study, 135 (47.7%) of the patients used TEM. There was no difference with regard to age and sex distribution of patients using TEM and those who did. Patients with history of trauma were more likely to use TEM. Common forms of TEM used were human breast milk 61(45.2%), leafy matter 40(29.6%), castor oil 16 (11.9%), and hen's blood 8 (5.9%). CONCLUSION: Though the awareness of intraocular lens implantation for cataract surgery is very high in this segment of the population, it is still tragic that an awareness of primary eye care following trauma has not been created. Health education is mandatory to prevent this avoidable cause of blindness.

Consideraçöes sobre o tratamento de úlceras corneanas presumivelmente bacterianas / Suspected bacterial keratitis

Avaliar a eficácia das culturas e antibiogramas no tratamento de úlceras de córneas presumivelmente bacteriana. Coloraçäo de gram e culturas foram realizadas antes do tratamento. As úlceras foram classificadas como moderadas e graves. Todos os pacientes foram tratados com colírios fortificados de cefalotina e aminoglicosídeo. A cultura das úlceras resultou negativa em 12 casos e positiva nos outros 36. Das úlceras, 29 foram classificadas como moderadas e 19 como graves. Houve mudança de terapêutica em 5 (17,2 p/cento) das 29 úlceras moderadas e em 5 (26,3 p/cento) das 19 úlceras graves. A maioria dos casos de úlceras bacterianas adquiridas na comunidade resolvem com terapêutica empírica de largo espectro. A realizaçäo dos exames rotineiros de cultura e antibiograma podem ser úteis na modificaçäo do esquema terapêutico dos casos que näo apresentem boa evoluçäo