Epidemiological Characteristis, Predisposing Factors and Outcome of Corneal Ulcer Management In Nepal

Sanjay Kumar Singh

AIM— Suppurative keratitis is a potentially sight threatening ocular infection. Epidemiological characteristics and aetiological diagnosis of suppurative keratitis varies from one population and geographical clime to another. The following hospital based study was carried out to determine the epidemiological characteristics and aetiology of suppurative keratitis and to understand health seeking behavior of suppurative keratitis patients in the eastern region of Nepal.

METHOD— All patients with suppurative keratitis who attended the outpatient and emergency department of Sagarmatha Chaudhary Eye Hospital were included in the study. Ethical approval was obtained from the hospital administration. A detailed history was recorded and patients were examined using a slit lamp bio-microscope. Corneal scraping and microscopy was carried out for all patients and treatment selected on the basis of microscopy findings.

RESULT—. In a period of 5 years (Jan 2003 to Dec 2007), 1898 eyes of 1897 patients with corneal ulcer were evaluated. More than half of (51%) of suppurative keratitis patients were in between 26-45 yrs of age and presenting visual acuity was <3/60 in two third (66.6%) eyes. Trauma was the most common predisposing factor found in 54.3% patients. Two thirds of suppurative keratitis patients had consulted medical shop keepers, relatives, traditional healers and medical doctors before visiting the eye hospital and the majority of them were using medicines (61.9%). Gram-positive cocci and fungi accounted for (10%) and (38.6%) of all causative micro-organisms. Mixed infection with Gram-positive cocci and fungi was found in 39% patients.

CONCLUSION— Result of this study showed that corneal ulceration is more common in the socio-economically active age group. Most of the affected patients had corneal ulcer of severe grade and were on empirical treatment from local people including traditional healers, relatives and drug sellers. Initial corneal ulcer treatment based on clinial findings and laboratory investigations was found effective in most of the patients