Causation and management of microbial keratitis in subtropical Africa

Microbial keratitis is a major cause of corneal blindness in developing countries. One hundred thirty-one episodes of corneal infection in 120 patients over an 11-month period from Soweto, South Africa, were reviewed. Severe staphylococcal lid disease, trauma, and the secondary infection of climatic droplet keratopathy were the major precedents. Unilateral mixed patterns of infection, bilateral keratitis, and childhood keratitis were common. Staphylococci, streptococci, or gram-negative enteric bacilli were the usual causative organisms. Admission rates of corneal perforation were high. Small perforations often could be managed medically without tissue glue. In developing countries, logistic problems necessitate subconjunctival antibiotic therapy; the nursing staff may be too overextended to satisfactorily maintain topical antibiotic regimens. Effective, inexpensive antibiotic dosing schedules, which are appropriate for use by the general medical officer and ancillary health worker, must be developed.