Corneal blindness

Mr Massae (not his real name) is a forty-eight year old farmer who recently presented at a tertiary ophthalmology unit in Tanzania with a three-week long history of pain, purulent discharge, and loss of vision in the left eye. Several days after the onset, he had received treatment from his local health centre (chloroamphenicol drops), but his eye continued to get worse. At presentation, he had a large corneal ulcer with infiltration and a hypopyon. A filamentous fungus was cultured from microbiology specimens. He was treated with intensive topical antifungal (econazole) and anti-bacterial (ciprofloxacin) drops, a topical cycloplegic (atropine), and an oral antifungal medication (itraconazole). A small corneal perforation developed which plugged with iris and then sealed. The infection gradually responded to prolonged antifungal therapy, leaving a dense scar and small eccentric pupil (Figure 1, over page). Four years earlier, Mr Massae had lost sight in his right eye due to severe suppurative keratitis following a minor corneal abrasion from a maize leaf; this caused dense scarring of his right cornea (Figure 2, over page). Mr Massae is now blind.