OP4.6 | Corneal Blindness — Summary & Reflection

KEY TAKEAWAYS

WHO blindness: presenting VA <3/60 in the better eye. India NPCBVI definition: VA <6/60 in better eye.

Corneal blindness causes: infective (microbial keratitis — fungal/bacterial — commonest in India; trachoma — leading infectious cause globally); nutritional (vitamin A deficiency → xerophthalmia → keratomalacia); traumatic (chemical burns — alkali worse; mechanical); iatrogenic (surgical complications); congenital (Peters' anomaly, sclerocornea).

Xerophthalmia WHO stages: XN (night blindness) → X1A (conjunctival xerosis) → X1B (Bitot's spots on conjunctiva, not cornea) → X2 (corneal xerosis) → X3A (<1/3 keratomalacia) → X3B (≥1/3) → XS (scar) → XF (fundus). Keratomalacia treatment: vitamin A 200,000 IU orally day 1, day 2, day 14 (100,000 IU for children <1 year or <8 kg).

Trachoma stages TF→TI→TS→TT→CO; SAFE strategy: Surgery (trichiasis correction), Antibiotics (azithromycin single dose MDA), Facial cleanliness, Environmental improvement.

National programme: NPCBVI; Vision 2020 Right to Sight. India targets: vitamin A supplementation programme (bi-annual 6 months – 5 years), trachoma control, eye donation expansion.

REFLECT

Corneal blindness is the most preventable category of blindness in India. Vitamin A deficiency blindness was nearly eradicated in India by the national supplementation programme — yet gaps remain. Trachoma, once endemic across north-west India, has been dramatically reduced by SAFE. But fungal keratitis from agricultural trauma continues to claim corneas every day in rural India, often because the initial treating doctor did not know that feathery margins mean fungi, not bacteria. As a future doctor who will likely work at some point in a rural area: what single clinical skill from this cluster would you commit to mastering — and what would you teach the paramedical staff at your health centre to prevent the next fungal leukoma?