Severe corneal infections: prevention, diagnosis and treatment

Infection of the cornea caused by bacteria or fungi is a major and painful cause of blindness in low- and middle-income countries. There are many challenges to the care of people with a cornea infection including delayed presentation, use of traditional eye medicine, limited training for health workers, limited availability and efficacy of anti-fungals and diagnostic uncertainty. Progressive corneal destruction is mediated by human and pathogen-derived enzymes (proteases) that destroy tissue and cause blindness.

Affordable, effective and readily available anti-fungal eye drops are needed. We will compare a simple formulation of chlorhexidine with the current standard care natamycin. Treatments to stop protease-mediated corneal destruction during infection are urgently needed. We will compare ilomastat with placebo eye drops in a trial, to stop holes developing in eyes. We will also use a cluster trial to see whether a combination of interventions together can prevent the delay to patients starting to take effective antimicrobials. The package includes giving chlorhexidine eye drops in the community and smartphone-assisted diagnosis, treatment and referral support. We will also evaluate which diagnostic tools are most useful in determining the type of infection.

Our findings could help improve prevention, diagnosis and treatment of corneal infections, reducing the rates of blindness in low- and middle-income countries.