|Year : 1961 | Volume
| Issue : 3 | Page : 56-59
R Surya Prasadrao
Department of Ophthalmology, A.M. College, Visakhapatnam, India
|Date of Web Publication||7-Apr-2008|
R Surya Prasadrao
Department of Ophthalmology, A.M. College, Visakhapatnam
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prasadrao R S. Fisherman's keratopathy. Indian J Ophthalmol 1961;9:56-9
I wish to present to this learned gathering a new clinical condition which 1 have come across among the fishing folk of Visakhapatnam on the East Coast of India. The condition involves the cornea of seafaring fishermen of the age group between 20-50, all men, in good health without any obvious known cause like avitaminosis, malnutrition, conjunctival or corneal infection. The lesions are of a degenerative nature, of a chronic course which have been not previously reported elsewhere as a special entity. For this reason and as it appears to be an occupational disease the condition may be called provisionally "Fisherman's Keratopathy". It affects those who regularly go out to sea for fishing, some times to a distance of 10-15 miles on Catamarans and come in intimate contact with salt water or its froth and foam which constantly splashes into their face and eyes. The women folk and other male members below the age of 12 years or over 55 years, who do not go out to the sea and work on the seashore only, but in every other respect live in identical conditions as those who are affected, are not seen to develop this condition. The condition is a corneal degeneration of a fairly long duration seen after 5 years or more of sea life which brings about a train of symptoms, like pain, watering of eye and some fall of vision for which the incapacitated fishermen would seek relief, particularly for the distressing pain and after a variable period of time, pain and other symptoms gradually tend to subside either due to enforced rest or treatment and are likely to recur again after the individual resumes his activities at sea. There are instances of these individuals reporting for treatment on five previous occasions. Besides exposure of eyes to the sea water, the affected individuals also get exposed to solar radiation in the form of a reflected sun light from the surface of the sea. The corneal lesions are not marginal in position but are paracentral, mostly in infero-temperol or exposed quadrant of cornea, situated deep to corneal epithelium and Bowman's membrane which appear to be normal. The appearance of the lesion is greyish white located in the substantia propria of the cornea and the area of cornea involved appears to be thickened and sensations are impaired over the lesion, but not on the rest of the cornea.
The slit lamp examination shows following appearances.
1. Central elevated opacities with a pale yellowish tint forming a distinct zone which is subepithelial in position.
2. Surrounding this zone is a clear halo.
3. This clear halo is surrounded by a illdefined haze with fluffy margin. It is a stippled area in the superficial and middle layers of substantia propria extending over an area of 1 to 2 mm surrounding the halo. There is no vascularization of the cornea.
| Condition of Patient on Examination|| |
General condition of the patients did not reveal anything abnormal regarding nutritional status or general health. None of them showed any avita_minosis or nutritional deficiency or anaemia. They were all sthenic and an active type of people who were capable of exertion continuously for a number of hours at sea under trying conditions of extremes of weather either by day or night. Of the 14 cases studied the condition was unilateral in 13 and bilateral in one. The anterior segment of eye appears to be normal except for corneal lesion with slight ciliary flush. There was no evidence of any regional lymphadenopathy.
The following investigations were conducted on all these patients
1. Smear examination, Culture of conjunctival sac.
2. Staining with flourescein which always shows that the corneal epithelium was intact.
3. Scrapings from the lesion were subjected to histological examination.
4. Tests were performed for the presence of amyloid and inorganic calcium. The superficial area of lesion was scraped off and tested for the presence of inorganic calcium and amyloid.
In all the above investigations some of the conjunctival sac smear examination showed staphylo or mixed organisms. None showed any fungus infections. Culture of scrapings were negative for pathogenic organisms. Ten cases showed the presence of inorganic calcium in the lesion. Three cases showed inorganic calcium and amyloid. Two cases with minimal lesions showed neither inorganic calcium nor amyloid.
5. Histological examination of biopsy material of the tissue under study at the level of the lesion, showed vacuolation and disintegration of cells which did not reveal identity of the details of tissue cells
| Treatment|| |
Treatment was adopted on a non-specific basis with 1% atropin for giving rest to the eye. 1%, mercurochrome drops and plasma ointment and bandage was applied after scraping the tissue for examination but not otherwise.
Supportive Treatment : in the form of Reboflavin 10 mgms orally or parenterally daily was also given to improve nutrition of the cornea. No special diet or other vitamin supplements were administered.
| Course of the Disease|| |
On an average treatment for about a fortnight there was noticeable improvement in subjective symptoms namely pain, lacrimation and improvement of vision. All the cases in which epithelium was scraped off showed epithelial healing in about 48-72 hours. The rest of the lesion also showed improvement of the greyish white central zone which was thinned out and the clear halo less prominent than before and peripheral stippled zone becoming inconspicuous and thickness of cornea reduced.
These individuals get back to work alter relief is obtained. Recurrences were noticed among them after months to years of sea life. These individuals hail from sea side villages situated along coastal areas. A home survey of one of the villages consisting of about thousand villagers was conducted to spot out any possible lesions in other members, who have not reported and the survey revealed that all the men and women below 20 and above 50 years i.e. those who do not go out to sea were free from the corneal lesions only 3 people with corneal lesions were discovered acid 2 of them already reported before. Among the older age group there was one who gave past history of recurrent attacks which quietened later on.
| Etiological Factors|| |
As traumatic, infective, nutritional hereditary, etiological factors can be ruled cut and the lesion is of a degenerative nature affecting rind confined to an occupational group of seafaring men, it is reasonable to conclude that the condition is a secondary type of degeneration consequent upon some factor or factors associated with such an occupation. The salt water or brine is a chemical irritant and a hypertonic fluid containing salt of sodium potassium and magnesium in it. Repeated spurting of sea water into eyes of these individuals might he etiological factor either alone or associated with other accessory factors. Very likely the solar radiation by way of direct reflected sun from the surface of sea to which they are very much exposed might in conjunction with above act as accessory factor. It was rather significant that 13 out of 14 cases the lesion was unilateral and site of the lesion coincided with the state or posture of the person on the catamaran, the water or surf beating more on the affected side. But it is rather difficult to come to definite conclusion unless the effect of sea water has been tried on experimental animals for a long period alone or in conjunction with the accessory factors like solar radiation on different groups of animals with proper controls in order to establish the etiological factors and also the histopathological study of serial section of cornea, which car, be adequately studied on experimental animals. It is proposed to conduct the above experimental study during the course of this year. I would like to urge on other Ophthalmologists who are favourably situated along the coast to be on the look out for these cases and make a study which this condition deserves. It is very likely that it may pass unnoticed unless it is borne in mind that every suspecious degenerative condition of the cornea of the above description, the patient is interrogated about his occupation, as to whether he would go out to sea.
| Summary|| |
A keratopathy in healthy fisherfolks who have been exposed for long hours to sea-water and sun is described.
The lesions are mostly unilateral paracentral in the exposed part of the cornea, mostly infero-lateral, and situated deep to Bowman's membrane. They are characterised by the presence of 3 zones, a central elevated pale yellowish zone, a clear halo surrounding it, surrounding which is an ill-defined hage with fluffy margin.
Improvement takes place with rest from work and routine treatment, for ulcer cornea, with recurrence again after a long time on returning to sea-faring.
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3]