Year : 1999 | Volume
: 47 | Issue : 1 | Page : 15--18
Use of traditional eye medicines by corneal ulcer patients presenting to a hospital in South India
Venkatesh N Prajna, Manju R Pillai, TK Manimegalai, M Srinivasan
Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Madurai, India
Venkatesh N Prajna
Aravind Eye Hospital, 1 Anna Nagar, Madurai - 625 020
Purpose: To investigate the nature and frequency of use of Traditional Eye Medicine (TEM) for corneal ulcer in patients from predominantly rural background.
Methods: We documented the the use of TEM by corneal ulcer patients presenting to a tertiary eye-care centre in South India during two months of 1996.
Results: Of 283 patients enrolled in the study, 135 (47.7%) of the patients used TEM. There was no difference with regard to age and sex distribution of patients using TEM and those who did. Patients with history of trauma were more likely to use TEM. Common forms of TEM used were human breast milk 61(45.2%), leafy matter 40(29.6%), castor oil 16 (11.9%), and hen«SQ»s blood 8 (5.9%).
Conclusion: Though the awareness of intraocular lens implantation for cataract surgery is very high in this segment of the population, it is still tragic that an awareness of primary eye care following trauma has not been created. Health education is mandatory to prevent this avoidable cause of blindness.
|How to cite this article:|
Prajna VN, Pillai MR, Manimegalai T K, Srinivasan M. Use of traditional eye medicines by corneal ulcer patients presenting to a hospital in South India.Indian J Ophthalmol 1999;47:15-18
|How to cite this URL:|
Prajna VN, Pillai MR, Manimegalai T K, Srinivasan M. Use of traditional eye medicines by corneal ulcer patients presenting to a hospital in South India. Indian J Ophthalmol [serial online] 1999 [cited 2021 Jun 13 ];47:15-18
Available from: https://www.ijo.in/text.asp?1999/47/1/15/22801
Rapid strides are taking place in the field of ophthalmology worldwide and India is no exception to this. In the field of cataract surgical intervention programmes, there is a perceptible shift from intracapsular cataract extraction towards extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation, even amongst the rural population. Awareness about the advantages of IOL and the improved quality of life as perceived by the patient has aided this metamorphosis. While such developments have taken place in the field of cataract surgery, the problem of corneal blindness in India assumes a different picture altogether. India has probably the largest number of people affected by corneal blindness worldwide, estimated to be around a million eyes. This problem is compounded by the fact that it affects young people, resulting in a colossal loss of man days. The major cause of corneal blindness in our country is infective corneal ulcers following trauma.
At Aravind Eye Hospital, the cornea service treats about 2000 corneal ulcers and about 1000 corneal injuries every year. In spite of the best available treatment, about 50% of them become either partially or totally blind in one eye. The poor results among these patients are due to the severity of infections, injuries, delay in seeking ophthalmic care, and poor socioeconomic conditions. Patients with corneal ulcers often present late to the hospital due to ignorance, inaccessibility of health-care facilities and inappropriate primary eye care. There is anecdotal evidence of these patients getting primary treatment from traditional eye healers before presenting to an eye-care facility. Studies on these types of treatment done in Africa have helped reduce needless corneal blindness. We undertook a study to document the role of traditional eye medicines (TEM) used by patients with corneal ulcers who presented to our hospital.
Materials and Methods
This study included all the patients presenting with a first episode of acute corneal ulcer to the non-paying section of the Aravind Eye Hospital during October and November, 1996. The patients were initially screened by an ophthalmologist. AH the patients who had corneal ulcer which stained with fluoroscein were then subjected to a questionnaire administered by a trained social worker. Interviews were performed before a detailed clinical examination to offset any possible bias. The questionnaire contained simple questions including the history of the disease, the nature of help sought and the nature of remedies used. Patients were then subjected to a complete clinical examination by an ophthalmologist using a slitlamp. Corneal scrapings were performed on all patients using Gram's stain and 10% Potassium Hydroxide. In addition, all the ulcer specimens were cultured on blood agar and potato dextrose agar.
A total of 283 patients who fulfilled the inclusion criteria mentioned above were enrolled in the study. Of these, 135 (47.7%) patients used TEM and 148 (52.3%) did not. There was no difference in the age (p=0.12) and sex distribution (p=0.93) of patients who reported TEM use compared with those who did not.
Patients with a history of trauma were more likely to use TEM than patients without a history of trauma (p=0.002) [Table:1]. The common TEM used were: human breast milk, 61 (45.2%); leafy matter, 40 (29.6%); castor oil, 16 (11.9%); and hen's blood, 8 (5.9%), in the descending order of frequency [Table:2]. There was no difference in the proportion of bacterial and fungal ulcers between the two groups [Table:3].
This study was designed to document the prevalence of usage of traditional eye medicine amongst patients presenting with corneal ulcer to a tertiary care facility in southern Tamil Nadu, India. We found that of 283 patients with corneal ulcer, 135 (47.7%) patients used TEM. There was no difference between the groups with regard to age, sex and the organism causing the ulcer. The common medicines used were human breast milk, leafy extracts, castor oil and hen's blood. Of all these, human breast milk was the most common medicine used, accounting for around 45%. The leafy extracts were nonspecific and were usually ground into a paste and applied in and around the eye. The hen's blood was usually obtained from making a small nick around the hen's legs and poured out into a container and used later. Human milk and castor oil were applied usually by a senior member of the family, while leafy extract and hen's blood were usually applied by regularly paid local traditional healers. Traditional healers were practising this art of medicine part time and were usually from the same village as the patient. Interestingly, they were not paid or in some occasions were paid a meagre amount for the services rendered.
TEM may cause corneal damage either by its toxic effects per se or by introducing microorganisms into the eye which lead to primary or secondary infections. Some TEM may act as culture media, thus aiding the growth of microorganisms. For example, human milk contains significantly more lactose, even more than cow's milk and this may also stimulate the growth of microorganisms.
Large-scale use of TEM has been reported from Africa. Courtwright reported that 33% of patients with corneal disease who had presented to the district hospitals of rural Malawi in Africa had already used TEM. These patients took an average of 4 times as long to present as those who did not use TEM. Lewallen et al described peripheral corneal ulcers and the lack of fungal ulcers associated with the use of TEM. Most drugs consisted of dried plant material crushed into powder, boiled in water, and made into aqueous solutions. Animal products were not used in this area. Sugar water was reported to be a common TEM used in Nigeria while Vicks Vaporub was traditionally used in Haiti. Investigators from Tanzania, found that corneal ulcers associated with TEM use were more likely to cause dense scars. Chirambo et al attributed to the use of TEM 26% of blindness among blind school children. Many publications have linked the use of harmful TEM in epidemics of acute haemorrhagic conjunctivitis., In contrast to practice in Africa the TEM most commonly used India is human breast milk. The persons who were instilling the TEM in Indian setting were usually elders from the family of the patient, and occasionally the traditional healers. These people were usually agricultural workers and practiced this art of medicine part time. In contrast to the African system, where animal products were not used, hen's blood was commonly used in our setting. In this study, there was no difference in the proportion of fungal ulcers between the group using TEM and the group which did not use TEM.
In Africa, there is, on average, one ophthalmologist per one million population. There are relatively few trained nurses or assistants. Ophthalmic medicines are often not available in health-care centres and are expensive in private pharmacies. The result is that eye care is not easily accessible to the majority of Africans., This is further demonstrated by the fact that fewer than 1 in 10 people blind from cataract in Africa eventually ever receive cataract surgery. On the other hand, in India, there is one ophthalmologist per 107,000 of population. Each primary health center which subserves 30,000 population is staffed at least by one ophthalmic assistant, who can refer them to adequate secondary and tertiary care facilities. We had previously reported the large-scale awareness about IOL for cataract surgery in the same population. However, while patients with cataract are aware of IOL implantation, a significant number of patients with corneal ulcer prefer to try TEM. Though the hospital may be physically accessible, cultural accessibility may be a major issue. The issues relating to accessibility start with the process of creating awareness, motivation and finally, delivery of eye-care services with necessary follow up. The process of creating awareness or making relevant information available needs a good understanding of the patient population in terms of health behaviour, literacy needs, economic status, barriers to access and logistics of information transmission. Similarly, in delivery of eye-care services, while it is necessary to know about the clinical nature of the eye diseases in the community, it is even more important to understand the barriers to access. The barriers could be grouped as social, psychological, economic, and logistics-related.
In conclusion, this study documents widespread use of traditional eye medicines in the treatment of corneal ulcer in a predominantly rural population attending a tertiary-care centre in South India. Though the awareness of IOL for cataract surgery is very high in this set of population, it is still tragic that an awareness of the need for primary eye care following trauma has not been created. The realization of the conventional and innate wisdom in every community should form the basis for engendering and fostering community interest and participation. Dialogue between health personnel and the community in all aspects of planning and implementation of primary eye-care services is particularly important in mass intervention programmes. The health personnel should learn how to relate their technical knowledge to the material, social and psychological realities of the community. There is much that people do not understand about modern scientific concepts, and so every effort should be made in health education to bring these changes to the grass roots level.
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