Corneal blindnesses in tropical environment.

Corneal blindnesses make up a main public health problem in numerous developing countries where they constitute a sign of low sanitary level. The main diseases which cause corneal blindnesses are: Trachoma. Xerophthalmia. Measles. Corneal ulcerations and keratitis. Onchocercosis. Neonatorum ophthalmia. Leprosy. Injuries. Some therapeutic practices. Epidemiological analysis leads to the definition of risk groups: Small children. Isolated rural communities. Unhealthy urban communities. Out of place populations. Under-fed populations. Only a joint prevention can be able to fight against this social, economic, a human plague constituted by corneal blindnesses. Simple prevention measures which are often not very expensive, showed their efficiency. They are as follows: Individual and collective hygiene measures. Improvement of alimentary conditions. Earliness and quickness in ocular care. Vaccination against measles. Improvement of the care to mother and child. Sanitary education for prevention. These prevention tasks are supported by the health workers who are spread out inside the population. Their formation, the means they are granted with constitute a main priority which has to be taken into account in the choices and the decisions to be made in order to fight against blindness linked with cornea opacification with efficacy.

Pterygium. Clinical course and treatment.

The author reviews the current concepts of the pathogenesis, clinical course and treatment of pterygium. This neoplasm can be considered as to be a manifestation of a chronic irritative process caused by solar radiation and repeated microtrauma and, to a lesser degree, by other aetiological factors which are studied successively. The clinical course of the disease consists of two phases: a conjunctival phase and a corneal or true pterygial phase. The anatomical and clinical forms studied in a population of 2,350 subjects in an endemic region of pterygium (Central Sahara) appear to be closely related to the severity and the duration of exposure to predisposing factors. Prevention therefore constitutes the best treatment when it can be applied in highly endemic zones. The various preoperative and postoperative medical and physical treatment modalities (radiotherapy--beta therapy--cryotherapy--laser photocoagulation--antimitotic drugs--corticosteroids) are analysed together with the three main groups of surgical techniques: deviation--excision--lamellar keratoplasties. Medical and physical treatment modalities appear to be minimally effective in the primary treatment, but are valuable and essential adjuvants to surgical treatment. Surgery is the only treatment modality indicated in the corneal phase of the disease. Recurrence remains the major risk of this surgery which means that the surgical indications must be very carefully defined. Only a small number of techniques can be considered to be valid. Lamellar keratoplasties and their variants are indicated in the great majority of cases and have demonstrated their efficacy in the prevention of postoperative recurrences.

[Comparative study of fungicidal activity in vitro of various quaternary ammonium compounds used in ophthalmology]. / Etude comparée de l'activité antifongique in vitro de quelques ammoniums quaternaires utilisés en ophtalmologie.

A study was conducted to evaluate the antifungal activity in vitro of 5 quaternary ammonium compounds. N cetylpyridinium was found to be particularly active against Candida albicans and Aspergillus fumigatus. The association of N cetylpyridinium and of neosynephrine, found in various eye drop compositions, resulted in potentation of the antifungal activity of this quaternary ammonium.

[The Haik fornix conjunctival flap (author's transl)]. / Le récouvrement conjonctival de Haik.

The Haik fornix conjonctival flap has been described before the second world war, in order to protect cornea with conjonctiva without cutting the latter as in the classic conjonctival flap. This operation requires only a limited number of instruments and no special ophtalmologic training for the operator. The main indications are: -- keratitis caused by lagophtalmia; -- neurophtalmic keratitis; -- ulcerous keratitis and specially the meta-herpetic ones; -- necessity of a protection before a sanitary evacuation in penetrating wounds of the ocular globe.

[Trachomatous tarsitis: its consequences and their surgical treatment (author's transl)]. / La tarsite trachomateuse: ses conséquences et leur traitement chirurgical.

Trachomatous tarsitis is characterized by personal criteria the development of a fibrous and retractile scar tissue inducing cirrhosis with static and hemodynamic changes of the eye lid: lesions of the ciliary stratum, entropion and trichiasis which in their turn give a range of conjunctivocorneal complications, the ultimate stage being xerosis and blindness. To avoid this kind of evolution some easy surgical technics are available. The option between them is mainly oriented by personal criteria and the following pattern may be proposed: -- For upper lid, in regard to degree of tarsis hypertrophy, either Trabut's tarsotomy, or Streatfield-Snellen's tarsectomy, or a joint intervention of Cuenod and Nataf, might be selected. -- For lower lid and in children, the Trabut's transconjunctival tarsotomy is recommended. -- In relapsing cases and when trichiasis prevails over entropion, Van Millingen's marginoplasty will give satisfactory results.