Bacterial keratitis in Christchurch, New Zealand, 1997-2001.

PURPOSE: To identify which organisms cause bacterial keratitis in a local community and to determine how patients with suspected bacterial keratitis should be initially treated. METHODS: The results of all corneal scrapes performed in the ophthalmology department of Christchurch Hospital between 1997 and 2001 were reviewed. All samples were collected at the 'bedside' by a technician from the microbiology department and were processed immediately. RESULTS: Eighty-seven corneal scrapes were performed on 78 patients. There was a positive Gram stain in 43.7% (38/87) of scrapes. There was a positive culture in 58.6% (51/87) of scrapes. The commonest Gram-positive organisms were coagulase negative Staphylococci (19.4%) and Corynebacterium spp. (16.1%). The commonest Gram-negative organisms were Moraxella spp. (19.4%) and Pseudomonas aeruginosa (3.2%). Every Gram-positive organism was sensitive to chloramphenicol and every Gram-negative organism was sensitive to ciprofloxacin. In contrast, 89% of Gram-negative organisms were sensitive to chloramphenicol and 88% of Gram-positive organisms were sensitive to ciprofloxacin. CONCLUSION: The results are very different to those reported by other centres. Most notably, a much higher incidence of infection by Corynebacterium spp. and Moraxella spp. and a lower incidence of Pseudomonas aeruginosa was found. In this centre it appears appropriate to initially treat patients with Gram-positive organisms with chloramphenicol and patients with Gram-negative organisms with ciprofloxacin. Patients with a negative Gram stain should be treated with alternating chloramphenicol and ciprofloxacin while awaiting culture results.

Black eye drop bottle tips improve compliance.

AIM: To determine if dark coloured tips on eye drop bottles facilitate ocular therapy. METHODS: Eye drop bottles were modified by placing sterile black tape around the bottle tip. Patients on regular timolol therapy were asked to use bottles with the modified tip for one month. They then completed a questionnaire comparing the black tips with the standard tips on the bottle they normally use. RESULTS: Eighty-eight per cent of patients found the black tipped bottles easier to use than bottles with the standard tip. Sixty-eight per cent of patients had fewer occasions on which they needed to instil a second drop and 30% of patients touched their eyelid less when using the modified bottle tips. CONCLUSION: Black coloured bottle tips aid ocular therapy. They are easier to use, result in less contact with the eye on instillation and patients note a reduction in need for a second or additional drop. This is likely to improve compliance and reduce contamination. A change in manufacturing practise should be encouraged.