Leprosy Mailing List – March 20th, 2007
Ref.: Corneal sensory
testing
From: Ahmad L., Karachi, Pakistan
Dear Dr
Salvatore,
Thank you very much for your
last messages; I am particularly referring to David Scollard's mail
along with the important comments of Dr Daniel Ebenezer (LML March 17th,
2007).
Ophthalmology is in no
doubt a highly skilled and technologically advanced field. BUT if an ophthalmic
evaluation of a patient in rural areas is done by a field team of
an under-developed or developing country, they have to rely on simple
and handy tools. When I
was doing a course on "eyes in leprosy" conducted by Dr
Joffrion back in early 80s in ALERT Addis Ababa, he used wooden tongue
spatula instead of lid clamps to operate for correction of entropion
and tarsorrhaphy in field clinic.
Cochet and Bonnet
aesthesiometer is of course a very sophisticated tool which can
differentiate mild to severe hypoesthesia and total anaesthesia but
even this tool in the hand of an enthusiastic health worker can be
damaging to the cornea. I
would disagree with him on use of cotton wool in eyes because even in
modern ophthalmic surgery wet cotton wool squeezed to make an
almond shaped cone is used to wipe cornea and exposed sclera (it is
better than using a gauze piece which is more damaging). If pointed end of this cone is
touched gently with cornea while patient is gazing on a far and
fixed object is unlikely to produce corneal ulcer, besides, if cotton
is sterilized chances of transferring spores and other live micro
organisms are minimal.
A delayed blinking reflex
compared with examiner himself can also give information about
patients at risk and this simple test can rule out impaired corneal
sensation in field clinics.
I would like to know further
comments on this.
With best regards,
Dr Latif Ahmad
