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SYNOPSIS FOR PG DISSERTATION FOR MD/MS,
UNDER RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU.
NAME OF THE
Dr. GAURAV CHOWDHURY
CANDIDATE
DEPARTMENT OF OPHTHALMOLOGY,
AND
RAJARAJESWARI MEDICAL COLLEGE,
ADDRESS
BANGALORE – 560074
(IN BLOCK LETTERS)
NAME OF THE
RAJARAJESWARI MEDICAL COLLEGE AND
INSTITUTION
HOSPITAL
COURSE OF THE STUDY
M.S. (OPHTHALMOLOGY)
AND SUBJECT
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA BANGALORE
ANNEXURE -1
SYNOPSIS SUBMISSION
MS OPHTHALMOLOGY
RAJARAJESWARI MEDICAL COLLEGE AND
HOSPITAL
BANGALORE-560074
SYNOPSIS TOPIC
“A STUDY OF CORNEAL INJURIES IN A TERTIARY
CARE HOSPITAL”
BY: DR GAURAV CHOWDHURY
DEPARTMENT OF OPHTHALMOLOGY
RAJARAJESWARI MEDICAL COLLEGE AND
HOSPITAL
BANGALORE-560074
GUIDE NAME: DR M SHIVAKUMAR
PROFESSOR AND HOD
DEPARTMENT OF OPHTHALMOLOGY
RAJARAJESWARI COLLEGE AND HOSPITAL
BANGALORE-567004
2
3
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
ANNEXURE – II
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the candidate
and Address
(In Block Letters)
Dr. GAURAV CHOWDHURY
DEPARTMENT OF OPHTHALMOLOGY,
RAJARAJESWARI MEDICAL COLLEGE,
BANGALORE – 560074
2. Name of the Institute
RAJARAJESWARI MEDICAL COLLEGE AND
HOSPITAL
3. Course of Study and
M.S. DEGREE IN OPHTHALMOLOGY
Subject
4. Date of Admission to
Course
5. Title of Topic
17-05-2012
“A STUDY OF CORNEAL INJURIES IN A
TERTIARY CARE HOSPITAL ”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
The cornea, as the most anterior structure of the eye, is exposed to various
hazards ranging from airborne debris to blunt trauma of sufficient force to disrupt
the globe itself. As a result, corneal injury may assume multiple forms and
clinical presentations. Because the cornea is also the major refracting surface of
the eye, even minor changes in its contour result in significant visual problems.(1)
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6.1 NEED FOR THE STUDY
Blindness is a major public health problem in most developing countries.
Corneal opacification, as a cause of blindness, is second only to cataract in
magnitude
(2)
. One of the most important preventable and avoidable cause of
corneal blindness is corneal injuries. By understanding the different types of
injuries to which the cornea is exposed, the practitioner may more capably
manage these injuries and minimise the structural and visual sequelae of corneal
injury.
6.2 REVIEW OF LITERATURE
M.P. UPADHYAY, P.C. KARMACHARYA , S.KOIRALA and et al studied a
defined population of 34 902 individuals was closely followed prospectively for 2
years by 81 primary eye care workers who referred all cases of ocular trauma
and/or infection to one of the three local secondary eye study centres in Bhaktapur
for examination, treatment, and follow up by an ophthalmologist. Over the 2 year
period there were 1248 cases of ocular trauma reported in the population of 34
902 (1788/100 000 annual incidence) and 551 cases of corneal abrasion (789/100
000 annual incidence). The number of clinically documented corneal ulcers was
558 (799/100 000 annual incidence). Conclusions—Ocular trauma and corneal
ulceration are serious public health problems that are occurring in epidemic
proportions.(3)
R.DANDONA and L.DANDONA studied A total of 11 786 people of all ages
from 94 clusters representative of the population of the Indian state of Andhra
Pradesh were sampled using a stratified, random, cluster, systematic sampling
strategy. These participants underwent a detailed interview and eye examination
including measurement of visual acuity with logMAR charts, refraction, slit lamp
biomicroscopy, applanation tonometry, gonioscopy, and stereoscopic dilated
fundus evaluation. Of those sampled, 10 293 (87.3%) people participated in the
study. Corneal blindness in at least one eye was present in 86 participants, an age,
sex, and urban-rural distribution adjusted prevalence of 0.66% (95% confidence
interval 0.49 to 0.86), which included 0.10% prevalence of corneal blindness in
both eyes and 0.56% in one eye. The most frequent causes of corneal blindness in
at least one eye included keratitis during childhood (36.7%), trauma (28.6%), and
keratitis during adulthood (17.7%). Nearly 95% of all corneal blindness was
avoidable. Conclusions: There is a significant burden of corneal blindness in this
population, the majority of which is avoidable.(4)
S.K.KHATRY, A.E.LEWIS, O.D.SCHEIN and et al studied reports of ocular
trauma collected from 1995 through 2000 from patients presenting to the
only eye care clinic in Sarlahi district, Nepal. Patients were given a standard free
eye examination and interviewed about the context of their injury. Follow up
examination was performed 2–4 months after the initial injury. 525 cases of
incident ocular injury were reported, with a mean age of 28 years. Using census
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data, the incidence was 0.65 per 1000 males per year, and 0.38 per 1000 females
per year. The most common types of injury were lacerating and blunt, with the
majority occurring at home or in the fields. Conclusions: The detrimental effects
of delayed care or care outside of the specialty eye clinic may reflect geographic
or economic barriers to care. For optimal visual outcomes, patients who are
injured in a rural setting should recognise the injury and seek early care at a
specialty eye care facility.(5)
RAJESH SINHA, NAMRATA SINHA and RASIK B. VAJPAYEE studied that
in India, there are approximately 6.8 million people who have corneal blindness
with vision less than 6/60 in at least one eye, and of these, about 1 million have
bilateral corneal blindness.(6) If the present trend continues, it is expected that the
number of corneally blind individuals in India will increase to 8.4 million in 2010
and 10.6 million by 2020.(7) Ocular trauma and corneal ulceration are also
significant causes of corneal blindness and may be responsible for 1.5 to 2.0 million
new cases of uniocular blindness every year.(8) Ocular trauma has been reported to
be the most important cause of the unilateral loss of vision in developing
countries, and up to 5% of all bilateral blindness has been attributed to direct
ocular trauma.15 Corneal and corneoscleral perforation and subsequent scarring
due to ocular trauma may result in a variable amount of blindness.(9)
GULLAPALLI N.RAO studied that Ocular trauma is responsible for 1% to 10%
of corneal blindness. The geographic location, pattern of injury, causative agent,
and age are some of the factors that determine the degree of damage (Table 1).
TABLE 1. Pathways to Corneal Blindness from Trauma(10)
Corneal foreign body
Secondary infection Corneal ulcer and
opacity
Chemical injuries
Keratitis
Corneal
opacification
Blunt injury
Laceration
Corneal
opacification
Penetrating injury (including
intraocular foreign body)
Wound & secondary Corneal
infection
opacification
In urban areas and in the industrialized world, chemical injuries, accidents at the
workplace, and automobile injuries are common. In rural areas of developing
countries, minor trauma due to hazardous practices in agriculture, cottage
industries, and other work places, as well as sports accidents, are responsible for a
large proportion of corneal blindness.(11)
Corneal abrasions (removal of part of the corneal epithelium) are one of the most
common ophthalmic injuries. In one English series, corneal abrasions were the
cause of 10% of new patient visits to the ophthalmic emergency room.(12) the
common causative agents include fingernails, paper, mascara brushes, and plants.
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Important non contact sources of epithelial injury include chemicals, radiations
and heat. Second to corneal abrasions , corneal foreign bodies are the most
common forms of ophthalmic trauma. In a recent study in northern Sweden the
incidence of eye injuries was estimated to be 8.1 per 1000 population with corneal
and conjunctival foreign bodies comprising 40% of these.(13)
Traditionally , acid injuries of the eye are , for the most part, thought to be
somewhat less destructive than exposure to alkaline compounds. Depending upon
the concentration, strength, and duration of contact acids cause a wide spectrum
of injury from mild keratoconjunctivitis to devastating bilateral blindness.(14)
The entire anterior segment of the eye is seriously jeopardized by exposure to
alkali. Non perforating ocular injuries of this type results in destruction of cellular
components, denaturation and degradation of collagenous tissues and release of
inflammatory mediators by alkaline hydrolysis of a broad range of intracellular
and extracellular proteins as well as invading cells.(15)
6.3 OBJECTIVES OF THE STUDY
To study the various patterns of corneal injuries and its outcome among
patients of ocular trauma attending our tertiary care hospital.
7. MATERIAL AND METHODS
7.1 SOURCE OF DATA
All patients who fulfill the inclusion/exclusion criteria will be selected from
both the inpatient and outpatient department of ophthalmology of Rajarajeswari
Medical College and Hospital.
7.2 METHODS OF COLLECTION OF DATA – (Including sampling
procedure if any)

The data for this study will be collected from the subjects fulfilling the
inclusion/exclusion criteria admitted in RRMCH.

Sample size- all patients with corneal injury attending the ophthalmology
OPD of RRMCH from 1.11.2012 to 31.10.2013 will be taken for the
study.

Study duration-data will be collected for 1 year and their follow up will be
done for a minimum period of 4 months.

Study design-prospective study.
Methodology:
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All patients of ocular trauma above 14 years of either sex will be subjected to slit
lamp examination to ensure corneal involvement.
Once the cornea is involved the aetiology of the injury would be noted. Then the
pattern of the corneal injury would be studied under the slit lamp examination.
Informed consent will be obtained after informing the study subjects the details of
the procedure. After initial examination the cornea would be stained with 2%
fluoroscein strip paper and examined under the slit lamp with blue light to note
the type of corneal injury in the form of abrasions of epithelium, stroma and
others.
After establishing a diagnosis the patient would be subjected to keratometry, A
scan, B scan ultrasound or anterior segment Optical Coherence Tomography if
required.
After noting all the details the patient would be given treatment as needed for the
specific type of corneal injury.
The patient will then be followed up on day 1, day 3, after 15 days, after 2 months
and after 4 months. They would be examined under the slit lamp and staining
would be done if required. The improvement or the opacification if developed
will be noted.
Inclusion criteria.

Patients of ocular trauma aged above 14 years of either sex with corneoscleral involvement.
Exclusion criteria

Patients aged below 14 years.

Ocular trauma where cornea is uninvolved
Statistical Analysis:
The data collected will be analyzed statistically using descriptive statistics like
frequency and percentage. The results will be depicted in the form of percentages
and graphs. Test of significance will be done with ‘chi-square’ test.
7.3 Does the study require any investigation or intervention to be conducted
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on patients or other humans or animals? If so please describe briefly?
Yes.

Routine eye examination with slit lamp biomicroscopy

2% fluoroscien staining of cornea

FBS

PPBS

HIV

HBsAg

Urine routine

Keratometry

A-scan

B-scan ultrasound

Anterior segment Optical Coherence Tomography
7.4 Has ethical clearances been obtained from your institution in case of 7.3
Yes. Ethical clearance has been obtained from Institutional Ethical
Committee of Rajarajeswari Medical College, Bangalore
8. LIST OF REFERENCES
1) KRACHMER, MANNIS AND HOLLAND: BOOK OF CORNEA; SECOND
EDITION 2005:VOLUME 1;SECTION 8-CORNEAL TRAUMA; CHAPTER
100: MECHANICAL INJURY: pg 1245.
2) THYLEFORS B, NEGREL AD, PARARAJASEGARAM R, DADZIE KY:
GLOBAL DATA ON BLINDNESS 1995 BULL WHO 72:115.
3) M P UPADHYAY, P C KARMACHARYA, S KOIRALA, D N SHAH, S
SHAKYA, J K SHRESTHA, H BAJRACHARYA, C K GURUNG, J P
WHITCHER: THE BHAKTAPUR EYE STUDY: OCULAR TRAUMA AND
ANTIBIOTIC PROPHYLAXIS FOR THE PREVENTION OF
CORNEAL ULCERATION IN NEPAL, BRITISH JOURNAL OF
OPHTHALMOLOGY 2001; 85:388-392.
4) R DANDONA, L DANDONA: CORNEAL BLINDNESS IN A SOUTHERN
INDIAN POPULATION: NEED FOR HEALTH PROMOTION STRATEGIES,
BRITISH JOURNAL OF OPHTHALMOLOGY 2003; 87:133-141.
5) S K KHATRY, A E LEWIS, O D SCHEIN, M D THAPA, E K PRADHAN, J
KATZ: THE EPIDEMIOLOGY OF OCULAR TRAUMA IN RURAL NEPAL,
BRITISH JOURNAL OF OPHTHALMOLOGY 2004; 88: 456-460.
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RAJESH SINHA, NAMRATA SINHA, RASIK B. VAJPAYEE: CORNEAL
BLINDNESS PRESENT STATUS, TACKLING WORLD BLINDNESS
OCTOBER 2005:
6) GLOBAL INITIATIVE FOR THE ELIMINATION OF AVOIDABLE
BLINDNESS. GENEVA, WORLD HEALTH ORGANIZATION, 1997
(UNPUBLISHED DOCUMENT WHO/PBL/97.61/REV 1).
7) LIM AS. MASS BLINDNESS HAS SHIFTED FROM INFECTION
(ONCHOCERCIASIS, TRACHOMA, CORNEAL ULCERS) TO CATARACT.
OPHTHALMOLOGICA. 1997; 211 : 270.
8) GUPTA V, DADA T, PANGTEY M, VAJPAYEE RB. INDICATIONS FOR
LAMELLAR KERATOPLASTY IN INDIA. CORNEA. 2001;20:4:398-399.
9) RAJESH SINHA, NAMRATA SINHA, RASIK B. VAJPAYEE: CORNEAL
BLINDNESS PRESENT STATUS, TACKLING WORLD BLINDNESS
OCTOBER 2005 pg 61.
10) ADAPTED FROM WORLD HEALTH ORGANIZATION: REPORT OF
THE INTERNATIONAL MEETING ON CONTROL OF CORNEAL
BLINDNESS WITHIN PRIMARY HEALTH CARE SYSTEMS. GENEVA,
WHO, 1988, pp 1-22.
11) GULLAPALLI N. RAO : CORNEAL OPACIFICATION IN THE
DEVELOPING WORLD CHAPTER 61.
12) CHIAPELLA AP, ROSENTHAL AR: ONE YEAR IN EYE CASUALTY,
BRITISH JOURNAL OF OPHTHALMOLOGY 1985; 69:865-870.
13) KRACHMER, MANNIS AND HOLLAND: BOOK OF CORNEA;
SECOND EDITION 2005:VOLUME 1;SECTION 8-CORNEAL TRAUMA;
CHAPTER 100: MECHANICAL INJURY: pg 1256
14) KRACHMER, MANNIS AND HOLLAND: BOOK OF CORNEA;
SECOND EDITION 2005: VOLUME 1; SECTION 8-CORNEAL TRAUMA;
CHAPTER 102: ACID INJURIES OF THE EYE: pg 1277.
15) KRACHMER, MANNIS AND HOLLAND: BOOK OF CORNEA;
SECOND EDITION 2005: VOLUME 1;SECTION 8-CORNEAL TRAUMA;
CHAPTER 103 : ALKALI INJURIES OF THE EYE : pg 1285.
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9.
SIGNATURE OF
THE CANDIDATE
10. REMARKS
OF Corneal injuries are very common in both the adult and
THE GUIDE
pediatric population and account for a significant
proportion of the workload of most emergency
departments. The blink reflex normally protects the
cornea from most injuries. Eye injuries can range from
relatively trivial to extremely serious, resulting in
permanent loss of vision. Corneal injuries can cause
significant morbidity with respect to vision, but accurate
diagnosis appropriate intervention at the right time can
improve the prognosis. Proper management are vital to
prevent potentially sight-threatening sequelae.
11. NAME &
DESIGNATION (IN
BLOCK LETTERS)
11.1 GUIDE
Dr. M.SHIVAKUMAR
M.S, D.O.M.S,
PROFESSOR AND HOD,
DEPARTMENT OF OPHTHALMOLOGY,
RAJARAJESWARI MEDICAL COLLEGE,
BANGALORE.
11.2 SIGNATURE
11.3 CO-GUIDE (IF
ANY)
11.4 SIGNATURE
-
11
11.5 HEAD OF THE Dr. M.SHIVAKUMAR,
DEPARTMENT
M.S, D.O.M.S,
PROFESSOR AND HOD,
DEPARTMENT OF OPHTHALMOLOGY,
RAJARAJESWARI MEDICAL COLLEGE,
BANGALORE.
11.6 SIGNATURE
12. 12.1 REMARKS OF
THE CHAIRMAN
& PRINCIPAL
12.2 SIGNATURE
12
PROFORMA
1.
2.
3.
4.
5.
6.
7.
NAME OF THE PATIENT:AGE:SEX:ADDRESS:CONTACT NUMBER:OP NUMBER:IP NUMBER:-
Parameters:1. H/O INJURY SUSTAINED
2. TYPE OF INJURY SUSTAINED
3. SLIT LAMP EXAMINATION FINDINGS
4. 2% FLUROSCIN STAINING FINDINGS
5. OTHER INVESTIGATION FINDINGS IF DONE LIKE
 KERATOMETRY
 A-SCAN
 B-SCAN USG
 ANTERIOR SEGMENT OCT
6. TYPE OF TREATMENT GIVEN IN DETAILS
FOLLOW UP OF PATIENTS
FOLLOW UP
PERIOD
FINDINGS
IMPROVEMENT FURTHER
TREATMENT IF
REQUIRED
DAY 1
DAY 3
DAY 15
AFTER 2
MONTHS
AFTER 4
MONTHS
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Consent form
STUDY: “A STUDY OF CORNEAL INJURIES
IN A TERTIARY CARE HOSPITAL”.
I have been explained in a language best known to me about my participation in the
following study “A STUDY OF CORNEAL INJURIES IN A TERTIARY CARE
HOSPITAL”. I have also been explained the procedure “A STUDY OF CORNEAL
INJURIES IN A TERTIARY CARE HOSPITAL” and the related risks and possible
complications that may be involved.
I have read the information above and have understood wholly and give my voluntary
consent for the same.
Interviewers name and signature
signature
Date:
Patients name and
Date:
14
BANGALORE
16-10-2012
FROM
THE PROFESSOR,
DEPARTMENT OF OPHTHALMOLOGY
RAJARAJESWARI MEDICAL COLLEGE,
BANGALORE, KARNATAKA
TO
THE PRINCIPAL,
RAJARAJESWARI MEDICAL COLLEGE,
BANGALORE, KARNATAKA
Through proper channel
Sir,
As per the regulations of the RGUHS for the Dissertation topic, the following
post graduate student in M.S DEGREE IN OPHTHALMOLOGY has been allotted
the Dissertation topic as follows by the official registration committee of all qualified
and eligible guides of the Department of Ophthalmology.
NAME
TOPIC
GUIDE
Dr. GAURAV
“ A STUDY OF CORNEAL Dr. M.SHIVAKUMAR,
CHOWDHURY,
INJURIES IN A TERTIARY M.S, D.O.M.S,
P.G. IN DEPARTMENT
CARE HOSPITAL ”
PROFESSOR AND HOD,
OF
DEPARTMENT OF
OPHTHALMOLOGY,
OPHTHALMOLOGY
RAJARAJESWARI
RAJARAJESWARI MEDICAL
MEDICAL COLLEGE,
COLLEGE, BANGALORE
BANGALORE – 560074
Therefore I request you to kindly communicate the acceptance of the dissertation
topic allotted to the P.G student at an early date.
Thanking you
Yours faithfully
(Dr. M.SHIVAKUMAR)
15
BANGALORE
16-10-2012
FROM
THE PROFESSOR,
DEPARTMENT OF OPHTHALMOLOGY
RAJARAJESWARI MEDICAL COLLEGE, BANGALORE
TO
THE REGISTRAR,
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
Sir,
Through proper channel
As per the regulations of the RGUHS for the Dissertation topic, the following post
graduate student in M.S DEGREE IN OPHTHALMOLOGY has been allotted the
Dissertation topic as follows by the official registration committee of all qualified and
eligible guides of the Department of Ophthalmology
NAME
TOPIC
GUIDE
Dr. GAURAV
“ A STUDY OF
Dr. M.SHIVAKUMAR,
CHOWDHURY,
CORNEAL INJURIES M.S, D.O.M.S,
P.G. IN DEPARTMENT
IN A TERTIARY
PROFESSOR AND HOD,
OF OPHTHALMOLOGY
CARE HOSPITAL”
DEPARTMENT OF
RAJARAJESWARI
OPHTHALMOLOGY
MEDICAL COLLEGE,
RAJARAJESWARI
BANGALORE
MEDICAL COLLEGE,
BANGALORE
Therefore I request you to kindly communicate the acceptance of the dissertation
topic allotted to the P.G student at an early date.
Thanking you
Yours faithfully
(Dr. M.SHIVAKUMAR)
16
BANGALORE
16-10-2012
FROM
Dr. GAURAV CHOWDHURY,
P.G. IN DEPARTMENT OF OPHTHALMOLOGY
RAJARAJESWARI MEDICAL COLLEGE, BANGALORE
TO
THE PRINCIPAL,
RAJARAJESWARI MEDICAL COLLEGE,
BANGALORE
THROUGH PROPER CHANNEL
Respected sir,
Sub: ACCEPTANCE, REGISTRATION AND FORWARDING OF
DISSERTATION TOPIC
In accordance with the above cited topic, I the undersigned studying in P.G course in
M.S degree in Ophthalmology have been allotted the Dissertation topic “A STUDY
OF CORNEAL INJURIES IN A TERTIARY CARE HOSPITAL” under the guidance
of Dr. M.SHIVAKUMAR, M.S, D.O.M.S, Professor and HOD, Department Of
Ophthalmology, Rajarajeswari Medical College, Bangalore. I request you to kindly
forward the dissertation topic in the prescribed form to the University for Approval.
Thanking you,
Yours faithfully
(Dr. GAURAV CHOWDHURY)
GUIDE:
Dr. M.SHIVAKUMAR,
M.S, D.O.M.S,
PROFESSOR AND HOD,
DEPARTMENT OF OPHTHALMOLOGY,
RAJARAJESWARI MEDICAL COLLEGE, BANGALORE.
17