Page 51 - NAME OF CONDITION: REFRACTIVE ERRORS

 Reduction in congestion of bulbar conjunctiva
 Visual improvement
Topical therapy is tapered according to the clinical response, taking into account the
baseline clinical picture and the virulence of the pathogen.

Standard Operating Procedure

a. In Patient
 Severe keratitis (ulcer more than 5mm and deep)

 No response to initial management
 Doubtful compliance
b. Out Patient

 Small ulcers
 Patients who can come for frequent follow up and those who understand the
importance of compliance

c. Day Care

 Not applicable

d) Referral criteria:
Immediate referral on presentation if there is

 Immediate threat to vision
 Ulcer involved in the only seeing eye
 Pediatric patients needing anesthesia
 Impending or actual perforation

Referral following initial treatment if,

Non healing or progressive ulcer inspite of adequate and appropriate anti microbial
therapy, apart from all the points mentioned above.

*Situation 2: At Super Specialty Facility in Metro location where higher-
end technology is available

a) Clinical Diagnosis:

Apart from the regular history taking, care should be exercised to fully understand the
treatment history of the patient, including all the medications along with the dosage

schedules which were prescribed at the secondary centre. This will avoid unnecessary
wastage of medicines and help in formulating an ideal treatment strategy. A fresh
comprehensive clinical examination, as detailed in the previous section should be
performed without being biased by the referral report.

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