Toothbrush-tooth paste, widely used in every house hold, may cause irreversible injury to the eye especially cornea that comes into contact with this substance. We present two cases of toothbrush-toothpaste injury who accidentally injured their own eye. These were combination of chemical (Toothpaste) and trivial mechanical (Toothbrush) trauma. Ocular contact with toothpaste causes severe unbearable burning sensation. One of the cases developed suppurative corneal ulcer with hypopyon and lost vision in the affected eye. Toothpastes with more ph can cause blindness when it comes into contact with the eye if not treated urgently. The other patient (One of the consultants in our institute) reported immediately in the morning in emergency with complaints of severe burning sensation in the involved eye after accidental injury with toothbrush-toothpaste. His eyes were washed with normal saline for 30 to 40 minutes. Because he was treated immediately, he recovered within one week. Clinicians should take adequate precautions to prevent serious complication. In case of an accidental contact of eye with toothpaste, it is important to wash the eye efficiently. We decided to estimate the ph of commonly used various brands of toothpaste in over biochemistry lab and it was found that ph of various toothpaste varies from 7 to 10. The pH of the brand of the toothpaste which was used by one of the case was (pH 9.6), which shows that it is a combination of mechanical and alkali injury. pH near to neutral (7.1 and 7.4) was detected in one of the herbal toothpaste and one the oldest brand of toothpaste (Which was not herbal). These cases are being reported to make aware the ophthalmologists and public that although rare but these cases should not be taken lightly and should be treated urgently to prevent the loss of vision in the involved eye. One of the risk factors, may be the hurried activities in the morning in this era of fast life as one of the patients was working in a metropolitan city and the other a pathologist in our institution. KEYWORDS: toothbrush, tooth paste, hypopyon, ph, cornel ulcer. CASE 1: A 43 year old male (motor mechanic working in a service centre in Delhi) presented with history of injury with tooth brush-toothpaste in right eye five days back. Immediately he had severe burning sensation in the involved eye. He washed it with the tap water but did not get any relief. He gave history of OPD treatment in Delhi. But his symptoms did not improve. He came back to his native village in Himachal Pradesh and reported in our institution about a week after the onset injury. On day of presentation his BCVA in the right was HMCF and in the left eye was 20/20. There was no past history of diminution of vision in either eye. There was suppurative corneal ulcer in his right eye of size 9x10mm with hypopyon of height 2mm which was thin and mobile ( Figure-1). Other sections of the eye could not be examined clinically because of the lack of corneal translucency. Direct microscopy and culture examination of the cor...

Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents. Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture. Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively. Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.