De la conjonctivite à l'ulcère de Mooren : errance diagnostique ou insuffisance des spécialistes

Nous rapportons une observation d'un homme âgé de 25 ans, mélanoderme sans antécédent médico-chirurgical connu, qui a consulté pour douleur oculaire,larmoiement, baisse de l'acuité visuelle, photophobie évoluant depuis environ huit mois, l'examen ophtalmologique note une hyperhémie conjonctivale, une ulcération cornéenne marginale compliquée de perforation cornéenne avec hernie de l'iris rongeant la moitié de la cornée, une excavation papillaire asymétrique.Le diagnostic d'ulcère de Mooren bilatéral est fortement suspecté, puis retenu sur la base d'argument épidémiologique ; clinique ophtalmologique (kératite ulcéreuse chronique inflammatoire qui affecte initialement la périphérie de la cornée, avec progression circonférentielle et centrale, puis perforation) ; paraclinique (la négativité de tous les examens complémentaires : les facteurs rhumatoïdes, les sérologies de l'hépatite B, C, VIH et de la syphilis, l'examen parasitologique des selles, la protéinurie de 24 h …) mais aussi après avoir exclu un certain nombre de diagnostics,notamment les maladies systémiques, les maladies infectieuses, les atteintes traumatiques des yeux.La collaboration entre ophtalmologiste et interniste a abouti à la mise en route immédiate d'un traitement à base de corticothérapie locale, d'antibiothérapie et des topiques locaux. L'évolution a été favorable avec récupération progressive de l'acuité visuelle au niveau des deux yeux deux semaines après la mise en route du traitement

Oculoplastic training and its role in eye care services in a Nigeria tertiary hospital

Background: Oculoplasty subspecialty in Ophthalmology was barely 7 years in Nigeria. National statistics shows increased number of cases that should have benefitted from this expertise that is rare. As a result of this deficit, a consultant ophthalmologist was sent to Sankara Nethralaya Eye Hospital, Chennai, India for 3 months oculoplastic training with the help of International Council Ophthalmology (ICO). Aim: To evaluate the role of oculoplasty training in eye-service care in our hospital. Methods: All patients seen at our oculoplasty unit during the 8 months period from April to November 2017, had information extracted from their medical record. The data obtained was analysed using SPSS version 20. Results: Out of 53 patients seen 30 (56.65) were males and 23 (43.4%) were females. Majority 10 (18.9%) were diagnosed with traumatic irreparable ruptured globe, while 10 (18.9%) had congenital nasolacrimal duct obstruction. Thirty-six (67.9%) patients had surgery and 10 (18.9%) were successfully managed with lacrimal sac massage for congenital nasolacrimal duct obstruction in children. Majority 10(18.9%) of the surgery were evisceration with primary ocular implants. One patient with clinically significant orbital floor fracture was referred. Four cases of congenital ptosis declined surgery. This expertise resulted in increased patient turnout by 30% and income to the department, while it saves cost to patients who need not to be referred. Conclusion: The skills acquired from oculoplasty training have help in rendering oculoplasty services to the people of Kebbi State and its environs at a reduced cost. Also, there is improved internally generated revenue to the hospital. The importance of skill transfer and subspecialty training is underscored

Le glaucome primitif à angle ouvert: Evaluation du niveau de connaissance du medecin généraliste à Brazzaville sur cette maladie

Introduction: Le glaucome primitif à angle ouvert (GPAO) est la forme la plus courante du glaucome en Afrique. C'est une maladie grave, elle induit une cécité non curable. Son diagnostic précoce est un atout majeur pour prévenir cette cécité. En Afrique noire, le manque d'ophtalmologues confère aux médecins généralistes un rôle particulier, celui d'être généralement le premier contact du patient. Entre 2011 et 2013, notre service a reçu 215 patients souffrant du GPAO, et adréssés par leur médecin généraliste pour une baisse visuelle. Dans 100% des cas, une lunette de lecture pour presbytie leur a été prèscrite pendant une durée moyenne de 2 ans avant la consultation chez l'ophtalmologue. Dans 97,67% des cas (210 patients/215) le GPAO était au stade terminal des deux côtés. Cette étude a eu pour objectif d'évaluer les connaissances de ces médecins généralistes sur le GPAO.Méthodes : C'est une série de 100 médecins généralistes travaillant en privé à Brazzaville, qui ont répondu à un questionnaire sous forme de question à choix multiple (QCM). C'est une étude transversale analytique sur un mois (janvier 2014). Ces médecins étaient choisis au hasard en fonction de leur disponibilité à répondre aux QCM. Chaque médecin n'a été vu qu'une fois et a disposé de 30 min pour répondre à 4 questions, à savoir, la définition du GPAO, ses circonstances de découverte, la durée de son suivi et la nécessité ou non d'un dépistage familial en cas de GPAO. Chaque réponse était côté 1. La connaissance du glaucome était jugée insuffisante pour une note inferieure ou égale à 1/4, moyenne pour une note supérieure à 1/4 mais inferieure ou égale à 3/4, suffisante pour une note égale à 4/4. Résultats : Seuls 8% avaient pu définir le GPAO, 12% avaient une idée précise sur les circonstances de découverte de cette maladie, 10% savaient que le suivi se faisait à vie, et 16% avaient coché la bonne case concernant le dépistage familial en cas de GPAO. Six (6)% avaient une note égale à 4/4, dix-huit (18)% avaient une note entre 1/4 et 3/4, et 76% avaient une note inferieure à 1/4. Conclusion : Le GPAO est peu connu par le médecin généraliste à Brazzaville. D'où les handicaps visuels graves lors du diagnostic car celui-ci est souvent tardif. Les programmes de formation des étudiants en médecine devraient être adaptés

The state of peadiatric eye care in Nigeria: a situational review and call for action

The fight against childhood blindness is being given top priority by the World Health Organization especially in regions of the world; like Nigeria where the gross income per capita is relatively low with up to 60.9 of them living in absolute poverty as at 2010. Avoidable causes of blindness in children needs to be eliminated through the development of sustainable and equitably distributed high quality children eye care services as part of our national health care system. However enough attention has not been given to achieve this yet. The purpose of this editorial is to highlight the challenges in childhood eye care in this country as well as discuss ways the current negative trend can be reversed

Assessing the Knowledge and Skills in Clinical Ophthalmology of Medical Interns: Survey Results from Enugu; South-Eastern Nigeria

Purpose: To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu; Nigeria; to the recommendations of the International Council of Ophthalmology (ICO). Materials and Methods: A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital; from April 2010 to June 2010. Data on cohort demographics; undergraduate ophthalmology exposure; clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P 0.05. Results: The cohort comprised 81 males and 48 females (sex ratio . The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3); lens/cataract (95.3) and glaucoma (92.2); but not in vitreo-retinal disease (47.3); neuro-ophthalmology (45.7) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7) and visual field examination (93.0). There was lower competency at anterior chamber assessment (49.6) and slit-lamp examination (39.5). The majority could confidently diagnose conjunctivitis (96.1) and cataract (90.7); but not strabismus (42.6) or macular degeneration (20.2). Conclusions: Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure; clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum; provision of training resources and compliance with ICO guidelines could address the deficiencies

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2). The mean test score was 52.5(standard deviation [SD]: 22.2). The mean self-rating was 51.9(SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9of them would attend such courses. Also; 82of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2 was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2). The mean test score was 52.5 (standard deviation [SD]: 22.2). The mean self-rating was 51.9(SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9 of them would attend such courses. Also; 82 of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Primary Health Eye Care Knowledge among General Practitioners Working in the Cape Town Metropole

The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general.Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town.Results: A response rate of 79.2). The mean test score was 52.5 (standard deviation [SD]: 22.2). The mean self-rating was 51.9 (SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9 of them would attend such courses. Also; 82 of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Primary Health Eye Care: Evaluation of the Competence of Medical Students in Performing Fundoscopy with the Direct Ophthalmoscope

Background: To evaluate the skill of fifth-year medical students at the University of Cape Town in the performance of fundoscopy at the end of their ophthalmology rotation. Methods: The design was a prospective cohort study. The study was conducted at Groote Schuur Hospital in Cape Town. The ability of fifth-year medical students to perform fundoscopy on mannequin heads fitted with fundus photographs using direct ophthalmoscopes was evaluated. The outcome measures used were ability to see the fundus and ability to recognise fundus pathology. Results: The fundus photographs could be seen in 95of cases. The correct diagnosis could be made in only 57of cases. Conclusion: Medical students at the University of Cape Town need more than the current one week of practical ophthalmology training to improve their fundoscopy skills

Ophthalmology as a career choice of final year medical students in Nigeria

Background: There are 370 ophthalmologists and 200 diplomates in Ophthalmology inequitably distributed in Nigeria; giving a ratio of one ophthalmologist to 600;000 population. This is below the recommended ratio by World Health Organization. Despite obvious increase in medical graduates in the country; only a few select ophthalmology as a future career. Aim: To present the career preferences of final year medical students of the University of Port Harcourt Medical School; Rivers State with respect to Ophthalmology. Methodology: This is a cross-sectional descriptive study. After two weeks posting in Ophthalmology in 2006; a self-administered questionnaire; after informed consent to medical students in their final year; was used. Analysis was with SPSS version 11. Results: One hundred and fifty three students responded. There were 81 males and 72 females; a ratio of 1.1:1. Mean age was 25 + 2.2years. Ophthalmology ranked 6th as a career with less than 10[n=12(7.8)] choosing it for a career. Only 2(n=3)of the students declared it their best posting. More women were interested [n=7(58.3)].Twenty five percent of those who chose ophthalmology as a career wanted to qualify for the 2 available postgraduate colleges in Nigeria. None wanted to practice in the rural or general hospital setup. Conclusion: Less than 10of medical students are willing to consider ophthalmology as a career option. They need to be attracted to consider Ophthalmology as a viable career. Responses indicate that medical doctors do not want to offer service to the rural Nigerian

Job satisfaction amongst Nigerian ophthalmologists: an exploratory study

Aim: This study aimed to assess job satisfaction amongst Nigerian Ophthalmologists. Methods: The study was conducted during the annual congress of the Ophthalmological Society of Nigeria in September 2008. One hundred and ten ophthalmologists were selected by simple random sampling and asked to complete a structured questionnaire. Results: The response rate was 73. The resulting sample comprised of 48 consultants (60); four diplomates (5); and 28 residents (35). Most respondents 62 (78.5) were satisfied with their job as ophthalmologists and 17 (21.5) were not satisfied. Only 12 (15.4) were satisfied with their remuneration and 42 (53.2) were satisfied with their skill. Most respondents (75.6) expressed readiness to pursue a career in ophthalmology if they were to make a choice again. Conclusion: Most respondents were satisfied with their job but only minorities were satisfied with their remuneration. Therefore; there is a need to address the issue of enhancement of remuneration for ophthalmologists in Nigeria

Profile of Amblyopia at the Pediatric Ophthalmology Clinic of Menilik II Hospital; Addis Ababa

Background- Amblyopia is one of the common causes of childhood and adult visual impairment. Its prevalence is usually underestimated; often because of lack of awareness. Objective: To assess the magnitude and clinical profile of amblyopia among children presenting at the pediatric ophthalmology clinic of Menillik II Hospital in Addis Ababa. Methods: The study was hospital-based and cross-sectional by design; and data were collected during the period of January to June 2007. Visual acuity; refractive status and fixation patterns were assessed and included in the examinations of clinical profiles of children with amblyopia presenting to a Pediatric Ophthalmology clinic in Menilik II Hospital. Results: Out of a total of 2;020 children examined during the study period; 183 (9.1) were amblyopic. Among these 91 (49.7) were males and 92 (50.3) were females. The mean age at presentation was 6.9+3.0 years. Strabismic amblyopia was the most common subtype seen in 39.3(n=72) of children. Fifty (27.3) children had combined amblyopia. One hundred thirteen (61.7) of the amblyopic children had hypermetropic refractive error and 22 (12.0) had myopia. Conclusion: Lack of community or preschool vision screening was the main cause to pick up amblyopic children for timely management of late presentations and significant visual impairment associated with the condition

The Undergraduate Training in Ophthalmology: The University of Nigeria Nsukka Medical Students

Objective: The study was embarked upon to determine the view of University of Nigeria final year medical students on the adequacy of their undergraduate training in ophthal- mology; vis-a-vis rendering basic eye care as general duty doctors. Methods: One hundred final year medical students; who had finished their ophthalmology clinical postings; completed a self-administered; structured and semi structured questionnaires in August 2004. Data analysis was done manually using an electronic calculator. Result: Majority of the students (60) were of the view that the training was inadequate. This was largely attributed to the low level of clinical exposure and community experience in the programme. Conclusion: The undergraduate training in ophthalmology undergone by these final year medical students may not have equipped them with adequate knowledge and skills to render basic eye care as general duty doctors. There is a need to improve the relevance and quality of the training.) were of the view that the training was inadequate. This was largely attributed to the low level of clinical exposure and community experience in the programme. Conclusion: The undergraduate training in ophthalmology undergone by these final year medical students may not have equipped them with adequate knowledge and skills to render basic eye care as general duty doctors. There is a need to improve the relevance and quality of the training

Paediatric ophthalmology - What every GP should know

At birth one does not know for sure that a baby's eyes are normal and fully functional. The general practitioner's role is to identify the risk of inherited disease and to perform the relatively simple screening examinations for conditions that require referral for specialist attention. These depend on the child's age and serve to identify different conditions at different ages. Acquired conditions are most commonly allergic or infective in origin. The present review will highlight some of these conditions

Glaucome primitif a angle ouvert chez le diabetique noir africain: a propos de 207 patients etudies a Abidjan Service d'ophtalmologie - CHU de Treichville

Notre etude transversale; de type exploratoire et descriptive; avait pour objectif d'etudier les caracteristiques epidemio-cliniques du glaucome primitif a angle ouvert chez le diabetique ivoirien. Elle a porte sur une periode de douze (12) mois allant de Decembre 2004 a Decembre 2005 inclus 207 patients. Il ressort de cette enquete que : -Le glaucome a ete plus frequent sur le terrain diabetique avec une prevalence hospitaliere de 18;8pour cent contre 2pour cent dans la population generale comparativement a la litterature. -Les femmes diabetiques ont ete les plus atteintes par le glaucome que les hommes diabetiques; soit respectivement 52;4pour cent contre 47;6pour cent. -La tranche d'age la plus touchee a ete celle comprise entre 51 et 60 ans. -Le glaucome a pression normale s'est avere etre la forme clinique du glaucome primitif a angle ouvert la plus frequente avec 60;7pour cent des cas observes. Cette etude a donc permis de nous rendre compte que l'association glaucome diabete est une realite en Cote d'Ivoire

Interet du champ visuel dans le diagnostic du glaucome primitif a angle ouvert a l'IOTA : a propos de 60 cas

Cette etude transversale a passage unique qui a eu lieu a l'IOTA de juillet 2004 a Avril 2005 a permis d'atteindre tous nos objectifs assignes. A partir d'un examen complemen- taire comme le champ visuel nous avons pu confirmer le diagnostic de GPAO avec une prevalence de 27;3. Les prevalences d'autres affections comme le GPN (16;4); de l'excavation (15;9) de l'ametropie (15); des maculopathies (9;5) de la cataracte (5;9) et le NORB (2;3) ont pu etre determinees. Le glaucome neovasculaire; les atteintes chias- matiques; les retinopathies exsudatives etaient faiblement representes au cours de notre etude. Plus de la moitie des consultations de l'IOTA etait motivee par la baisse de l'acuite visuelle (57;7); puis suivaient le flou visuel; la douleur oculaire; les cephalees et les troubles visuels soit respectivement 12;7 ; 6;4 ; 4;5 ; et 4;1. Les autres motifs etaient faiblement representes. L'age constituait un facteur de risque important du GPAO qui est frequent dans notre etude a partir de 42 ans. La mesure de la pression intra- oculaire et le Cup sur disk etaient significativement associes au GPAO avec une sensibilite et une specificite assez bonnes d'ou leur prise en compte dans le diagnostic des GPAO confirmes par une bonne realisation du champ visuel au moniteur ophtalmologique STAT 76

Apport de l'echographie dans le diagnostic des affections oculo-orbitaires a l'IOTA

L'echographie B aide au diagnostic de certaines affections oculaires masquees par l'opacification des milieux transparents. Afin de montrer son importance en ophtalmologie; une etude a ete menee a l'IOTA a Bamako au Mali chez 250 sujets d'age median 39;50 ans presentant soit une inaccessibilite du segment posterieur soit chez qui le diagnostic etait incertain a l'examen clinique. Il s'agissait surtout de patients atteints de cataracte (85 des indications a visee exploratoire) et avec une tres mauvaise acuite visuelle (50 des patients etaient classes aveugles); tous examines par un ophtalmologiste et explores par echographie B.des patients etaient classes aveugles); tous examines par un ophtalmologiste et explores par echographie B. L'examen echographique etait normal chez la plupart des patients (195/298). Pour le cas particulier de la cataracte 170 des 226 echographies etaient normales; ce qui a permis une intervention chirurgicale chez la majorite des patients (131/170). L'acuite visuelle mesuree selon la classification de l'OMS pres d'un mois apres la chirurgie etait amelioree chez au moins 77 des 116 atteints de cataracte

Probleme de la prise en charge de la cataracte congenitale en Cote d'Ivoire. Experience du CHU de Treichville a propos de 16 cas

Notre etude retrospective; a porte sur 16 patients ayant ete admis dans le service d'ophtalmologie du CHU de Treichville pour cataracte congenitale. Le but de notre etude etait de contribuer a une meilleure prise en charge de la cataracte congenitale en milieu africain. Au terme de cette etude; nous avons etabli que les caracteristiques de la cataracte congenitale chez l'enfant noir africain ne differe en rien au plan clinique des cataractes congenitales des enfants des autres races. Seule la prise en charge precoce et efficace font la difference entre nos resultats et ceux de la litterature. Cette difference est liee d'une part au manque de moyens d'exploration complementaire et au manque de moyens techniques de la prise en charge et d'autre part au manque d'information et de sensibilisation des principaux acteurs de la maladie. Nous avons juge utile de faire des suggestions afin de permettre un diagnostic beaucoup plus precoce et une meilleure prise en charge dans les pays en voie de developpement