The Effect of Music on Operative Anxiety markers in patients undergoing Cataract Surgery: Adual centre cross-sectional comparative study.

OBJECTIVE: To determine the effect of intraoperative music on various markers of anxiety among adult patients undergoing small incision cataract surgery. METHODS: This was a hospital-based, age-sex matched, comparative cross-sectional study of consenting 144 adult participants aged 46 years and above with operable, age-related cataracts undergoing small incision cataract surgery under local anaesthesia in two ophthalmic centres. All participants were allotted into two equal groups consisting of 72 participants in the experimental group (exposed to music of their choice) and 72 participants in the control group (no music exposure). Blood pressure, pulse rate and salivary cortisol assay levels were measured. Data obtained were analyzed using statistical package for social sciences (IBM SPSS version 23.0). RESULTS: One hundred and forty-four participants with total male-to-female ratio of 1:2.1 were studied. Gender ratio was 1:2.3 and 1:2.0 and the median age (Q1-Q3) of 65.00 (55.5-71.5) years and 65.50 (56.5-72.0) years for music and non-music groups respectively. Participants in the music group showed a statistically significant reduction in systolic blood pressure, diastolic blood pressure and pulse rate (p < 0.05) except at baseline. The mean value salivary cortisol level showed a statistically significant decrease in both groups from baseline for music (23.91ng/ml) and nonmusic (19.12ng/ml) group (p<0.001) respectively. Similarly, participants in the music group showed a statistically significant reduction of Spielberger State anxiety score after music intervention compared to control (p<0.001). CONCLUSIONS: This study demonstrated the effectiveness of music in decreasing anxiety indicators during cataract surgery with markers like salivary cortisol assay, pulse rate, systolic and diastolic blood pressure.

OBJECTIF: Déterminer l'effet de la musique intra-opératoire sur divers marqueurs d'anxiété chez les patients adultes subissant une chirurgie de la cataracte par petite incision. MÉTHODES: Il s'agissait d'une étude transversale comparative, basée à l'hôpital, appariée selon l'âge et le sexe, portant sur 144 participants adultes consentants âgés de 46 ans et plus, présentant des cataractes liées à l'âge opérables et subissant une chirurgie de la cataracte par petite incision sous anesthésie locale dans deux centres ophtalmologiques. Tous les participants ont été répartis en deux groupes égaux, soit 72 participants dans le groupe expérimental (exposé à de la musique de leur choix) et 72 participants dans le groupe témoin (pas d'exposition à la musique). La pression artérielle, la fréquence cardiaque et les taux de cortisol salivaire ont été mesurés. Les données obtenues ont été analysées à l'aid du logiciel statistique pour les sciences sociales (IBM SPSS version 23.0). RÉSULTATS: Cent quarante-quatre participants avec un rapport total d'hommes à femmes de 1:2,1 ont été étudiés. Le ratio hommes-femmes était de 1:2,3 et 1:2,0, avec un âge médian (Q1-Q3) de 65,00 (55,5-71,5) ans et 65,50 (56,5-72,0) ans pour les groupes musique et non-musique, respectivement. Les participants du groupe musique ont montré une réduction statistiquement significative de la pression artérielle systolique, de la pression artérielle diastolique et de la fréquence cardiaque (p < 0,05) sauf au départ. La valeur moyenne du taux de cortisol salivaire a montré une diminution statistiquement significative dans les deux groupes par rapport au départ pour le groupe musique (23,91 ng/ml) et le groupe non-musique (19,12 ng/ml) (p <0,001) respectivement. De même, les participants du groupe musique ont montré une réduction statistiquement significative du score d'anxiété à l'état de Spielberger après l'intervention musicale par rapport au groupe témoin (p <0,001). CONCLUSIONS: Cette étude a démontré l'efficacité de la musique dans la diminution des indicateurs d'anxiété pendant la chirurgie de la cataracte, avec des marqueurs tels que le dosage du cortisol salivaire, la fréquence cardiaque, la pression artérielle systolique et diastolique. Mots-clés: Musique binaurale, peur, anxiété, stress, chirurgie de la cataracte par petite incision, anxiolytique non pharmacologique.

Outcome of training of maternal and child health workers in Ifo Local Government Area, Ogun State, Nigeria, on common childhood blinding diseases: a pre-test, post-test, one-group quasi-experimental study.

BACKGROUND: Maternal and child health workers (MCHWs) are often the first point of contact with pregnant women, children, and caregivers. Therefore, they can play a significant role in early detection of causes of childhood blindness, facilitate prompt referral to specialized centers and provide health education to caregivers for preventive eye care. METHODS: This is a pre-test, post-test, single group, quasi-experimental study to evaluate the outcome of training MCHWs on common blinding childhood diseases. All MCHWs in Ifo Local Government Area were selected to participate in the study. Pre-training, qualitative data was obtained from two focus group discussions while quantitative data was obtained using a self-administered questionnaire. Three months post-training, quantitative data was obtained using the same self-administered questionnaire as was used pre-training. Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. McNemar's test was used to determine differences in proportions between pre- and post-training quantitative measurements. RESULTS: Of the 65 MCHWs in the Local Government Area, 61 participated in the study giving a response rate of 93.8%. The age range of study participants was from 28 to 57 years with a mean age of 41 ± 8.3 years. The male: female ratio was 1:7.7. During the focus group discussions, measles was the most commonly mentioned cause of childhood blindness however, participants showed more knowledge of the signs and symptoms of new-born conjunctivitis. Based on a sufficient knowledge score of ≥70%, only one participant (1.6%) demonstrated sufficient knowledge on quantitative survey pre-training. Post-training, there was a statistically significant increase (20, 32.8%) in the proportion of participants with sufficient knowledge (McNemar's test p = .000). CONCLUSIONS: This study demonstrated that the training of MCHWs on common childhood blinding diseases (such as congenital cataract and congenital glaucoma) had the potential to improve knowledge regarding prevention, prompt recognition and early referral of common treatable potentially blinding diseases.

Visual acuity, safe/unsafe practices and self-reported road traffic crash experiences among commuter bus drivers from two motor parks in Lagos, Nigeria.

BACKGROUND: Road Traffic injuries remain a significant public health problem with serious health and economic implications. This study was conducted to determine visual acuity, safety practices and road traffic crash (RTC) experiences of commercial bus drivers in Lagos, Nigeria. METHODS: This cross-sectional study involved visual acuity screening and interviewer- administered questionnaire survey. Participating motor parks were selected by simple random sampling and all intercity, commercial minibus drivers were included. Data was analyzed with Epi info version 3.5.1. RESULTS: A total of 407 drivers participated with a mean age of 43.4 ± 10.8 years. A total of 68 (16.7%) of the drivers did not meet the minimum VA standard required for driving; 8.6% of them use mobile phones while driving; 97% fasten their seatbelt, out of which almost 98% do so always. Fourteen percent also admitted eating while driving. Sixty two (15.2%) of drivers had been involved in RTC in the past 5 years prior to interview. CONCLUSION: A proportion of commercial minibus drivers did not meet the minimum VA required for driving. Some of them also practiced distracted driving. Free visual acuity screening within the motor park is recommended for commercial drivers at least once a year. There should be awareness campaigns to enlighten commercial drivers on the dangers of distracted driving in addition to strict enforcement of regulations and Highway Code.

The Pattern of Uveitis In An African Tertiary Eye Care Centre.

OBJECTIVE: To determine the pattern of presentation of uveitis at the Guinness Eye Centre of the Lagos University Teaching Hospital, Lagos, Nigeria. MATERIALS AND METHODS: The case files of all patients with the diagnosis of uveitis who presented at the center from January 2006 to December 2010 were reviewed. Data on age, sex, ethnicity, symptoms, duration of symptoms before presentation, eye affected, anatomical type of uveitis and clinical type of uveitis were extracted onto a form for analysis. RESULTS: A total of 68 cases of uveitis were reviewed. There were 38(60.3%) males and 25 (39.7%) females. The range was from 12 to 90 years. The peak incidence occurred within the age range 21-40 years inclusive. Anterior uveitis and posterior uveitis occurred in 34(54.0%) and 17(27%) patients respectively. While reduction in vision was reported as a symptom by 54(85.7%) patients, only 41(65.1%) patients presented within 4 weeks of onset of symptoms. CONCLUSION: Anterior uveitis was the most common clinical type in this study. The highest incidence of uveitis occurred in the third and fourth decades of life.

Retinopathy of prematurity and associated factors in Lagos, Nigeria.

BACKGROUND: Screening and early treatment of retinopathy of prematurity (ROP) is important to reduce visual impairment in at risk infants. AIM: To determine the frequency and risk factors associated with ROP in preterm infants in Lagos University Teaching Hospital. METHODS: This was a prospective cohort study of preterm infants with gestational age (GA) less than 32 weeks and birthweight 1500 g or less conducted from November 2011 to May 2014. The infants' eyes were examined using an indirect ophthalmoscope at 4-6 weeks of life or at 34 weeks post-conceptual age. Examinations were repeated weekly until regression or progression to a high risk pre-threshold disease. Staging was according to the revised International Classification for ROP and treatment criteria were as defined by the Early Treatment for ROP study. The GA, birth weight (BW), use of oxygen, presence of respiratory distress syndrome and other risk factors were recorded and tested for significance. RESULTS: Twelve (15%) of the 80 infants examined had any ROP and six (7.5%) had treatable ROP. The mean (SD) GA and BW for infants with ROP were both lower than for those without ROP; 28.2 (1.7) weeks vs 29.1 (1.6) weeks and 1124 (212) g vs 1251 (274) g for GA and BW, respectively. Risk factors such as supplemental oxygen, sepsis, respiratory distress and anaemia were not significantly associated with ROP. CONCLUSION: The frequency of ROP and treatable ROP was high; it is therefore recommended that routine care of preterm infants should include screening for ROP and that affordable treatment facilities should be provided in public hospitals.

A ten year review of diabetic retinopathy at the Guinness Eye Centre, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos.

BACKGROUND: Diabetic retinopathy is an important complication of diabetes mellitus, which may lead to blindness. OBJECTIVE: The study is to analyze posterior segment lesions in Diabetes Mellitus patients seen in Guinness Eye Centre, Lagos University Teaching Hospital in relation to the number, duration and severity. METHODS: All the case files of Diabetes Mellitus patients seen during the period of study were retrieved and data extracted from them were analyzed. Such information included age, sex, duration of Diabetic Retinopathy and its severity. RESULTS: A total of 84 case files were reviewed. There were 47 males and 37 females with a male to female ratio of 1.3:1. No diabetic patient was seen in the age group 30 years and below. Fifty-five (65%) patients who presented themselves did so very late. Of the 35 patients found to have diabetic retinopathy at presentation, 16 had the disease bilaterally. The most common form of Diabetic Retinopathy was clinically significant macula oedema. The study shows that a high proportion of the patients (41.6%) had Diabetic Retinopathy. CONCLUSIONS: Patients with DM should be referred early for eye examinations. Physicians Residents should be made to rotate through eye Departments for a period of at least 2 weeks so they can learn fundoscopy. Diabetic patients should be educated on the eye complications that may arise from their condition. Regular eye screening with fundus camera and laser therapy should be part of the routine management of Diabetics in Nigeria as is done in advanced countries.

Ocular findings in acquired immunodeficiency syndrome patients in Lagos, Nigeria.

BACKGROUND: There is paucity of studies on the prevalence and pattern of ocular complication in HIV patients in developing countries where 90% of all HIV sufferers live. Most studies were carried out in industrialized countries and are not representative of the spectrum of ocular complication of HIV and it's prevalence in developing countries. OBJECTIVE: To determine the prevalence of ocular disorders in adult (> 15 years ) AIDS patients at PEPFAR clinic in Lagos, Nigeria. MATERIAL AND METHODS: All consecutive adult Seropositive HIV/AIDS patients of PEPFAR Clinic at the Lagos University Teaching Hospital between February 1st-March 15th 2008 were enrolled into the study Cross sectional and non randomized, convenient study was used. Biodata and medical history were recorded on interviewer administered questionnaire. Participants were examined according to standard protocol comprising visual acuity, intraocular pressure, anterior segment examination with slit lamp biomicroscopy, dilated fundoscopy and fundus photograph where necessary. PCV, CD4+ count, viral load at diagnosis, stage of HIV disease were extracted from patients' records. Details of drug were regimen also recorded. Data analysis was performed with EPI-lnfo 6.04 version; Chi square and student t test used to describe statistical association. RESULTS: A total of 400 patients were studied. Male:female ratio was 1.7 and mean age was 40 years (S.D. + 9.12). Ocular disorders seen in 78.5% of patients; HIV related ocular disorders occurred in 45 (11.3) patients. Conjunctival microvasculopathy 166 patients (41.5%), pingueculum in 114 (28.5%), pterygium in 76 (19.0%), refractive error in 93 (23.3%), cataract in 12 (3.0%), and 22 (5.5%) Glaucoma suspects. HIV retinopathy and allergic eye disease in one patient each (0.3%). Presumed Cytomegalovirus retinitis 7 (1.8%), 14 (3.5%) Toxoplasmosis, 8 (2.0%) HZO, and 15 (3.8%) Presumed Squamous cell carcinoma. Eighty six (21.5%) of the patients had no abnormality. 91.4% of eyes examined had visual acuity with best correction of > 6/18. CD4+ in 79.3% of the patients was > 200 cells/ul and < 5% had counts < 50 cells with an overall mean of 406 cell/ul. 375 (93.8%) patients were on Highly Active Antiretroviral therapy (HAART), and 25 (6.2%) were not. CONCLUSION: Study revealed low prevalence of HIV related ocular disorders. This could be due to few patients at low level of immunosuppresion where the infections occur.

Pattern of conjunctival masses seen at Guinness Eye Centre Luth Idi-Araba.

BACKGROUND: Conjunctival masses are growth on the surface of the outer eye; which may represent benign or malignant transformations. OBJECTIVE: To determine the pattern of presentation of conjunctival masses at the Guinness Eye Centre (GEC), Lagos University Teaching Hospital (LUTH) Idi-Araba over a 13 year period (Jan 1995-Dec 2007). METHOD: A retrospective review of the clinical notes of all patients that presented to GEC with conjunctival masses during the study period was carried out. The bio-data, clinical features, stage, laterality and associated features of the masses were noted. The diagnosis, treatment and complications of treatment were also recorded. RESULTS: Case notes of 612 eyes of 393 patients were included in the study. There were 219 (55.7%) males, 174 (44.3%) females with ages ranging from 4-85 years with a male to female ratio of 1.26: 1. Three hundred and eighty-eight patients (98.7%) presented as elective cases to the outpatient department while 5 (1.3%) presented as emergencies on account of associated ocular inflammation. There were 220 (56%) bilateral masses while 44% were uniocular. Pterygium was the leading conjunctival mass affecting 548 eyes (89.5%) of 329 patients. Pingueculae occurred in 53 eyes (8.7%), conjunctival cysts in 5 (0.8%) eyes, neoplastic growths in 3 (0.5%) eyes, conjunctival granulomas in 2 (0.3%) eyes and limbal teratoma in 1 (0.2%) eye. Most of these patients defaulted from surgery as only 141 eyes (23%) of 121 patients had surgery. Post-operative complications occurred in 33 eyes (5.4%) of 30 patients. The commonest postoperative complication was pterygium recurrence which occurred in 18 eyes of 15 patients. CONCLUSION: Pterygium was the commonest conjunctival mass and preventive strategies need to be advocated. Prevention of recurrence remains a challenge in the management of pterygium as recurrence after surgical excision occurred in 13.2% of eyes. Our study however did not confirm outdoor occupations as a risk factor for pterygium.

Hydrocephalus and the eyes: a teaching hospital experience.

BACKGROUND: The eye developes from prosencephalon, the primitive forebrain and hence share similar embryonic origin with brain. This gives insight into primary or secondary involvement of eyes in intra-cranial pathology. OBJECTIVE: The study was done to describe ocular findings in hydrocephalus patients and effect of intervention on the complications. METHODS: Forty one consecutive hydrocephalus patients were examined pre and post ventriculo-peritoneal shunts. Comprehensive ocular examinations included dilated fundoscopy in all cases. RESULTS: A total of 41 patients were examined with the age range of between 4 hours to 108 months and a mean age of 21 months. Onset of the hydrocephalus varies from 4hours to 108 months, with a mean of 4.1 weeks. Twenty two patients (51.2%) presented after 2 months of onset of hydrocephalus. Most common presenting complaint was enlarged head seeing in 29 patients (70.7%). CONCLUSION: A total of 12 (30%) out of 41 patients with hydrocephalus had optic atrophy. Another 10 patients had sun-setting phenomenon, 3 of these sun-setting phenomena resolved a week after ventriculo-peritoneal shunts. The ocular morbidity is high among hydrocephalus patients.

Aetiology of vitreous haemorrhage in Guinness Eye Centre, Lagos University Teaching Hospital over a two year period (June 2007-May 2009).

BACKGROUND: The Vitreous Humour is the transparent biological gel which fills the posterior 5/6th of the eyeball. Extravasations of blood into this delicate tissue may cause visual loss. OBJECTIVE: The study was to determine the causes and pattern of vitreous haemorrhage in Guinness eye centre, Lagos University Teaching Hospital. METHODS: Retrospective consecutive case series of all patients with Vitreous haemorrhage over a 2 year period (June 2007 - May 2009) RESULTS: A total of 5137 new patient were seen at Guinness eye centre during the study period. 13 of them had vitreous heamorrhage giving an incidence of 0.25%. 12 of the patients were males. The mean age was 41 year. The age range was from 14years to 69 years. Majority of the patients (69%) presented within 4 weeks of drop in vision. Vitreous heamorrhage was caused by trauma in 46% of the patients and proliferative sickle cell retinopathy in 30% of the patients. All the patients with vitreous haemorrhage due to proliferative sickle cell retinopathy had the Hb genotype SC. CONCLUSION: Trauma and proliferative sickle cell retinopathy were found to be important causes of vitreous heamorrhage in this case series.

Vernal keratoconjunctivitis at Guinness Eye Centre, Luth (a five year study).

INTRODUCTION: Vernal keratoconjunctivitis (VKC) (Spring Catarrh) is a chronic, seasonally exacerbated bilateral external allergic ocular inflammation which causes a lot of ocular discomfort to children and young adults and, in severe or poorly managed cases, can even lead to blindness. OBJECTIVES: To determine age/sex distribution, seasonal pattern, and frequency of clinical features. METHODOLOGY: A review of medical records of patients who presented with VKC between January 2001 - December 2006. RESULTS: A total of 148 patients' records were reviewed. There was male preponderance with a Male to Female ratio of 1.27:1, and higher frequency in patients less than 10 yrs was observed. A trimodal peak pattern (January-February, April-July and September-October) was seen. Itching was the most common symptom and brownish conjunctival discolouration, the most common sign. CONCLUSION: This study is in agreement with previous findings of male preponderance and the tendency for the condition to affect children and young adults. It also detected an increase in number of cases in periods of seasonal changes from dry to wet. The necessity of patients' being assessed by an ophthalmologist was highlighted as several patients had been treated with antibiotics solely, which is insufficient for control of the condition.

Orbito-ocular lesions in Lagos.

OBJECTIVE: we present a 10year retrospective clinicopathologic study of 135 cases of orbito-ocular lesions. The aim is to document pattern of orbito-ocular lesions, with their site, age and sex distribution. MATERIALS AND METHODS: The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all orbito-ocular samples received at the Morbid Anatomy Department of Lagos University Teaching Hospital Idi-Araba Lagos between 1994 and 2003. RESULTS: A total of 135 samples from 75(56%) males and 60(44%) females were analysed. The conjunctival, intraocular, orbital and eye lid lesions accounted for 27(20.1%), 75(55.5%), 18(13.4%) and 15(11%) cases respectively. The ages ranged from 20 days to 79 years with a mean age of 35 years. Sixty nine cases (51.1%) of all orbito-ocular lesions were seen in children of age 15 years and below. Squamous cell carcinoma was the commonest malignant conjunctival lesion (4 out of the 5 cases) occurring in adults with a mean age of 45 years. Retinoblastoma accounted for 46(85%) of all orbito-ocular malignancies with the peak in the 1-5year age group accounting for 37(80 %). Panophthalmitis, endophthalmitis and phthisis bulbi were common non neoplastic lesions requiring enucleation. Pseudotumour and rhabdomyosarcoma accounted for 5(27.8 %) and 4(22.2 %) cases respectively of all orbital lesions. CONCLUSION: Retinoblastoma remains the commonest ocular malignancy while rhabdomyosarcoma was the commonest orbital malignancy with both occurring in childhood. Inflammatory lesions unfortunately are important orbito-ocular lesions requiring surgery in our environment.

Pupillary changes among Nigerian adults following the instillation of Garcinia kola nut extracts: multicentric studies.

BACKGROUND: A multi-centre, open, within-patient controlled study was performed on 106 adult volunteers to investigate the effects of Garcinia kolanut extracts on the pupillary sizes. STUDY DESIGN: 106 participants in three Nigerian Ophthalmic Centres with no pupillary defects and associated ocular or systemic co-morbidities had their pupillary diameters measured at 0, 15, 30 and 45 minutes respectively with a pupillometer (Neuroptics model # 586009). Using the left eyes as control, Garcinia kolanut extract was instilled into the right eyes at 15 minutes intervals. RESULTS: There were 63 females and 43 males ranging in age from 18 to 58 years with the mean age of 34.9 years. Average pupillary diameter measured among participants was 4.1 - 8.4 mm with the mean value of 6.0 mm prior to garcinia kola nut extract instillation. There was a gradual reduction in the baseline pupillary size with age in years at 0.2mm per decade without garcinia extract instillation. There was a significant higher baseline pupillary diameter in males than females with males and females mean values of 6.29mm (6.00 - 6.56mm) and 5.85mm (5.60 - 6.11mm) in the right eye (p=0.026) and mean pupillary diameters 6.16mm (5.90 - 6.42mm) and 5.80mm (5.56 - 6.04mm) in the left eyes (p=0.05) respectively. There were consistent significant miosis in the right eyes with instilled Garcinia kola nut extract compared to the left eyes at 15, 30 and 45 minutes (p=0.0000). CONCLUSION: 4% Garcinia kola nut extract drop has a transient miotic effect on human pupils not sustainable for more than 45 minutes.

Levels of evidence of published articles in major Nigerian medical journals: a critical appraisal.

In modern day medical practice, "rules of evidence" have been established to grade clinical and research findings according to strength. The aim of this study is to describe the current pattern of publications in 5 major Nigerian medical journals in terms of levels of evidence. Five major peer-review medical journals (Nigerian Q J Hosp Med, Nigerian Post grad Med J, West African J Med, African J Med Med Sci, and Nigerian J Clin Pract) published in Nigeria were included in the study. All articles published in 2005 and 2006 were accessed, classified into four levels of evidence, and pattern of publications was described. All eligible 580 published articles were analysed. None (0%) achieved level I evidence, 15 (3%) were level II, 47 (8%) level III, and 258 (44%) level IV; and the majority (n = 260, 45%) of the published were classified as non-evidence. There were more evidence articles in indexed journals than in non-indexed one (P = 0.000). Among the 260 non-evidence articles there were 97 (37.3%) case reports, 28 (10.8%) non-systematic review articles, 30 (11.5%) animal studies, 6 (2.3%) laboratory studies, 3 (1.1%) technical notes and 94 (36.1%) were classified as others (KAP studies, reports, guidelines, questionnaire-based studies). The general level of evidence of articles published in the five major medical journals in the 2-year period 2005-2006 was low as only 11% of articles were levels II and III. There is a need to improve on the quality and funding of medical research in Nigeria in order to promote better patient care.

Mechanisms of orbital blowout fracture: a critical review of the literature.

OBJECTIVE: The aim of the present study is to critically review relevant literature regarding the mechanism of blowout fractures of the orbit and provide an answer to the question: Can one theory adequately explain the mechanism of orbital blowout fractures in the light of present day knowledge? MATERIALS AND METHODS: A computerised literature search using MEDLINE was conducted for published articles on orbital blowout fractures. Mesh phrases used in the search were: orbital blowout fractures AND mechanisms; orbital blowout fractures AND theory; orbital wall injury AND mechanisms. Only relevant articles were selected for the review. RESULTS: The physical mechanism of orbital blowout fracture has been a subject of debate for years by maxillofacial surgeons, ophthalmologists, plastic surgeons, otolaryngologists and orbitologists. However, only 3 mechanisms of injury have been proposed namely: "hydraulic" theory, "globe-to-wall" theory and "bone conduction" theory. Most of the theories of orbital blowout fractures have been confirmed through brilliant experiments and hypothetical explanation/analysis of clinical and radiologic findings, and each one appears to fit according to the different type of trauma received. CONCLUSIONS: Based on contemporary evidence, one theory may not adequately explain all types of fractures completely or be responsible exclusively in a given case for the pattern of fracture observed. Blowout fractures of the orbit could therefore be due to a combination of 2 or more mechanisms.

Pattern of ocular emergencies seen at L.U.T.H. over a period of 1 year.

AIM: To determine the commonest type of ocular emergencies seen at L.U.T.H. over a period of one year. METHODOLOGY: Data of all consecutive patients seen as emergencies within the designated period was taken. These included age, sex, symptoms, signs, agents of injury, duration and the complications. RESULTS: A total of 304 patients were seen. 207 (68.0%) of them were males, while 97 (32.0%) of them were females giving a ratio of 2.1:1. Out of the total number, 159 (52.3%) had non-injurious emergencies. Of the 145 (47.7%) injurious emergencies, blunt trauma was the commonest with 77 patients (25.3%). Penetrating trauma was next in frequency with 37 patients (12.2%) as compared to blunt injury with 77 patients. Foreign body injuries were seen in 18 patients (5.9%), followed by chemical injuries which constituted the least with 13 patients (4.3%). CONCLUSION: Majority of the ocular emergencies seen were due to non-injurious type, while blunt trauma was the commonest of the injurious type. RECOMMENDATION: Health education and awareness creation should be intensified on the various causes of the ocular emergencies, more importantly on the non-injurious causes to prevent the resultant ocular morbidity.

Conjunctival melanoma in a 55 year old male Nigerian: a case report.

BACKGROUND: Conjunctival melanoma is a rare occurrence in the Negroid race. PURPOSE: To report a case of a 55 year old security man with right conjunctival melanoma. METHOD: A 55 old man was operated on to remove a pigmented right bulbar conjuctival growth. The specimen was submitted to Lagos University Teaching Hospital Lagos and Harold Wood Hospital England for histopathologic examination and confirmation. RESULTS: Surgery was successful and histopathologic and immunohistochemical studies confirmed a diagnosis of a nodular malignant melanoma. CONCLUSION: The need for the provision of definitive investigative tool (immunohistochemical studies) to facilitate definitive diagnosis and management of such cases in some recognised centres in Nigeria cannot be overemphasised.

Clinical trial of diclofenac sodium (Naclof) eye drops on Nigerians.

Twenty-eight eyes of 26 age-matched patients who had planned extracapsular cataract extraction with or without intraocular lens implantation were enrolled into a double blind randomised actively controlled study of 2 groups. Each group of 14 eyes was assigned to receive 0.1% diclofenac sodium (Naclof) eye drops or 1% prednisolone acetate eye suspension. The patients received either 0.1% Diclofenac sodium eye drops or 1.0% prednisolone acetate eye suspension four times a day as their post operative anti-inflammatory medication for a period of four weeks. No significant difference was noticed in the subjective assessment of pain and conjunctival injection in the 28 days follow-up period except day 1 in the diclofenac sodium group (0.05> p >0.01). Other measured objective variables of inflammation such as anterior chamber cells and flare showed no significant difference from the 3rd-28th postoperative days (0.05< p > 0.20). The result demonstrated that 0.1% diclofenac sodium eye drops was as effective as 1% prednisolone acetate eye suspension in the control of postoperative inflammation after cataract surgery, and could serve as a viable alternative to topical steroids in Nigerians who are steroid responders.