Current pattern of ocular trauma as seen in tertiary institutions in south-eastern Nigeria.

BACKGROUND: Ocular trauma is a leading cause of monocular blindness worldwide and in developing countries, are not only more common but also more severe. Industrialization and urbanization may alter or modify prevalent aetiological factors and the presentation of ocular trauma. OBJECTIVE: To determine the current pattern of eye injuries in Teaching Hospitals in Enugu State. METHODS: This prospective cross-sectional descriptive study was carried out at the eye clinics and emergency units of two tertiary institutions in Enugu, Nigeria. Consecutive ocular trauma patients were enrolled over a 5-month period. On presentation, they underwent ocular examination including visual acuity (which was categorized according to the WHO classification of visual impairment and blindness}, anterior and posterior segment examinations. Injuries were grouped using the Birmingham Eye Trauma Terminology system. RESULTS: Within the study period, 2545 new patients presented to the hospitals where the study was conducted. A total of 89 patients presented with ocular trauma, giving an incidence of 3.5%. The male to female ratio was 1.3:1 and patients aged 10 to 19 years formed the majority (24%). Domestic accidents (22%) were the most common cause of ocular injuries while blunt objects (57%) were the most common agents. Closed globe injuries constituted 76% of all injuries. Forty-three per cent of patients presented within 24 h of injury. CONCLUSION: Ocular trauma is still prevalent in South-eastern Nigeria and there has indeed been a change in the pattern as well as the incidence. Assault and road traffic accidents have emerged as important causes of eye injuries. In addition, there has been an improvement in the health-seeking behaviour of people living in Enugu and this may reflect positively on the uptake of recommended preventive strategies.

Vision Screening in Infants Attending Immunization Clinics in a Developing Country.

Background: Vision screening in infants is an important part of the medical care of children as some eye abnormalities, if not treated in the first few months or years of life, can lead to irreversible vision loss. Objective: The objective of this cross-sectional, descriptive study was to identify ocular anomalies among infants attending immunization clinics in Nigeria and refer promptly and appropriately. Methodology: Infants were screened across 6 immunization clinics. Screening activities included relevant ocular history, vision assessment, external ocular examination, ocular motility, Hirschberg's test, pupil examination, and the red reflex test. Infants with abnormal findings were referred for comprehensive eye examination. Result: Of the 142 infants who underwent vision screening, 29 were referred. These referrals were either as a result of ocular abnormalities (n = 22) or presence of risk factors from history (n = 7). The prevalence of ocular abnormalities was 15.5% and neonatal conjunctivitis (38%), was the commonest ocular abnormality found. Others were bacterial conjunctivitis (14%), nasolacrimal duct obstruction (14%), strabismus (14%), capillary hemangiomas (10%), iris nevi (5%), and vernal keratoconjunctivitis (5%). Of the 7 infants referred based on history alone, 6 (85.7%) had a history of prematurity. Conclusion: Conjunctivitis, strabismus, congenital nasolacrimal duct obstruction, and capillary hemangioma are some of the prevalent disorders seen in infants at immunization clinics in Nigeria. Babies at risk of retinopathy of prematurity (preterm birth and oxygen therapy) can be identified. Immunization clinics can serve as good points of vision screening for infants in developing countries to facilitate prompt referral and treatment.

Monitoring cataract surgical outcome in a Nigerian mission hospital.

AIM: To evaluate the visual outcome of cataract operations in a Nigerian mission hospital. METHODS: The computer system cataract surgery record forms were used to collect data on the first 100 consecutive cataract surgeries performed in January and part of February 2003 at a Nigerian mission hospital, Mercy Eye Centre, Abak. RESULTS: There were 54 males and 30 females (100 eyes). Sixteen patients had bilateral cataract. The mean age was 58.45 years (SD 13.58). Four patients were hypertensive, 3 diabetic, 2 both hypertensive and diabetic; and also 2 both hypertensive and asthmatic. Four patients had post-uveitic cataract, 3 traumatic cataract, 1 subluxated cataract not related to trauma and the rest had age-related cataract. One patient each had age-related macular degeneration and glaucoma. Only 42 patients (49 eyes) kept with their follow-up visits until 12 weeks post-operatively. Among these, pin hole or corrected visual acuity of 6/6-6/18 was achieved in 35.4%, <6/18-6/60 in 50%, and <6/60 in 14.6%. Almost half of those with poor outcome were attributed to inappropriate selection. CONCLUSION: The main cause of poor visual outcome in our centre is unsuspected co-morbidity. In spite of this, there is potential for good quality cataract surgery in Africa. As we pay more attention to appropriate patient selection we expect our outcome to improve. Provision of facilities for biometry would also be a great help in this direction.