Ocular disorders in stroke patients in a tertiary hospital in Nigeria.

BACKGROUND: Stroke is a medical emergency of public health importance which affects the physical, mental, and emotional well-being of its victims. Management and rehabilitation are cumbersome for patients and caregivers. Ocular involvement and visual loss could further increase the burden of care. AIM: To determine the prevalence of ocular disorders in patients with stroke in a Tertiary Hospital in Nigeria. MATERIALS AND METHODS: A descriptive hospital-based study was performed on all consenting and conscious adult patients aged 18 years and above with a diagnosis of stroke made within 1-year who were admitted to the stroke ward or attended the stroke clinic of the Neurology Unit in the Department of Medicine, University of Benin Teaching Hospital, Benin City from October 2013 to December 2013. RESULTS: A total of 170 eyes of 85 patients were studied with a mean age of 66.08 years ± 10.99; range 43-88 years. There was a male: female ratio of 2.6:1. Ocular abnormalities were documented in 95.5% of the patients. A presenting visual acuity of ≥6/18 was found in 66.7%. Mild ptosis and exotropia were seen in 2.9% and 0.6% of the eyes respectively. Intraocular pressure was between 10-21 mmHg in 87.7% eyes while 11.8% eyes had afferent pupillary defects. Cataract was seen in 71.8% eyes and optic nerve head changes in 48.8% eyes which includes temporal disc pallor and glaucomatous optic neuropathy in 29.4% and 14.2% eyes, respectively. Abnormalities found in the retina include retinal hemorrhages in 10.6% eyes, cotton wool spots in 2.4% eyes, and hard exudates in 7.8% eyes. Retinal vascular abnormalities were documented in 32.4% eyes. Visual complaints following stroke were documented in 9.6% of the patients. CONCLUSION: Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke, and age-related changes. Routine ophthalmic evaluation is suggested in the management of patients with cerebrovascular accident in our environment for better quality of care.

Effectiveness of intra-operative Mitomycin-C in reducing the recurrence of pterygium in Irrua, Nigeria.

AIMS AND OBJECTIVES: To evaluate the effectiveness of intra-operative Mitomycin-C application after pterygium surgery in Irrua, Nigeria. MATERIALS AND METHODS: The medical records of all patients who had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C between June 2002 and May 2007 and followed up for at least a year were reviewed. RESULTS: Two hundred and forty three eyes (196 patients) had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C over this period. Male to female ratio was 2:1. The mean age of the patients was 47.1years (SD+ 15.4) Eleven eyes had recurrence after a minimum follow up period of one year. Six (54.5%) out of the eleven eyes that had recurrence had conjunctival granuloma and in such cases recurrence was early (between 2 to 3 months of surgery). Conjunctival granuloma was the main complication occurring in 35 eyes (14.4%). Occurrence of granuloma was significantly associated with recurrence (P =0.0006). Delayed wound healing occurred in 5 eyes (2.1%). There was no case of either scleral or corneal melting. CONCLUSION: Intra-operative application of 0.4mg/ml Mitomycin C is very effective in reduction of recurrence of pterygium after excision. Hence patients should be given the benefit of intra-operative use of Mitomycin C during pterygium surgery.

Ultrasonographic ocular diameters in Nigerians.

BACKGROUND: There is little information on the biometric ultrasonography of the eyeball, especially in Africans. The eyeball diameters form the basis for the calculation of the intraocular lens power and diagnosis of axial hypermetropia and myopia OBJECTIVE: To determine the ocular diameters of healthy Nigerian eyes. METHODS: Measurements of the eyeball in volunteers were taken on the B-mode image using a Medison's Sonoace 1500 ultrasound machine using a 6.5 MHz curvi-linear transducer placed over the closed eyelid. The vertical, horizontal and axial diameters of the eyes of healthy subjects were recorded. The age and sex of the subjects were also recorded. RESULTS: Four hundred eyes of 200 subjects comprising 125 females (62%) and 75 (38%) males (38%) were studied. The age range was 3-92 years with an overall mean age of 41.48 +/- 23.26 years for both sexes. The mean axial eyeball diameter for the entire study population was 21.7 +/- 0.16 mm. There was a gradual increase in all eyeball diameters with age. The highest value for eyeball diameter (22.5 +/- 0.18 mm) was recorded for the elderly age group. The (SD) mean eyeball diameters for males were slightly higher than that for the females; mean for males, 21.8 +/- 0.13 mm, 95% CI = 21.781-21.819, vs females, 21.6 +/- 0.14 mm, 95% CI = 21.581-21.619. However, the difference was not statistically significant (p = 0.409). CONCLUSIONS: The eyeball diameters found in this sample of Nigerians are lower than the dimensions reported in Caucasians. These values may be used as reference values for normal African eyes.

Current concepts in the diagnosis of primary open angle glaucoma.

BACKGROUND: Primary open angle glaucoma is characterized by quantifiable parameters including the intraocular pressure, the aqueous outflow facility, and geometric measurements of the optic disc and visual defects. Despite this, diagnosis remains controversial. OBJECTIVE: To review the current concepts in the diagnosis of primary open angle glaucoma and adapt them to situations where high technology facilities are lacking. DATA SOURCE: Information was obtained from journals/medline, Hinari, the American Academy of Ophthalmology preferred practice pattern CD, and reputable textbooks using publications from 1972 to 2007. RESULTS: The Preferred Practice Pattern Committee of the American Academy of Ophthalmology recommends that the comprehensive initial glaucoma evaluation (history and physical examination) includes comprehensive adult eye evaluation with special attention to those factors that specifically bear on the diagnosis such as the optic disc, nerve fibre layer and visual field evaluation, open anterior chamber angles on gonioscopy and absence of secondary causes of glaucoma. Intraocular pressure is no longer relied onin the diagnosis of primary open angle glaucoma. Sequential evaluation of optic disc cup and size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc haemorrhages enhance the ability to detect glaucomatous damages. CONCLUSION: A simple systematic approach in examination of the optic discs and visual field will improve accurate diagnosis of glaucoma.

Non-traumatic Ocular Findings in Industrial Technical Workers in Delta State, Nigeria.

PURPOSE: To determine the pattern of non-traumatic ocular disorders in industrial technical workers in the Delta state, Nigeria. METHODS: A cross-sectional study of the pattern of non-traumatic ocular disorders among industrial technical workers in 3 factories in Ughelli North local Government Area of Delta state, Nigeria was conducted between February, 2002 and May, 2002. In addition to the demographic, the workers were studied for the presence of any non-trauma related ocular findings. Visual acuity of these workers was obtained as well as ocular examination was performed by using the Snellen's chart, pen torch, ophthalmoscope, Perkins hand-held tonometer, Ishihara plates. Patients were refracted if their visual acuity was less than normal. RESULTS: Five hundred technical workers were screened that included 200 (40%) from the construction industry, 180 (36%) from the rubber factory and 120(24%) from the oil mill. All the workers studied were males. Ocular disorders were seen in 664 (66.4%) of the eyes. The most common ocular disorders were pingueculum 215 (21.5%), presbyopia 97 (9.7%), refractive error 94 (9.4%), pterygium 86 (8.6%) and chronic conjunctivitis 45 (4.5%). None of the workers was blind from non-traumatic causes. Only 36 (7.2%) workers wore any protective eye devices at work. CONCLUSION: Non-traumatic ocular disorders are common in the industrialized technical workers in the Delta state of Nigeria. The use of protective eye devices is low in these workers and suggests that measures to implement ocular safety should be undertaken in these industries.

Non-traumatic ocular findings in industrial technical workers in Delta State; Nigeria

Purpose: To determine the pattern of non-traumatic ocular disorders in industrial technical workers in the Delta state; Nigeria. Methods: A cross-sectional study of the pattern of non-traumatic ocular disorders among industrial technical workers in 3 factories in Ughelli North local Government Area of Delta state; Nigeria was conducted between February; 2002 and May; 2002. In addition to the demographic; the workers were studied for the presence of any non-trauma related ocular findings. Visual acuity of these workers was obtained as well as ocular examination was performed by using the Snellen's chart; pen torch; ophthalmoscope; Perkins hand-held tonometer; Ishihara plates. Patients were refracted if their visual acuity was less than normal. Results: Five hundred technical workers were screened that included 200 (40) from the construction industry; 180 (36) from the rubber factory and 120(24) from the oil mill. All the workers studied were males. Ocular disorders were seen in 664 (66.4) of the eyes. The most common ocular disorders were pingueculum 215 (21.5); presbyopia 97 (9.7); refractive error 94 (9.4); pterygium 86 (8.6) and chronic conjunctivitis 45 (4.5). None of the workers was blind from non-traumatic causes. Only 36 (7.2) workers wore any protective eye devices at work. Conclusion: Non-traumatic ocular disorders are common in the industrialized technical workers in the Delta state of Nigeria. The use of protective eye devices is low in these workers and suggests that measures to implement ocular safety should be undertaken in these industries

Presenting Visual Acuities in a Referral Eye Center in an Oil-Producing Area of Nigeria

Objectives: To determine the pattern of presenting visual acuities at an eye center in the Niger Delta region of Nigeria. Study Design: Retrospective chart review Methods: A retrospective review of patient records attending a private referral eye center providing services for company patients and the general public in the region. Information was obtained from computerized medical records of 6533 patients who attended the center for various eye concerns in a 5-year period (January 1998 to December 2002). Results: A total of 6533 patients were seen in this 5-year period of which 2472 (37.8) were company patients and 4061 (62.2). were private patients. There were 3879 males (59.4) and 2654 females (40.6). A visual acuity of 6/6 or better was seen in 50.8of the patients. In 76.6of patients; a visual acuity of 6/18 or better was recorded. There were 21.4of patients in the low vision group. Bilateral blindness occurred in 2.1of patients. Monocular blindness occurred in 3.7of patients. Low vision occurred in 16.9of company patients and 24.1of private patients. Bilateral blindness occurred in 0.9of company patients and 2.7of private patients; while monocular blindness occurred in 1.2of company patients and 5.2of private patients. The main ocular problems were refractive error; glaucoma; conjunctivitis; headaches; ocular trauma; retina and related pathologies; cataract; uveitis; pterygium and corneal problems. Conclusion: The incidence of low vision and blindness is high in the oil-producing area of the Niger Delta region of Nigeria. Low vision and blindness were more common in private patients than in company patients

Ophthalmic disorders in Adult Lymphoma Patients in Africa

Context: Ocular manifestations of lymphoma are rare events. Most reports of ocular involvement in lymphoma are case reports or reports of a few patients. Aims: To determine the ophthalmic disorders in adult; African; lymphoma patients. Settings and Design: A prospective study of ocular disorders in adult patients with lymphoma was conducted at the University of Benin Teaching Hospital; Benin City; Nigeria; between July 2004 and June 2007. Materials and Methods: The patients were interviewed and examined by the authors and the ocular findings recorded. Statistical Analysis: Data was analyzed on computer with the aid of the Instat GraghPadT v2.05a statistical package software. The mean; standard deviation; Mann-Whitney U-statistic and P value were calculated. Results: A total of 111 patients with hematological malignancies were seen over a period of three years of which 62 (55.85) had lymphomas. Of these; 51(82.3) were non-Hodgkin's lymphoma and 11(17.7) were Hodgkin's lymphoma. Ocular disorders occurred in 16 patients (31.4) with non-Hodgkin's lymphoma and none of the patients with Hodgkin's lymphoma (Mann-Whitney U-statistic is equal to 7.500; U' is equal to161.50; P ; 0.0001). The ocular disorders due to non-Hodgkin's lymphoma were seen as - proptosis in six patients (11.8); retinopathies in three (5.9); conjunctival infiltration in three (5.9); optic atrophy in two (3.9); keratoconjunctivitis in one (two per cent); desquamating nodular lid lesions in one (two per cent); papilloedema in one (two per cent); and upper lid mass in one (two per cent). Four patients (6.5) had monocular blindness. Conclusions: Ophthalmic disorders are relatively common in non-Hodgkin's lymphoma. Ophthalmic evaluation is needed in these patients for early identification and treatment of potentially blinding conditions

Glaucomatocyclitic crisis in Edo State, Nigeria: report of two cases.

OBJECTIVE: To report two classical cases of glaucomatocylitic crisis in tertiary Health Centres in Edo State, Nigeria. METHOD: Two cases of glaucomatocylitic crisis seen at Irrua Specialist Teaching Hospital, Irrua, and University of Benin Teaching Hospital, Benin City, both in Edo State, Nigeria are reported. Diagnosis was based on typical history and findings on examination. RESULTS: The first was a female who presented in December 2002 at Irrua Specialist Teaching Hospital and the second was a male who presented at the University of Benin Teaching Hospital, in March 2004. Both presented with blurring of vision in the affected eye and seeing halos around light. The intraocular pressures in the affected eyes were markedly elevated, there were fine keratic precipitates in the corneal endothelium of the involved eyes and the optic discs and visual fields were normal. Repeated episodes of the symptoms confirmed the diagnosis ofglaucomatocyclitic crisis. CONCLUSION: This report shows that typical cases of glaucomatocylitic crisis occur in Nigerians but require a high index of suspicion for the diagnosis.

Ocular disorders in adult patients with tuberculosis in a tertiary care hospital in Nigeria.

OBJECTIVES: To determine the ocular disorders in adult tuberculosis (TB) patients in Benin City, Nigeria. METHODS: A prospective study of adult TB patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria, between March 2006 and October 2006 was undertaken. The patients were interviewed and examined by the authors and the ocular findings recorded. RESULTS: There were 92 patients (45 males and 47 females) with mean age 37.9 years (SD±15.6). Only one (1.1 percent) was HIV positive. Among the ocular findings in patients with TB, 8 patients had monocular blindness that included cataracts in 3 (37.5 percent), glaucoma in 2 (25 percent), optic atrophy, retinal vasculitis and maculopathy accounting for one case each (12.5 percent). Ocular disorders due to TB occurred in 9 patients (9.8 percent). These include cataract in 2 cases (2.2 percent), phlyctenular conjunctivitis in 2 cases (2.2 percent), glaucoma, anterior uveitis, chorioretinitis, retinal vasculitis, maculopathy, and optic atrophy each occurring in 1 case (1.1 percent). CONCLUSION: Tuberculosis is a cause of ocular morbidity, visual impairment and blindness. Prevention, early diagnosis and early treatment of TB may prevent avoidable visual loss.

Ocular disorders in a petroleum industry in Nigeria.

OBJECTIVE: To determine the ocular disorders in the petroleum industry in Warri, Nigeria. METHODS: A clinic-based prospective study of the pattern of ocular disorders in workers of the Nigerian National Petroleum Corporation in Warri, Delta state of Nigeria was carried out over a 1-year period. Technical and non-technical workers were interviewed and examined using the Snellen's chart, pen-torch, direct ophthalmoscope, slit-lamp biomicroscope, Perkin's hand-held applanation tonometer, and the Kowa automatic visual field plotter where indicated. RESULTS: A total of 154 technical workers comprising 146 males (94.8%) and eight females (5.2%), and 116 non-technical workers comprising 90 males (77.6%) and 26 females (22.4%) were seen. There was no reported case of ocular trauma. Symptoms suggestive of ocular irritation were much more common in technical workers. Allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea were significantly more common in technical workers P<0.0001. CONCLUSIONS: Exposure to irritant chemicals in the petroleum industry makes the technical workers more prone to allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea. Protection goggles should be provided for all the technical workers.

Problems of management of primary congenital glaucoma in Benin City, Nigeria.

OBJECTIVES: To determine the problems encountered in the management of primary congenital glaucoma in developing countries. METHODS: A prospective study of new patients with a diagnosis of primary congenital glaucoma attending the eye clinic of the University of Benin Teaching hospital, Benin City, Nigeria over a 5 year period, from July 2001 to June 2006. The age, sex, presenting complaints and duration were recorded. They were examined by the aid of a pen torch, hand-held slit lamp and direct ophthalmoscope. Intraocular pressure and corneal diameter were measured under anaesthesia. The patients were followed up till June 2006 and the problems encountered in management were recorded. RESULTS: Eight children comprising 5 males (62.5%) and 3 females (37.5%) with primary congenital glaucoma were seen. All the patients (100%) presented with buphthalmos and 7 (87.5%) had corneal opacity. Four (50%) accepted surgery but only 2 (25%) eventually had surgery. Maximum follow-up was 7 months. CONCLUSION: Presentation with features of advanced disease, poor acceptability of surgery, poor follow-up and low surgical rate are problems associated with the management of congenital glaucoma in Benin City, Nigeria.

Maxillary herpes zoster with corneal involvement in a HIV positive pregnant woman.

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.

Pattern of neuro-ophthalmic disorders in a tertiary eye centre in Nigeria.

AIM: To determine the incidence and types of neuro-ophthalmic disorders at the eye clinic of University of Benin Teaching Hospital, Benin City, Nigeria. METHODS: All the new patients presenting to the eye clinic of the University of Benin Teaching Hospital between May 2001 and April 2003 with neuro-ophthalmic disorders were interviewed, examined and investigated when possible. They were analysed in the context of age, gender, diagnosis, major clinical features and visual acuity. RESULTS: A total of 76 patients with neuro-ophthalmic disorders were seen among a total of 1,698 new patients giving an incidence of 4.47%. The most common disorders were motor nerve palsies (27.6%), optic neuropathies (22.4%) and migraine (14.5%). The most presenting features were poor vision (39.5%), double vision (18.4%) and headache (17.1%). Twenty-nine patients (38.2%) were blind in the affected eye. CONCLUSION: The incidence of neuro-ophthalmic disorders is relatively low but constitute a significant cause of ocular morbidity and blindness. Improvement in diagnostic facilities and awareness are required.

A review of the risk factors in primary open angle glaucoma.

The aetiology of primary open-angle glaucoma is still uncertain. However certain factors are known or suspected of having an aetiologic role. These are known as the risk factors. These include higher intraocular pressures, black race, old age especially after the age of 40 years, the peculiar larger optic disc structure of black people, a positive family history, vascular factors such as systemic hypertension, perfusion pressure, vasospasm, atherosclerosis and acute hypotension which is a risk factor for normal-tension glaucoma. Others are diabetes, which is prone to selection bias, myopia, a history of typical migraine headaches, thinner central corneal thickness and the ability to taste phenylthiourea. If a particular patient is identified as having one or more of these risk factors, that patient is by definition, at greater risk of developing glaucoma than a patient who does not.

Ophthalmic mortality in a tertiary centre in Nigeria.

OBJECTIVES: To determine the mortality rate of ophthalmic ward patients and the causes of death. METHODS: A retrospective study of all ophthalmic patients admitted into the ophthalmic wards of the University of Benin Teaching Hospital, Benin City between May 1989 and April 2005 was conducted. The case records of all ophthalmic deaths were analysed. The age, sex, diagnosis and cause of death were recorded. RESULTS: A total of 1854 patients were admitted into the ophthalmic ward comprising 1,057 males (57%) and 797 females (43%) giving a male-to-female ratio of 1.3:1. There were 7 deaths in the ophthalmic wards during the period giving a mortality rate of 3.8/100 admission. Three patients (42.8%) were being managed for orbital cellulitis, 2 patients (28.6%) had malignant tumours and the remaining 2 patients (28.6%) had cataract extraction. CONCLUSION: The mortality rate in the ophthalmic ward was low. Deaths could be prevented by early presentation, adequate preoperative screening, good nursing care, high index of suspicion by clinicians and provision of affordable drugs for life-threatening conditions.

Hereditary wide angle exotropia in a nigerian family.

AIM: To present a report of a Nigerian family with wide angle exotropia resulting in amblyopia. METHODS: A family of two wives and 12 children from Benin City, Edo State, Nigeria were interviewed and examined at the University of Benin Teaching Hospital, Benin City with the aid of a Snellen's chart, pen torch, slit lamp biomicroscope, ophthalmoscope and the pulsair non-contact tonometer. RESULTS: There was 450 exotropia in the right eye of the 72 year old father, his 36 year old son, his 22 years old daughter and their 24 year old half sister. There was restriction of ocular motility in the right eye medially and some degree of amblyopia in the right eye of all the patients. The father and his 22 years old daughter were myopic of between -4.00 and -6.00 dioptre sphere but the son and his 24 years old half sister had -0.75 and -1.00 dioptre sphere myopia respectively. None of them presented to hospital because of the strabismus. CONCLUSION: This report highlights the need to screen family members of patients with squint in order to detect the condition early and prevent amblyopia.

Ophthalmic manifestations of lymphoma.

BACKGROUND: Ophthalmic involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an intraocular manifestation of systemic lymphoma. This report reviews the ophthalmic manifestations of lymphoma. METHODS: Review of relevant information from journal articles and Internet search. RESULTS: Almost all the structures in the orbit, adnexiae and eye can be involved in lymphoma. Lymphoma of the eye and adnexiae are most frequently of B lineage. Most of the ocular manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis, uveitis, multiple evanescent white dot syndrome, acute retinal necrosis or herpetic retinitis. Correct diagnosis thus depends on a high index of suspicion and frequently requires radiologic imaging, histologic analysis, particularly vitreous biopsy or flow cytometry, subretinal aspiration and retinal biopsy. Diagnosis is often delayed and may lead to a fatal outcome. Recognition of its modes of presentation facilitates early diagnosis and treatment that may improve prognosis. CONCLUSIONS: It is important to review the ocular manifestations of lymphoma to assist the ophthalmologist to play a pivotal role in the prompt diagnosis and treatment of ocular lymphoma, and the haematologist/oncologist to recognize the need for a complete ophthalmic evaluation in the diagnosis, follow-up and management of lymphoma patients.

Ophthalmic manifestations of multiple myeloma.

BACKGROUND: The ophthalmic manifestations of multiple myeloma can be seen in practically every ocular structure. Ocular findings may be the first manifestations of the disease. It may also occur as one of the extramedullary manifestations of the disease or as the first sign of insufficient chemotherapy. Multiple myeloma may cause ocular pathology by direct infiltration or as extramedullary plasmacytomas resulting in displacement or compression of tissues, by causing hyperviscosity syndrome, and by immunoglobulin light chain deposition in ocular tissues. OBJECTIVE: To outline the ophthalmic manifestations of multiple myeloma. METHODS: Information about multiple myeloma and ophthalmic manifestations was obtained from original journal articles, review articles, case reports and standard postgraduate textbooks. RESULTS: Ophthalmic manifestations include proptosis, diplopia, lid ecchymosis, xanthomatosis, conjunctival and corneal crystalline and non-crystalline deposits, scleritis, episcleritis, secondary glaucoma, ciliary body cysts, ciliochoroidal effusion, uveal plasmacytoma, hyperviscosity retinopathy, retinal vasculitis, detachment of sensory retina and retinal pigment epithelium, and neuro-ophthalmic manifestations. CONCLUSIONS: In multiple myeloma, it is necessary to take a closer look at the ophthalmic manifestations, both because of their local morbidity and because they might act as a reservoir for proliferation of myeloma cells and eventual systemic relapse. Early detection may permit safer and effective treatment. All patients with multiple myeloma should thus undergo thorough ophthalmic examination at the time of initial diagnosis and during follow-up.

Non-Laser Management of Post-Extraction Opacification of the Posterior Capsule

The objective of this study is to describe an alternative procedure to laser for the management of posterior capsule opacifications after extra capsular cataract extraction and posterior chamber intraocular lens implantation. Thirty-one patients with posterior capsule opacification had non-laser secondary capsulotomy. The procedure was performed with the aid of a 25 G capsulotomy needle through the opening of the peripheral iridectomy after injection of visco elastic between the posterior capsule and the intraocular lens. There was improvement in the visual acuity of all the patients and there was no significant intraoperative or postoperative complications. The technique described provides an alternative to Nd: yag Laser capsulotomy particularly in centers that do not have yag laser facilities