Uniocular Blindness among Children in the Gambia

Background: Uniocular blindness in children though not uncommon has not been given prominence; as emphasis is placed on binocular blindness.Aim: To determine the common causes of uniocular blindness in children; and to suggest strategies for prevention.Methods: A prospective study involving children seen at the Eye Clinic of the Royal Victoria Hospital; The Gambia was undertaken; from the 1st December 1999 to 30th June 2000. All newly diagnosed cases of children who attended the clinic and were blind in one eye during the period of the study were included. A history was taken; visualacuity using age specific methods and ocular examinations were carried out. When necessary an examination under anaesthesia was performed.Results: Out of 470 children; 45(10) had uniocular blindness; 39(86) were aged 6-15years. The male - female ratio was 4:1. Common causes were trauma 28(62); uveitis 4(9); and corneal ulcer 3(7) . Others included congenital cataract; glaucoma and retinoblastoma.Conclusion: The commonest cause of uniocular blindness was ocular trauma. Focus should be directed towards the prevention; early referral and appropriate treatment of ocular trauma in children. Strategies for the prevention of childhood blindness would also be applicable to uniocular blindness in The Gambia

Types of Glaucoma and recent trends applied in treatment: Observations from a Glaucoma Training Workshop in the Gambia.

OBJECTIVES: To determine types of glaucoma seen and the recent trends applied in treatment, a retrospective non-comparative case-series study was conducted in the Eye Unit of the Royal Victoria Hospital, Banjul, The Gambia. METHODS: The records of the 88 patients(145 eyes) seen during the glaucoma training workshop(organised by Prof.James Standefer, a clinical ophthalmologist from Minneapolis, U.S.A.) which held between 3rd and 14th of September, 2001, were analysed for types of glaucoma and treatment given. All but one patient who was a baby underwent the following tests: visual acuity measurement using the illiterate E-Chart with multiple optotypes; tonometry using the Schiotz tonometer with the 5.5g weight; oblique flashlight test; Van Herrick's estimation of the angle depth; pupillary reactions to light; Slitlamp biomicroscopy; gonioscopy using the 4-mirror pressure gonioprism; fundoscopy using the +78D Volk lens and confrontational visual field analysis. RESULTS: 27 eyes did not have definite glaucoma. Out of the remaining 118 eyes, 65(55.08%) had POAG;17(14.41%)ACG out of which 8 were CACG and 2 acute ACG. 8 eyes had pseudoexfoliation of the lens capsule with or without glaucoma. In the frail and elderly, guttae Timoptol 0.5% was given once daily. 27 eyes had trabeculectomy; all were with releasable sutures and intraoperative application of 5-Fluorouracil. 3 eyes had laser trabeculoplasty and 5, diode laser transscleral cyclophotocoagulation. CONCLUSIONS: POAG was the commonest type of glaucoma seen. Pseudoexfoliation of the lens capsule with or without glaucoma and ACG are not very rare in The Gambia. In the frail and elderly, guttae Timoptol 0.5% was given once daily and none at all in painless glaucoma-blind eyes. Trabeculectomy with releasable sutures and intraoperative application of 5-FU has a very satisfactory pressure-lowering effect. KEYWORDS: glaucoma; treatment; the Gambia.

Understanding the community perspectives of trachoma: The Gambia as a case study.

Trachoma has justifiably attracted an incredibly large amount of research interest and literature over the last several decades. Perhaps, the area which is least explored is the social aspect of the disease. Most of the major constraints to trachoma control on the global scale appear to be concerned with this aspect of the disease. Recently, a study was conducted in The Gambia with the aim of highlighting the socio-cultural determinants of trachoma. We applied qualitative methods of Focus Group Discussion and Semi-structured interview to explore the local people's concepts of the disease among two traditional ethnic groups, the Jolas and the Manjagos, in five rural communities. Our results show that there appears to be a poor understanding of the chronic nature of the active inflammatory phase of trachoma among the local people. But more importantly, there is a lack of mental connection between this childhood infection and blindness resulting from trichiasis in adults. This probably explains why it is difficult for the people in these communities to see the need for prolonged use of antibiotic eye ointment as required in the treatment of active inflammatory trachoma. Moreover, the local concepts about the cause(s) of the disease tend to compel the people to seek the traditional herbal remedies first, though there is adequate knowledge and experience among them that modern methods of treatment may produce cure, as in the case of corrective lid surgery for trichiasis. This ambivalent attitude of the people to health services appear to be a universal phenomenon in many local communities in Africa, and perhaps hinges on the local people's perspective of the disease, which varies from place to place. We conclude that for any intervention strategy to achieve the set goals of eliminating trachoma in spite of these constraints, community support and participation is essential, and in order to achieve this, the health care provider needs to have a better understanding of the community perspectives of the disease.

Tuberculoma of the eye; a case report.

A case of tuberculoma of the eye is reported occurring in a 3-year-old girl. Clinically presenting as a case of leucocoria a pre-operative diagnosis of retinoblastoma was made, necessitating enucleation of the eye. Post-operatively a diagnosis of intraocular tuberculosis was made. The differential diagnosis is discussed and the importance of inclusion of intraocular tuberculoma in the differential diagnosis of retinoblastoma is stressed.