Status of children in blind schools in the northern areas of Pakistan.

BACKGROUND: Prevalence of blindness in Pakistan is estimated to be 0.9%, which comes to about 1.25 million persons. A significant number of these are persons under 20 years of age. To make these children useful citizens in future, special facilities are to be provided to these children for their education and training. A study was done to find out the visual status of the students studying in a blind school in Abbottabad, Pakistan, the only such facility in the region. METHOD: A total of 50 patients were examined during our visit to the blind school in Abbottabad. Age of the patients ranged from 6 to 27 years (mean: 12.32 years). All the students, who were otherwise healthy, were included in the study. RESULT: The most common disorder identified was malformed globe or traumatic eyes (16 cases, 32%), in most of the cases, leading to phthisis bulbi. Other conditions noticed were Retinitis Pigmentosa (10 cases, 20%), Keratoconus, Optic atrophy, Buphthalmos (6 cases each, 12%), corneal opacity (4 cases, 8%) and retinal detachment (2 cases 4%). CONCLUSION: We should work towards betterment of these schools by providing them with more funds, equipment and manpower. Regular visits of Ophthalmologists to these schools may be helpful. Genetic counselling should be arranged for the families.

An unusual case of bloody tears.

Conjunctival bleeding is usually caused by non accidental or accidental conjunctival laceration, conjunctival tumors and nasolacrimal sac tumors. We report here a rare case of conjunctival bleeding which was self induced using cinnamon bark.

Recurrent episcleritis in children less than 5 years of age.

BACKGROUND: Episcleritis, though common in adults, is a rare disease in children. Episcleritis is associated with systemic diseases in a third of cases in adults. Here we describe systemic diseases associated with recurrent episcleritis in children less than five years of age. METHODS: This Retrospective Observational case series study was conducted at the Department of Ophthalmology of Ayub Teaching Hospital, Abbottabad, from March 1995 till February, 2006. Six children diagnosed clinically with recurrent episcleritis were included in this study. Complete ophthalmologic as well as systemic evaluation was done in each case. RESULTS: This study was conducted on 6 children with a diagnosis of recurrent episcleritis. There were four boys and two girls, with an age range of 35-52 months. Right eye was involved in three cases, left eye in two cases while one case had a bilateral disease. Recurrence occurred in the same eye in all cases, with one bilateral involvement. Four children (66%) had a history of upper respiratory tract infection in the recent past. No other systemic abnormality was detected in any case. Two cases had a history of contact with a pet animal. CONCLUSION: Recurrent episcleritis in young children is a benign condition. Upper respiratory tract infection is the most common systemic association. Pet animals may be a contributory factor.

Eclipse retinopathy: follow up of 36 cases after April 1995 solar eclipse in Pakistan.

BACKGROUND: A study was carried out at the Department of Ophthalmology Ayub Medical College, Abbottabad from April 1995 to April 2002 to study the visual acuity changes in patients of solar eclipse retinopathy. METHODS: Thirty-six patients with solar eclipse retinopathy were seen. Examination included assessment of Visual Acuity (VA), Slit Lamp examination, Fundoscopy, Fundus Photography and Fundus Fluorescein Angiography where the VA was 6/60. The patients were seen at weekly intervals then at monthly interval and later annually. RESULTS: Poor visual acuity was seen in all patients, after images in 28 patients, Erythopsia in 25 patients and Central Scotoma in 23 patients. Eye involvement was unilateral in 27 cases and bilateral in 9 cases. Twenty-nine patients were male and 7 patients were female. The commonest age group was between 10-30 years. CONCLUSIONS: Complete recovery was seen in 26 patients, 7 made partial recovery while in three patients the visual acuity remained poor. Maximum recovery occurred between two weeks to six months. After six months, no changes in the visual acuity or macular lesion were noticed.

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan.

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.