Indications for destructive ocular surgeries in Nigeria.

INTRODUCTION: Destructive ocular surgery (DOS) means eye loss. An audit of its indications would be useful in reducing its incidence. OBJECTIVE: To determine indications for destructive ocular surgeries. MATERIALS AND METHODS: The case records (files) of all the patients who had DOS in a tertiary health facility in Nigeria from January 2004 to December 2011 were reviewed retrospectively. The information extracted include the bio data, indication for DOS, type of surgery performed and history of the use of traditional eye medications (TEM) and willingness to use an artificial eye (AE). RESULTS: Thirty-seven patients had DOS. The mean age of the patients was 35.51years (SD 21.6) and the male to female ratio was 2.1:1. Evisceration was the commonest DOS performed , in 30 eyes (81.1 %). The most common indication for DOS was intraocular infection, in 15 eyes (40.5 %), followed, among others, by trauma in 13 (35.1 %) and malignant ocular tumours in 4 (10.8 %). There was association between age and indication for DOS (P = 0.032). Many patients, 15 (40.5%), used TEM and most, 34 (91.9%), refused an artificial eye (AE) after surgery. CONCLUSIONS: The most common indication for DOS in this study was intraocular infection. Evisceration was the commonest destructive eye surgery offered.

Poor cataract surgical output: eye care workers perspective in north central Nigeria.

BACKGROUND: Cataract remains a disease of priority being the leading cause of blindness globally. Although surgically curable, cataract surgical output has remained low in Nigeria, Kwara state inclusive. A study was carried out to investigate the perception of eye care workers (ECW) on low surgical output and their adjudged reasons; this has hitherto not being evaluated. MATERIALS AND METHODS: A cross-sectional quantitative survey with the aid of pretested structured questionnaire of all ECW and qualitative survey using in-depth interview on selected workers in Kwara State, Nigeria was done. RESULTS: A total of 142 out of the 157 ECWs (90.5%) working in the 14 surgical eye centers in the state were interviewed with a mean age of 40.37 years, SD ± 8.67. There were 94 (66.2%) females, with a female to male ratio of 2:1. 91 (64.1%) participants were of the opinion that the numbers of cataract surgeries in the state were inadequate. Hospital-based and human resource efficiency-related issues such as long clinic waiting time, multiple paying and procedural sites, poor staff mix, and gaps in available human resource were the major reasons given for low cataract output. Others reasons were high cost and fear of surgery, distance of eye clinics from patients. CONCLUSIONS: Regular operational researches, proper deployment, and efficient use of human and material resources in addition to subsidized cost and appropriate health education to allay fear of surgery are steps that could enhance cataract surgical output.

Minimising corneal scarring from the use of harmful traditional eye remedies in developing countries.

Corneal scarring is the fourth largest cause of blindness globally, and a much more prominent factor in developing countries. Blindness from corneal scarring is largely a preventable phenomenon, and is capable of causing significant morbidity that can last for a lifetime. A significant proportion of these cases are caused by the use of harmful traditional eye medicines/remedies, and are used and prescribed by friends, relatives and traditional healers, with widespread use especially in developing countries. Use of traditional remedies can also cause harm indirectly by causing delays before seeking medical treatment. Reducing corneal scarring from the use of harmful traditional medicine is through a combination of approaches with the key strategies being community diagnosis, education, participation, and intervention, with provision of basic eye care integrated into the primary health care of the community. Collaboration with traditional healers in the community is also another approach that has been found to be useful.

Minimising cornea scarring from the use of harmful traditional eye remedies in developing countries.

Corneal scarring is the fourth largest cause of blindness globally, and a much more prominent factor in developing countries. Blindness from corneal scarring is largely a preventable phenomenon, and is capable of causing significant morbidity that can last for a lifetime. A significant proportion of these cases are caused by the use of harmful traditional eye medicines/remedies, and are used and prescribed by friends, relatives and traditional healers, with widespread use especially in developing countries. Use of traditional remedies can also cause harm indirectly by causing delays before seeking medical treatment. Reducing corneal scarring from the use of harmful traditional medicine is through a combination of approaches with the key strategies being community diagnosis, education, participation, and intervention, with provision of basic eye care integrated into the primary health care of the community. Collaboration with traditional healers in the community is also another approach that has been found to be useful.

Appropriateness of ophthalmic cases presenting to a Nigerian tertiary health facility: implications for service delivery in a developing country.

OBJECTIVE: To assess whether the ophthalmic cases presenting at a Nigerian tertiary eye unit are appropriate for such level of care and also draw necessary implications for service delivery. METHODS: Data on 1321 consecutive new patients that presented at the ophthalmic clinic of the University of Teaching Hospital, Ilorin, Nigeria between February and July 2005 were reviewed on demographics, referral routes, and reasons for patronage, diagnoses and disease categories. Information on the general situation of health infrastructures prevailing at the surrounding health facilities was collected from key-informants. RESULTS: One thousand and ninety-one (82.6%) presented without any referral and 1095 (82.9%) patronized in order to access perceived good quality of eye care service being rendered. However, only a small proportion of their ailments (191, 14.5%) actually required attention at the tertiary level of eye care. The key informants painted a picture of severely-challenged general and health infrastructures particularly at the primary health care facility level. CONCLUSION: An overwhelming majority of ophthalmic patients directly accessed eye care at the tertiary level, even though most of their ailments could have been satisfactorily treated at the lower facilities of health care were the latter to be functioning optimally. A better coordinated and strengthened health care system, particularly at the primary and secondary health care facilities would ease the burden of inappropriate presentations on tertiary health facilities in Nigeria.

Awareness and knowledge of eye care providers among government workers in Ilorin, Nigeria.

OBJECTIVES: Often the public cannot differentiate among eye care providers with adverse effect on ocular health. This is to ascertain awareness and knowledge of Nigerian public workers about eye care providers. METHODS: Structured self administered questionnaire on respondents' socio-demography, awareness and knowledge about eye care providers was distributed to 500 consenting public workers in Ilorin, Nigeria. RESULTS: Four hundred and fifty one respondents, aged 20 to 57 years comprising 213 (50.8%) men and 206 (49.2%) women participated. Majority 348 (87.9%) had tertiary education while the remaining had at least primary education. Most respondents 392 (88.9%) were aware of the availability of eye care providers while 49 (11.1%) were unaware. Based on their knowledge of the eye care providers, three categories of respondents emerged: majority had correct perception, some had wrong perception and some knew nothing about eye care providers. The level of education was found to be significantly associated with the level of awareness and knowledge of the respondents (p< 0.05) while gender was not (p>0.05). CONCLUSION: Despite the majority of the respondents having good perception of eye care providers, the respondents who had wrong perception and those who were oblivious of eye care providers could be draw backs to eye health care.

Knowledge and attitude of guardians towards eye health of primary school pupils in Ilorin, Nigeria.

OBJECTIVE: To determine guardians' knowledge and attitude towards pupils' eye health and draw implication for designing children-oriented ocular health messages. METHODS: A survey of 1,393 guardians selected through multistage random sampling in Ilorin, Nigeria. Using structured questionnaire, information sought included guardians' demographic characteristics, relationship to pupils, occupation, awareness of eye specialists, perception of normal vision, pupils' eye complaints, and ways of treating children eye conditions. Data analysis was done with SPSS 12.0.1. The test of significance was performed using Chi square test and significance was taken at p < 0.05. RESULTS: Guardians comprised 689 (49.4%) males and 704 (50.6%) females, mean age 43.61 SD 11.45. Most (88.54%) were pupils' parents and (11.46%) were relations (n=1,318); (55.15%) were in low-paying occupations (n=1,311); (87.92%) were aware of eye specialists, (12.08%) unaware, (n=1192); (97.27%) adjudged normal vision at least important, (2.73%) not important (n=1,174). Pupils' eye complaints (n=914) included pain (26.04%), itching (24.73%), redness (21.12%), discharge (8.53%), blur vision (8.21%), photophobia (7.33%) and lacrimation (4.05%). Guardians (n=1,069) managed pupils' eye diseases using hospital treatment (61.65%), neglect (21.33%), self medication (9.26%) and traditional medication (7.76%). There were no significant associations between guardians' ways of managing pupils' eye diseases and their views on normal vision (p = 0.940); awareness of eye care specialists (p = 0.952); and economic occupational grouping (p = 0.959). CONCLUSION: The negative implications of neglecting eye diseases and use of self and harmful traditional eye-medications by some of the guardians need to be discouraged by appropriate eye health education.

Causes of childhood blindness at ECWA Eye Hospital, Kano, Nigeria.

The study aimed at identifying the causes of childhood blindness at ECWA Eye Hospital, Kano. The causes of visual loss in 31 consecutive patients aged < or = 16 years who attended the ECWA eye Hospital between 1993 and 1996, who had vision of < 3/60 in the better eye were recorded. The eyes were examined with a slit lamp or flashlight a loupe, and an ophthalmoscope. The intraocular pressure was taken with either a Schiotz or an applanation tonometer. There were 14 males (45.0%), the mean age was 6 years; range: 1 to 15 years. Corneal causes were responsible for blindness in 54.8%. Measles was responsible for 10 cases; neonatal infection was responsible in 2 cases. Four cases were due to lens lesions. By aetiologic category, childhood factors accounted for (32.3%). The causes in 51.7% were not known. Hereditary factors and perinatal factor accounted for 6.4% cases each. Intrauterine factors were responsible for 1 case. Eighteen (58.6%) of the cases were due to avoidable causes; 12(38.4%) being preventable and 6(19.2%) treatable. The causes of childhood blindness in this study are consistent with those of low economic region with high prevalence of avoidable blindness.

Fulfilling human resources development goal in West Africa: can the training of ophthalmologist diplomates be improved?

OBJECTIVE: To ascertain the perspectives of Trainee Ophthalmologist Diplomats (TOD) on the Ophthalmic Diploma Training (ODT) in West Africa with a view to improving the programme. METHODS: A survey of set 2005 TOD on ODT was carried out in Ghana, 2006. RESULTS: The trainees included 10 (83.35%) males and two (16.7%) females whose ages ranged between thirty-two and fifty-one years. The sponsors of the trainees included Sight Savers International, five (41.7%); Christian Blind Mission International, three (25.0%); Eye Foundation, Lagos, Nigeria two (16.7%); Ministry of Defence Nigeria, one (8.3%); and Health Authority Ghana, one (8.3%). Nine trainees (75.0%) felt the programme was well structured, training allowances were adequate eight (66.7%) and inadequate four (33.3%). Eleven (91.7%) trainees would work wherever they were posted; ten (83.3%) trainees had sense of fulfillment and three (25%) would like to proceed for residency training. All trainees were at least good in chalazion surgery and treatment of common medical eye conditions. Majority were at least good in eye surgery like cataract, eleven (91.7%); trabeculectomy nine (75.0%); pterygium 10 (83.3%); eyelid, eight (66.7%); destructive 11 (91.6%) and refraction 9 (75.0%). Some trainees' perceived problems included inadequate sponsorship (33.3%), short duration of the course four (33.3%) and poor accommodation facility two (16.7%). However, trainees' suggested increase in training posts, four (33.3); training allowance three (25.0%); and incentives for trainers/training hospitals two (16.7%). CONCLUSION: The ODT programme ensures ophthalmic manpower for secondary eye care level despite challenges. The stakeholders should look into problems facing the programme in order to improve it.

Community eye health module in West Africa: the trainee ophthalmologists perspectives.

BACKGROUND: Training programmes require regular evaluation both by the organisers and the trainees. OBJECTIVE: To ascertain the perspectives of trainee Ophthalmologists about a Community Eye Health (CEH) module in West Africa. METHODS: A cross sectional survey of trainee ophthalmologists attending CEH course in 2006, using structured self-administered questionnaires was carried out. Information sought through the questionnaire included age, sex designation, training stage and suggestion about the training programme. RESULTS: Twenty-three (85%) believed that the CEH programme was very relevant to Ophthalmology, 20 (74%), decried inadequate sponsorship, 20(74%) wanted module duration reduced, 18 (67%) rated resource persons good, while 23 (85%) wanted MSc (CEH) introduced in West Africa. In addition, the trainees rated CEH module organization good 14 (52%), viewed course content adequate 16 (59%). Regarding opinion on registration fees, 15 (56%), felt it was quite acceptable, and seven(26%) felt it was expensive. Improvement was suggested in the areas of accommodation, lecture schedule, kitchen schedule as well as of course manual. CONCLUSION: Most of the trainees believe CEH is important to Ophthalmology, rate most of the resource persons as being good, want course duration reduced, decry inadequate sponsorship and wanted MSc (CEH) programme introduced in West Africa. Improvements in areas like accommodation, feeding, delivery of module manual and lecture schedule are suggested.

Ophthalmic surgical patients: what additional information do they require before surgery?

BACKGROUND: It has been observed that often, post-operative eye patients still ask questions expected to have been addressed in the pre-operative routine clinic information. OBJECTIVE: To find out additional information that ophthalmic surgical patients require before surgery. METHODS: A survey of 103 post-operative ophthalmic patients was carried out using an interviewer administered semistructured questionnaire at three different hospitals in Kwara State of Nigeria between July 2005 and September 2006. Information sought included age, sex, ethnicity, and the type of eye surgery the patients had. Patients were to indicate what other information apart from those that had been given (routine information in the clinic) they would like to have had prior to surgery. RESULTS: One hundred and three patients consisting of 63 males and 40 females with an age range of 20 to 99 years were surveyed. Additional information required by the patients included duration of surgery 49 (47.6%), duration of hospital stay after surgery 70 (69%), and major complications of surgery 38 (36.9%). One patient each wanted information on period of convalescence at home before resuming work, authentic (written) cost of surgery, causes of the disease and chances of recurrence of the disease. CONCLUSION: Ophthalmic surgical patients require further information apart from routine clinic information on their surgeries. The need to improve on the present way of information transfer to the prospective ophthalmic surgical patients is underscored.

Pattern of ocular trauma among primary school pupils in Ilorin, Nigeria.

To report the pattern of ocular trauma among school pupils in Ilorin, Nigeria, a cross sectional survey of primary school children in 10 randomly selected primary schools within Ilorin, Nigeria was carried out between July 2005 and January 2006. Relevant ocular history and basic ocular examinations were carried out on the children that were selected from a multi-stage sampling process. Diagnosis of ocular trauma was based on historical recollection together with corroborating ocular signs among affected pupils. Ocular trauma was found among 11 (8 boys and 3 girls) out of 1393 (0.8%) pupils and their ages ranged from 5 to 13 years. The trauma related ocular pathology found among the 11 pupils included unilateral phthisis bulbi (2, 0.14%), couching (1, 0.07%) and retinal detachment (1, 0.07%) all leading to blindness in the affected eyes. There was also a unilateral visual impairment caused by traumatic optic atrophy. Others included eyelid bruises (2, 0.14%) and one pupil (0.07%) each with hyphema, eyelid ecchymosis, eyelid laceration, and subconjunctival haemorrhage. The ocular trauma occurred following unsupervised play (4, 36.40%), corporal punishment at school and at home (3, 27.30%), fight (2, 18.20%), home accident (1, 9.10%) and couching (1, 9.10%). School pupils can lose vision to preventable traumatic eye injuries both at school and at home. Measures to minimize ocular trauma both in the home and at school are advocated.

Conjunctival Kaposi's sarcoma in HIV-positive heterosexual Nigerian woman--a case report.

BACKGROUND: Neoplastic conditions are increasingly been encountered in HIV/AIDS patients. Till date only two cases of conjunctiva Kaposi sarcoma (KS) have been reported in the background of HIV and both in males. OBJECTIVE: To present a 27-year-old African woman with histologically proven conjunctival KS and marked CD4+ cell depletion and to reinforce the fact that KS is an important differential of conjunctival tumour especially in the background of immunosupression in Africa. METHODS: A 27-year-old housewife, presented to the hospital with a three-month history of a rapidly growing tumour attached to the right upper eyelid, cough and weight loss. Patient was given full workup including x-rays, HIV status determination and histological assessment. RESULTS: She was markedly wasted, with widespread pruritic papular skin lesion, and florid oropharyngeal candidiasis. Clinical and chest x-ray findings were suggestive of bilateral lower lobar pneumonia. Screening and confirmatory tests were positive for human immunodeficiency virus (HIV) with CD4+ lymphocyte cell count of 120 cells/ml. Histologic report of the biopsy revealed the mass to be a conjunctival KS. Patient was subsequently commenced on antibiotics and antiretroviral combination therapy. The mass had regressed in size considerably along with improvement in her clinical condition at six months review. She is still being followed up at the medical clinic. CONCLUSION: This is the first reported case of conjunctival KS in an HIV positive African woman. KS should be considered as a possible differential of conjunctiva mass, especially if the patient is HIV positive irrespective of patient's gender.

Ophthalmology training in Nigeria: the trainee ophthalmologists' perspective.

OBJECTIVE: To know the perspective of trainee Ophthalmologists on the present state of Ophthalmology training in Nigeria. MATERIALS AND METHODS: Semi structured questionnaires were administered on trainee ophthalmologists from 13 different training centres across Nigeria during revision courses and Fellowship examination in year 2004. Included were age, sex, training levels and number of year in training. Also assessed were information on acquisition of theoretical knowledge, surgical and managerial skills as well as availability of relevant ophthalmic resource materials and equipment in their training institutions. Suggestions on the ways to improve the training in Nigeria were also noted. RESULTS: There were 51 trainees with ages ranging from 29 to 51 years, with a mean of 34.65 (S.D+4.76) year. The male to female ratio was 1.6:1. There were 18 (36%) senior registrars, 31 (62%) registrars and 1 (2%) senior house officer. The period spent in training varied from 2 months to 10 years with a mean of. 3.6 years (S.D+2.2). Acquisition of theoretical knowledge was judged to be adequate by 48 (98%) of trainees. Also acquisition of surgical and managerial skills as well as availability of qualitative ophthalmic resource material were judged to be adequate by 35 (68.7%), 40 (81.6%) and 38 (74.5%) trainees respectively. Suggestions among others include improvement in quantity and quality of ophthalmic resource materials, high volume ophthalmic surgery to aid surgical skill acquisition and structured training programme. CONCLUSION: Ophthalmology training in Nigeria offers adequate theoretical knowledge and managerial skills acquisition. However, there is the need for further improvement in the area of surgical and diagnostic skills transfer and acquisition as well as availability of quality ophthalmic resources and a well-structured training programme in all the centres.

Non-gonococcal bacterial agents of conjunctivitis and their antibiotic susceptibility patterns in Ilorin, Nigeria.

Periodic bacteriological surveillance of purulent ocular discharge is a necessity. To determine the prevalent bacterial agents of purulent conjunctivitis and their antibiotic susceptibility patterns at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. All bacterial isolates obtained during routine processing of conjunctival swab specimens were studied at the Department of Microbiology UITH between January and December 2004. The isolates were obtained after inoculation of the specimens onto blood, chocolate and MacConkey agar plates, incubated at 37 degrees C for 18-24hours under aerobic conditions except for chocolate agar plates which were kept in candle extinction jar. The isolates were identified using a combination of colony morphology, biochemical and/or serological tests as applicable. Antibiotic sensitivity testing was performed using the modified Kirby Bauer method. One hundred and four conjunctival swabs from 104 patients were analysed and 72 were bacteriologically positive, giving prevalence rate of 69.2%. The positive samples were from 42 males and 30 females with M:F ratio of 1.4:1. The age range was from 5 hours of life to 80 years. Well over half (61.1%) of the swabs were from neonatal age group. The isolated organisms included Staphylococcus aureus 43.1%, Klebsiella pneumoniae 22.2%, Pseudomonas aeruginosa 3.9%, Streptococcus pneumoniae 11.1%, and Escherichia coli 9.7%. Most of the isolates were sensitive to fluoroquinolones while erythromycin has the least bacterial coverage. The most common bacterial agent of purulent conjunctivitis in Ilorin is Staphylococcus aureus and fluoroquinolones have the best coverage for common bacterial agents of purulent conjunctivitis.

The choice of ophthalmology as a career among Nigerian medical interns.

To determine the choice of ophthalmology as a career among Nigerian medical interns, structured questionnaire was administered to a set of medical interns at the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State in the year 2003. The key information sought included the University attended, duration of undergraduate ophthalmology posting, perception of ophthalmology as a specialty, and the choice of postgraduate specialty in order of preference. Also included were improvements they would like to see in the undergraduate teaching of ophthalmology and whether they support the view that interns should have mandatory clinical rotation in other surgical subspecialties like Ophthalmology and Otorhinolaryngology. Seventy-six interns who graduated from seven Nigerian medical schools participated in the study. Average duration of their undergraduate posting in Ophthalmology was 4 weeks. (SD = 3.327). Fifty (67.6%) considered Ophthalmology as an interesting and important specialty, 6 (8.1%) regarded it as a boring specialty, while 18 (24.3%) considered it as just one specialty in their curriculum. Only 5 (6.6%) of the respondents chose Ophthalmology as first choice career while 16 (21%), 14 (18.4%), 13 (17.1%) and 10 (13.2%) chose Surgery, Paediatrics, Community Health and Obstetrics and Gynaecology respectively. 78% of the respondent suggested that interns should have clinical rotation in surgical subspecialties such as Ophthalmology. Other suggestions offered included the need to increase the duration of undergraduate Ophthalmology posting, provision of audiovisual aids and more equipment like Ophthalmoscope for teaching. The interns considered Ophthalmology posting as an important and interesting specialty even though only a few chose it as their future career. There is therefore an urgent need to improve the undergraduate teaching of Ophthalmology. The Medical and Dental Council of Nigeria (MDCN) should make rotation through Ophthalmology a part of the internship curriculum. These measures may increase the interest of medical students and interns alike in Ophthalmology as a career.

Ocular and visual complications of head injury.

PURPOSE: To evaluate the pattern of ocular and visual complications of head injury. METHOD: A prospective study of 225 head-injured patients managed at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. For the purpose of extracting visual complications, a Neurosurgeon and an Ophthalmologist examined each patient and appropriate investigations were carried out. Patients with ocular morbidity were analysed for age, sex, cause of injury, admission Glasgow coma score, and associated injuries in addition to findings at ophthalmic and neurosurgical evaluations. RESULTS: Two major types of ocular and visual complications were observed in 57 (25.3%) of 225 head-injured patients studied. Soft-tissue injury to the globe and adnexae included periorbital ecchymosis, subconjuctival haemorrhage, lid laceration, or rarely globe rupture in 29 patients. Neuro-ophthalmic ocular cranial nerve palsies occurred in 28 patients, while orbital fracture was encountered in two patients. Ocular injuries were multiple in 60% of cases. The patients, comprising 37 male and 20 female subjects, were aged 9 months to 57 years (mean=28 years). Traffic accident was the leading cause of head injuries (84.2%), while fall from height (7%), assault (7%), and gunshot (1.8%) were miscellaneous causes. CONCLUSION: Injury to the globe and adnexae and ocular cranial nerve palsies constitute the most common oculovisual complications following head injury in our centre.