Child Abuse and the Eye in an African Population.

PURPOSE: There is a paucity of data on child abuse and the eye in West Africa. Therefore, a need exists to determine the causes and circumstances surrounding these occurrences and their effects on the eye and vision in a pediatric population. METHODS: A 3-year study of consecutive cases of ocular features that presented to an eye clinic following a history suggestive of child abuse along with any associated eye injury was carried out. Socio-demographic characteristics were obtained, as were the presenting and posttreatment visual acuity, and a full clinical eye examination was also done. RESULTS: Fifty-six children with 56 affected eyes were examined. The male to female ratio was 1.8 : 1; the mean age was 8.25 ± 3.5 years; and the subjects were predominately primary school children 30 (53.6%). The most common ocular disorders were conjunctiva hyperemia (46.4%), corneal abrasion/ulcer (25.4%), hyphema/uveitis (42.9%), retinal detachment (7.1%), sclera rupture (7.1%), and globe perforation (21.4%). The intraocular pressure was raised in 17.9% of participants. Presenting versus posttreatment visual acuities showed normal vision in four (7.1%) vs. eighteen (32.1%), visual impairment in 12 (21.4%) vs. six (10.7%), severe visual impairment in 20 (35.7%) vs. 12 (21.4%), and blindness in 12 (21.4%) vs. 14 (25%), p < 0.001. The most common injurious agents were canes (25.0%) and sticks (17.9%). The people who inflicted the injuries were parents/relatives (uncles) in 35.7% of cases and the children themselves (accidents) in 21.4% of cases. Circumstances predisposing participants to eye injuries were child labor in 39.3% and beatings in 25.0%. Complications were cataracts (25.0%), corneal opacity (39.3%), and retinal detachment (7.1%). CONCLUSIONS: Injuries commonly resulted from canes and sticks used during beatings, as well as from child labor, corporal punishment, accidents, and assaults. Legislation and laws need to be enacted to prevent negative psychosocial and economic impacts on the child, family and country as a whole.

Effects of fasting on intraocular pressure in a black population.

INTRODUCTION: There is a dearth of literature available on the effects of fasting on Intraocular pressure (IOP) among all races and worldwide. OBJECTIVES: To determine the effects of fasting on IOP in a black African population. MATERIALS AND METHODS: A population-based survey utilizing multistage random sampling techniques was carried out among healthy adult Muslims who were examined before and during Ramadan fast in Osogbo, Nigeria. Demographics were obtained, visual acuities, clinical examination of both eyes, and IOPs were done. Weights and waist circumference were measured. Data were analyzed using Statistical Package for Social Sciences ( SPSS) Version 16. Analysis generated frequencies and cross tabulations, whereas statistical significant values were derived using paired sample t-test and P < 0.05. RESULTS: A total of 60 subjects with 120 eyes were examined. Mean age was 42.3 years standard deviation (SD) 16.7, and the male to female ratio was 3:2. Majority were professionals (33.3%). Only 18.3% had less than secondary school education. Over 90% had normal vision (6/5-6/18). Before and during fasting, the mean weights were 65.92 kg SD 12.98 and 65.29 kg SD 12.41 with a reduction of 0.63 kg SD 3.82 (P = 0.214, 95% confidence interval (CI): 0.372-1.626); and the mean waist circumference was 87.20 cm SD 12.39 and 81.78 cm SD 11.65 (P = 0.000, 95% CI 4.128-6.720), respectively. Mean IOPs were 15.98 mmHg SD 3.11 and 14.08 mmHg SD 2.71 before and during fasting, respectively (P = 0.000, 95% CI 0.98558-2.82798). CONCLUSIONS: The study shows that fasting significantly reduced IOP in an ocularly healthy black African population.

Awareness of and Attitude towards glaucoma among an adult rural population of Osun State, Southwest Nigeria.

PURPOSE: To obtain baseline data and assess the level of awareness and attitudes towards glaucoma among rural communities of Osun State, Nigeria. MATERIALS AND METHODS: This was a community-based study that involved interviews and descriptive cross-sectional analysis. Serial-recruitment was performed of consenting participants who presented at a community-based screening service in March 2011. Socio-demographic data and information about glaucoma were obtained through face-to-face semi-structured questionnaires. RESULTS: The study population comprised 259 respondents (mean age 49.73 ± 16.6 years; range 18 to 90 years). There were 159 females (61.4%). Skilled workers were the most common 130/259 (50.3%) participants. Only 41 (15.8%; 95% CI: 11.4-20.2) participants had ever heard of glaucoma. Sources of information were from visits to an eye clinic for 21/41 (51.2%; 95% CI: 35.9-66.5) participants and 15/41 (36.6%) participants who know someone with glaucoma. Reponses to the causes of glaucoma included 20/41 (48.8%; 33.5-64.1) participant who said 'I don't know' and 24.4% of participants who responded 'curse-from-God'. Responses to questions on treatment included 20/41 (48.8%) participants who responded 'I don't know how it can be treated' and 10/41 (36.6%) said 'medically'. Thirty 30/41 (73.2%) participants would refuse surgery, half of them because 'it cannot cure or reverse the disease' while (26.7%) would refuse out of 'fear'. Only 8/41 (19.5%; 95% CI: 7.4-31.6) would accept surgery for maintenance. Statistically significant predictors of glaucoma awareness were older participants, males and skilled workers (teachers) (P = 0.028, P = 0.018, P = 0.0001, respectively). CONCLUSIONS: The outcomes of study indicate a low level of awareness of glaucoma. Health education at all levels of health and eye care services is required to prevent ocular morbidity and irreversible blindness from glaucoma.

Awareness, perceptions and knowledge of strabismus among patients visiting a tertiary eye clinic in Southwest Nigeria.

The purpose of this study was to assess the perceptions, knowledge of the causes, implications and treatment of strabismus in a black population. This was a descriptive cross-sectional study utilizing a total sampling technique. Face-to-face interviews were performed using a structured questionnaire. Socio-demographic characteristics, awareness, perceived causes, effect and treatment of squint were investigated. Data was analysed using descriptive and inferential (bivariate and binary regression) analysis. A total of 405 respondents (49.6 % male, 50.4 % female) were interviewed. Ages ranged from 11 ± 90 years (mean 41.26 ± 19.00). Modal age group was 17-44 (56 %). Levels of education showed that 22.0 % had no education, while primary, secondary and tertiary levels were 12.6, 31.6 and 33.8 %, respectively. Approximately 75 % of patients were aware of strabismus. Perceived causes were unknown to 53 % while 18.0 and 12 % mentioned eye disease and congenital-related, respectively. There was no knowledge of treatment in 54 % of patients, while 21 and 25 % knew about medical and surgical treatment, respectively. The effects on social and family life were stigmatization/social misfit (23 %), psychosocial/self pity/depression/inferiority complex (88 %), burden (economic/time) (7 %), and poor cosmesis (5 %). Females were significantly more aware than males (p = 0.043, OR 0.6, CI 0.399-0.986). Age (p = 0.187) and level of education (p = 0.321) had no significant relationship with the levels of awareness. Respondents who had no education were 1.25 times less likely to be aware of squint than those who had education (OR 0.8, CI 0.693-1.642). The awareness of the cause, effects and treatment of strabismus is poor in this population. Females were more aware than males.

Non-surgical management of congenital eversion of the eyelids.

PURPOSE: To report the effectiveness of non-invasive management of congenital eversion of the eyelids, a rare condition associated with serious socio-psychological consequences. CASE REPORT: Three neonates with congenital eversion of the eyelids and secondary conjunctival chemosis and prolapse were managed with 5% hypertonic normal saline, lubricants, antibiotics, and padding. Complete eye opening was achieved by the 10th day of presentation and the condition resolved. CONCLUSION: Non-invasive management of congenital eyelid eversion was found to be effective with no need for surgical management. All health care workers should be informed that this condition is amenable to conservative treatment if started early, so that prompt referral for expert management can be offered.

Congenital bilateral eversion of the eyelids.

The authors report a case of congenital bilateral eversion of the eyelids with secondary conjunctival prolapse in a 4-hour-old neonate. Conservative treatment with hypertonic normal saline, lubricants, antibiotics, and padding was instituted. No surgery was performed. Complete eye opening was achieved by the 10th day after birth. Medical management is advantageous in that it is inexpensive, noninvasive, and can be performed even in a center with poor surgical facilities, as is commonly encountered in developing countries. The sociopsychological aspect of the disease, possible pathophysiology, and treatment are discussed.

Pattern of eye diseases and visual impairment among students in southwestern Nigeria.

PURPOSE: The aim of the study was to determine the prevalence and causes of eye diseases and visual impairment in students in the Ilesa East local government area of Osun state, Nigeria. METHODS: A cross-sectional survey that utilised a multistage random sampling method to select 1,144 primary and secondary school students. RESULTS: A total of 1,144 students (504 males and 640 females) were involved in the study. Their ages ranged from 4 to 24 years. The majority (97.8%) of them were below 18 years of age. A total of 177 (15.5%) of the school children were found to have eye diseases. The major ocular disorders were in the following order: conjunctiva 91 (51.4%), refractive error 66 (37.3%), lid 7 (4.0%), corneal, including staphyloma and keratoconus 5 (2.8%) and then others. These included conjunctival diseases 91 (8%) constituted mainly by allergic/vernal conjunctivitis 85 (7.4%), refractive error 66 (5.8%), lid disorders 6 (0.6%), squint 3 (0.3%), corneal scarring 3 (0.3%) and cataract 2 (0.2%). A total of 15 students were visually impaired, with a prevalence of 1.26%. Only two students were blind, with a prevalence of 0.17%. Causes of visual impairment were refractive error 10 (0.87%), bilateral immature cataract 1 (0.08%), corneal opacities 2 (0.2%), amblyopia leading to squint 1 (0.08%) and cataract 1 (0.08%). The causes of blindness in students were bilateral corneal scars presumed to be due to vitamin A deficiency in one (0.08%) student and complicated bilateral keratoconus with complicated vernal ulcers in another (0.08%). CONCLUSIONS: Eye diseases are common amongst Nigerian students. Eye examination for all new intakes and regular screening in both public and private primary and secondary schools is advocated. Wearing of corrective glasses should be emphasised for children with refractive error. Causes of blindness and visual impairment in children attending regular schools in Nigeria were avoidable.