Bilateral Self-enucleation of the Eyes: Case Report and Literature Review.

Self-removal of the eyeball is an extreme form of self-harm, which is rare especially in a society ill-disposed to self-maiming. We report the case of a 75-year old man who plucked out his own two eyes in obedience to a voice urging him to do so. According to his wife, the patient had been exhibiting symptoms suggestive of a psychiatric disorder just before the incident. But this was overlooked. This case report draws attention to the devastating ophthalmic consequences of neglected psychiatric disorders in the elderly. We recommend greater attention to the mental health of the elderly. Prevention and management of auto-enucleation requires a collaboration between psychiatrists and ophthalmologists.

Eye Health-seeking Behaviour of Traders in Rural Nigeria.

Aim: The aim of this article was to determine the healthcare provider first sought, reasons for the choice, and symptom duration before hospital presentation among traders in rural Nigeria. Materials and Methods: This was a cross-sectional study of traders at a rural Nigerian market, selected by systematic random sampling. A structured questionnaire was used to obtain information on sociodemographics, eye disease symptoms, eye care provider first sought, and reasons for choice. The analysis was carried out with Statistical Package for Social Sciences using descriptive and inferential statistics with an alpha level at 0.05. Results: Of the 177 traders, 88 (49.7%) were males and 89 (50.3%) were females. The mean age was 46.5 ± 13.75 years (range 19-72). Of the 83 traders who had ocular symptoms 23 (27.7%) never sought any care. The eye care providers first sought were patent medicine vendors 22 (26.5%), orthodox hospital 17 (20.5%), eye glass vendors 3 (3.6%), and traditional healers 3 (3.6%). The median symptom duration before presentation to an eye health facility was 83 days. Reasons for not seeking orthodox eye care first included cost 33 (39.8%), 'ailment not serious' 22 (26.5%), and advice from friends 7 (8.4%). Females were more likely to seek orthodox care (χ2=4.22, P=0.04), whereas males were more likely to feel that their ailment was not serious. Traders aged >50 years were less likely to seek any care for eye ailment (χ2 =8.41, P=0.04). Conclusion: Traders with eye disorders seek care late and most first seek care outside the orthodox hospital. Cost and feeling that ailment was not serious are barriers to seeking orthodox eye care. Eye health education and cost reduction would improve uptake of orthodox eye care services.

Pattern of eye diseases in adults at the general outpatient clinic of a Tertiary Hospital in Nigeria.

Objective: To determine the pattern of eye diseases at the general outpatient department (GOPD) of a Nigerian tertiary hospital. Materials and Methods: Patients selected by systematic random sampling at the GOPD of a Nigerian tertiary hospital were studied. Information on sociodemographics and ocular complaints were obtained using interviewer-administered questionnaire. Ocular examination included visual acuity measurement and anterior and posterior segments examinations. Data analysis was with Statistical Package for the Social Sciences. Results: Three hundred and eighty-two patients, comprising 124 (32.5%) males and 258 (67.5%) females, aged between 18 and 86 years, mean 44.8 ± 15.4 years, were studied; 112 (29.3%) had eye diseases but only 88 (78.6%) patients complained of ocular disorder(s). Common complaints were poor vision 53 (60.4%), red eye and grittiness 15 (17.0%) each. Common eye diseases were lens 52 (13.6%) and conjunctiva 46 (12.0%) disorders. Attaining higher education was protective against eye diseases (P < 0.05). Conclusion: Nearly a third of patients at the GOPD have eye diseases. Therefore, primary eye care should be integrated into the GOPD service with provision of relevant manpower and facilities for care of the ophthalmic patients.

Résumé Objectif: Pour déterminer le schéma des maladies oculaires au service général de consultation externe d'un hôpital tertiaire nigérian. Matériels et Méthodes: Des malades sélectionnés par échantillonnages aléatoires systématiques au service ambulatoire général, d'un hôpital tertiaire au nigérian on été étudies. Les informations sur les données sociodémographiques et les plaintes oculaires ont été obtenues à l'aide d'un questionnaire lors d un interview. L'examen oculaire comprenait la mesure de l'acuité visuelle et de l'examen des segments antérieur et postérieur. L'analyse données a été effectuée par le progiciel des sciences sociales. Résultats: Trois cent quatre-vingt-deux malades, comprenant 124(32,5%) hommes et 258 (67,5%) femmes, âges entre 18 et 86 ans, moyenne 44,8 ± 15,4 ans, ont été étudiés ; 112 (29,3%) avaient des maladies oculaires mais seulement 88 (78,6%) malades se plaignaient de trouble(s) oculaire(s). Les plaintes les plus courantes étaient une mauvaise vision 53 (60,4%), les yeux rouges et la sécheresse oculaire 15(17,0%) chacun. les maladies oculaires courants étaient les troubles du cristallin 52(13,6%) et la conjonctive 46 (12,0%). le fait d'avoir fait des études supérieures ont protégé contre les maladies oculaires courant (P<0.05). Conclusion: Près d'un tiers des malades de la service ambulatoire général, Nigérian ont des maladies oculaires. Par conséquent, les soins oculaires primaires doivent être intégrés dans le service ambulatoire généra avec la fourniture de la main-d'œuvre et des installations nécessaires pour les soins a les malades d'ophtalmiques. Mots-clés: Maladies oculaires, troubles oculaire, service ambulatoire général, Nigérian.

Hand Hygiene Knowledge Among Eye Care Workers at an Eye Hospital in Nigeria.

Aim: The aim of this article is to determine the knowledge of hand hygiene (HH) practices among eye care workers in a tertiary eye hospital in Nigeria. Materials and Methods: This was a cross-sectional study of eye care workers at a tertiary eye hospital in Nigeria. Eye care workers, involved with clinical duties, responded to the WHO Hand Hygiene Knowledge questionnaire containing 24 multiple choice questions on HH knowledge. Each correct answer earned one point; zero was given for a wrong answer. Overall scores were expressed in percentage. An overall score of ≥75% was considered as good; 50-74% moderate; and <50% poor knowledge. Data analysis was with SPSS version 23. Results: Fifty-eight workers participated. Thirty-nine (67.2%) were females and 19 (32.8%) were males; the age range was 25-68 years; mean 39.6 ± 7.4 years. The average work experience was 15.3 ± 8.9 years; range 1-40 years. The mean knowledge score was 12.0 ± 2.9 (50%) which is moderate knowledge; range 3-18. Workers who had received training in HH had a significantly higher mean knowledge score than those who did not receive training (12.8 ± 2.3 vs. 11.3 ± 3.2; P = 0.04). There was no statistically significant association between knowledge of HH and age, sex, work experience, and professional category (P > 0.05). Conclusion: HH knowledge of the eye care workers studied is sub-optimal. This has negative implication for hospital infection control. Eye care workers' knowledge of HH can be improved through formal training and frequent rehearsals.

Sub-tenon Versus Sub-conjunctiva Anaesthesia for Intraocular Surgery.

Objective: To compare the pain relief achieved using sub-Tenon anesthesia with that of sub-conjunctival anesthesia technique in intraocular surgery at the Guinness Eye Centre Onitsha Nigeria. Materials and Methods: Consecutive adult patients who had intraocular surgery under local anesthesia were randomized into having sub-Tenon (3 mL) or sub-conjunctival (0.5 mL) injections using xylocaine ± adrenaline. The manual suture-less surgery technique was used for cataract surgery alone and cataract surgery with pterygium excision; the extra-capsular cataract extraction technique was adopted for combined trabeculectomy and cataract surgery. Surgery duration was recorded. Patient's pain perception graded as none, mild, moderate or severe. Results: 100 patients made up 51 (51.0%) males and 49 (49.0%) females, age range was 31-88 years, median - 68 years, participated. Sub-Tenon anesthetic technique was used in 52 (52.0%) and sub-conjunctival in 48 (48.0%) participants. Seventy-eight (78.0%) patients had cataract surgery; 10 (10.0%) had trabeculectomy; 7 (7.0%) had combined trabeculectomy and cataract surgery and 5 (5.0%) had pterygium excision with cataract surgery. The mean surgery duration in the sub-Tenon anesthesia group was 31.8 ± 8.5 minutes and 30.2 ± 9.8 minutes in the sub-conjunctival group (P > 0.05). Fifty (96.2%) patients in the sub-Tenon group and 38 (79.2%) in the sub-conjunctival group experienced mild or no pains; 2 (4.2%) patients in the sub-Tenon group and 10 (20.8%) in the sub-conjunctival group experienced moderate to severe pains (P < 0.05). Conclusions: Both sub-conjunctival and sub-Tenon anesthetic achieved effective analgesia in intraocular surgery. But sub-Tenon anesthesia is significantly associated with lower incidence of severe pains.