Cost-related antibiotic dosage omissions-challenge for orbital cellulitis management in resource poor communities.

BACKGROUND: Orbital cellulitis is a medical emergency with potential vision and life threatening complications. AIM: To highlight clinical presentation and challenges in the management of orbital cellulitis in resource poor communities of southwestern Nigeria. METHOD: Retrospective review of patients managed for orbital cellulitis at the Wesley Guild Hospital, Ilesa, Nigeria for biodata, socioeconomic status, clinical presentation, compliance to prescribed medications and treatment outcome. Data was analyzed using SPSS version 11. RESULT: Seventeen patients with mean age and standard deviation of 10 +/- 9.9 years were managed for orbital cellulitis. Thirteen (76.5%) females and 4(23.5%) males giving a male to female ratio of 1:3.3 (p = 0.03). Most patients (94.1%) belonged to low socioeconomic status and sinusitis was the most common predisposing factor. 10 (58.8%) had intravenous antibiotics only while 7(41.2%) had surgical drainage of abscess in addition. Delayed and irregular administration of antibiotics was observed in 9 (52.9%) patients due to lack of funds thus necessitating change of choice in antibiotics. Complication include ptosis 3(17.6%), corneal opacity 2 (11.8%), optic atrophy 1(5.9%) and 1(5.9%) meningitis and death 1(5.9%). CONCLUSION: Cost and affordability should be major determinants of choice of empirical antibiotics in resource poor communities to ensure timely and regular treatment and improve prognosis in management of orbital cellulitis.

Characteristics of patients who dropout from a glaucoma clinic.

PURPOSE: To find the dropout rate and identify the clinical characteristics of patients who drop out in the first year of follow-up from a glaucoma clinic. DESIGN: Descriptive hospital-based study at a tertiary hospital eye department. METHODS: Clinical characteristics of consecutive patients newly diagnosed with glaucoma who dropped out (n=452) were compared with patients who did not drop out (n=295) within 12 months. RESULTS: The rate of dropout from follow-up was 60.5% within 1 year; 43.1% of the study group dropped out after their first follow-up visit. The dropout rate was high in all age groups, but higher in the age groups 21 to 30 years, 41 to 50 years, and over 70 years. Males had a higher dropout rate than females (78.6% vs. 34.5%). Dropout rate was higher among those with mild/moderate glaucoma than those with severe disease (88.2% vs. 37.2%); those who lived further away from the hospital than those who lived nearer to the hospital (72.5% vs. 40.8%), those who were referred from screening clinics for nonblinding eye disease compared with those referred because of a blinding eye disease (72.2% vs. 58.9%). More patients (63.8%) unsure of their family eye disease history dropped out, compared with 34.3% of those with positive family history of glaucoma and other potentially blinding diseases. More patients who had no systemic disease dropped out, than those with systemic disease (54.6% vs. 39.6%); whereas patients on 2 medications or more had a higher dropout rate than those on less than 2 medications (68.1% vs. 52.1%). Of the study factors, those that were statistically significantly associated with dropping out of follow-up from the glaucoma clinic were age, sex, place of domicile, diagnosis at referral, severity of disease, family history, and polydrug use. CONCLUSIONS: The dropout rate from this glaucoma clinic in the first year was high (60.5%). Patients who were more likely to dropout were younger patients, male, those who travelled far distances to the clinic, those with mild to moderate glaucoma, those with no family history of blinding eye diseases, and patients taking 2 or more eyedrops. Patients who seem to perceive their problems as not serious dropped out of follow-up. These findings have great implications in planning future studies and intervention to improve the follow-up of glaucoma patients in the study area.

Relationship between Refraction, Anthropometrics, and Educational Status in a Nigerian Young Adult Population.

PURPOSE: The study aimed at determining the relationship between refraction and anthropometric measurements and the relationship between the level of education and refractive status in a Nigerian young adult population. MATERIALS AND METHODS: Healthy volunteers from the students and staff of a teaching hospital in South-Western Nigeria were studied. Demographic profiles including participants' highest educational status, parental educational level, and the age at first formal school enrollment were documented. The height and weight of the participants were measured. Noncycloplegic objective refraction was determined with autorefractor, and the spherical equivalent refraction (SER) of the right eye was used for analysis. SPSS 16 was used to explore the relationships between refraction, height, weight, and body mass index and the educational status of the participants. RESULTS: Two hundred and thirty-nine adults with a mean age of 28.4 ± 6.5 years comprising 116 males and 123 females were studied. The mean height, weight, body mass index, and right eye SER were 1.7 ± 0.1 m, 64.4 ± 12.2 kg, 23.6 ± 4.3 kg/m2, and -0.8 ± 1.4 D, respectively. Height was negatively correlated with the SER (R = -0.3, P < 0.01) in males but not in females. Refraction was not significantly related to weight or body mass index. Participants with higher levels of education were more likely to be myopic. Higher parental education and early formal school enrollment were significantly associated with myopia. CONCLUSION: This study demonstrated a significant positive relationship between height and myopia in male participants but not in females. Individual as well as parental higher levels of education have also shown a positive association with myopic tendency.

Cylindrocarpon lichenicola keratomycosis in Nigeria: the challenge of limited access to effective antimicrobials.

INTRODUCTION: We report a rare cause of keratitis, due to Cylindrocarpon lichenicola, in a farmer with keratomycosis. Despite the acknowledged virulence of this fungus, a suitable antifungal for its management was not accessible. CASE PRESENTATION: A 67-year-old farmer presented with a two-week history of pain, mucopurulent discharge, redness and a corneal ulcer with a visual acuity of hand movement in the right eye. With a working diagnosis of infective keratitis, corneal scrapings were taken under a slit lamp biomicroscope for microbiological testing. Direct lactophenol cotton blue mounts revealed septate fungal hyphae, while fungal culture on Sabouraud dextrose agar at room temperature grew woolly mould phenotypically consistent with C. lichenicola. MANAGEMENT AND OUTCOME: The patient was started on hourly topical natamycin (5%), ciprofloxacin (0.3%), two-hourly instillation of tobramycin (0.3%) and atropine (1%) twice daily for three months following the isolation of the fungus. The eye healed with a corneal scar and no improvements in visual acuity. DISCUSSION: This infection was difficult to manage due to the inaccessibility of a suitable antifungal, namely, voriconazole in our setting. Hence, there is a need for prompt identification and early institution of suitable antifungals in any patient with suspected keratomycosis.

Awareness and utilization of protective eye device among welders in a southwestern Nigeria community.

OBJECTIVE: To determine the level of awareness and practice of use of protective eye devices among welders in Ile-Ife. METHODS: This is a cross-sectional descriptive study of 405 consenting welders. A pretested proforma was utilized to obtain information on sociodemographic characteristics, as well as awareness and use of protective eye device. RESULTS: The age of the respondents ranged from 16 to 80 years. The mean age was 39 ± 13 years. A large proportion (315, 78%) of the welders was aged between 21 and 50 years. The youngest group aged ≤ 20 years accounted for 15 (4%) of all welders, while the oldest group aged > 60 years accounted for 21 (5.2%). 402 were males (99.3%) and three were females (0.7%). Three hundred thirty-six (83%) of the welders had practiced for 6 years and above. There was a high level of awareness of protective eye devices among the welders (367, 90.6%), being higher among arc welders compared with gas welders (P < 0.001). Less than half (186, 45.9%) of the welders possessed protective eye devices. Of these, only 39 (9.6%) made use of the devices always. Some of the reasons for not using the protective eye devices include discomfort and poor visibility (56, 13.6%) and inadequate appreciation of the necessity to wear it (49, 12.1%). CONCLUSION: The findings of this study suggest that a significant proportion of welders in Ile-Ife were not utilizing protective eye device. Health education and awareness campaigns about the importance and benefits of utilizing protective eye devices are recommended.

Bilateral sporadic aniridia: review of management.

PURPOSE: To report a rare case of bilateral sporadic aniridia in an African child and review the management modalities. PRESENTATION: We report a case of bilateral sporadic aniridia with horizontal nystagmus, axial cataract optic disc, and fovea hypoplasia in a 5-year-old female patient. She was managed conservatively. Various modalities of treatment are reviewed.

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.