Ocular surface squamous neoplasia at a tertiary eye facility, Southwestern Nigeria: a 10-year review.

BACKGROUND: Ocular surface squamous neoplasia (OSSN) is a low-grade malignancy arising from the squamous epithelium of the ocular surface AIM: To describe the clinical presentation, histological diagnoses, treatment, and outcome of treatment in patients with OSSN managed at a tertiary health facility. METHODS: Medical records of all patients with OSSN managed using a standardized treatment protocol over a 10-year period were reviewed. RESULTS: Eighty-six patients comprising 44 (51.2%) males and mean age of 48.2 ± 15.8 years were studied. The most common presentation was a fleshy growth in the eye in all patients, and 43 (50.0%) patients tested positive to human immunodeficiency virus. The right eye was affected in 44 (51.2%) patients with no bilateral tumors, and the medial limbus was involved in 28 (32.6%) patients. Morphologically, 40 (46.5%) patients had gelatinous growth, 24 (27.9%) patients were in Tis category while 30 (34.9%) patients were in T4 category. Twenty-eight (32.6%) patients received complete course of adjuvant topical mitomycin C (0.04%) while nine (10.5%) patients completed adjuvant systemic chemotherapy and external beam radiation. Overall, 61 (70.9%) patients had no tumor recurrence, seven (8.1%) patients had recurrent tumor, while the status of 18 (20.9%) patients was not known. CONCLUSION: OSSN occurs more commonly in younger age group in our studied population and is strongly associated with HIV seropositivity. Intraoperative cryotherapy in patients with carcinoma in situ and intraoperative cryotherapy with adjuvant topical mitomycin C in those with invasive SCC that is limited to the ocular surface are associated with low tumor recurrence.

Epithelial Lacrimal Gland Tumours in Nigeria: Clinicopathological Features and Treatment.

Background: Epithelial lacrimal gland tumours are uncommon orbital tumours and are not widely reported among African populations. Objective: This study aimed to describe the clinicopathological features, treatment, and outcomes of epithelial lacrimal gland tumours in Nigeria. Design: Retrospective case series. Setting: Ocular Oncology Unit, Ophthalmology Department and Pathology Department of University College Hospital, Ibadan, Nigeria. Materials and Methods: A review of the medical records of all patients with histopathological diagnoses of epithelial lacrimal gland tumours managed at a tertiary health facility, southwestern Nigeria over 11.5 years was carried out. Results: Eighteen patients with equal numbers of men and women, and mean age at presentation of 42.2 ± 15.7 years (median 42 years, range 17-70 years) were managed. All patients presented with orbital swelling and had nonaxial proptosis with palpable firm to hard mass in the superotemporal quadrant of the orbit. The mean duration of symptoms was 42.2 ± 38.6 months (median 24 months, range 3-120 months). Visual acuity was <3/60 at presentation in eight (44.4%) of the affected eyes. Thirteen (72.2%) patients underwent orbitotomy and tumour excision, while five (27.8%) patients had orbital exenteration, and two of whom (11.1%) had combined orbital exenteration and craniotomy. Histopathological examination of the specimens revealed pleomorphic adenoma in nine (50.0%) patients, low-grade mucoepidermoid carcinoma in three (16.7%) patients, high-grade mucoepidermoid carcinoma in two (11.1%) patients, adenoid cystic carcinoma in three (16.7%) patients, and adenocarcinoma "not otherwise specified" in one (5.6%) patient. Mortality was reported in four (44.4%) of nine patients with malignant tumours, while no mortality was noted in the patients with benign pleomorphic adenoma. The mean follow-up period for the patients was 28.9 months (median, 4.5 months; range, 2-140 months). Conclusion: The main presenting symptom of epithelial lacrimal gland tumours in our patients was an orbital mass and the most common clinical finding, in addition to the orbital mass, was nonaxial proptosis. The tumours were equally divided into benign and malignant lesions in our studied population. Pleomorphic adenoma was the only benign tumour while mucoepidermoid carcinoma was the commonest malignant lesion. Orbital exenteration was performed in a high proportion of our patients and high mortality was noted among patients with malignant tumours.

Contexte: Les tumeurs épithéliales des glandes lacrymales sont des tumeurs orbitales rares et ne sont pas largement rapportées parmi les populations africaines. Objectif: Cette étude visait à décrire les caractéristiques clinico-pathologiques, le traitement et le résultat des tumeurs épithéliales des glandes lacrymales au Nigeria. Conception: Série de cas rétrospectifs. Cadre: Unité d'oncologie oculaire, département d'ophtalmologie et département de pathologie du Collège Hospitalier Universitaire, Ibadan, Nigéria. Méthode: Un examen des dossiers médicaux de tous les patients présentant des diagnostics histopathologiques de tumeurs épithéliales des glandes lacrymales gérées dans un établissement de santé tertiaire du sud-ouest du Nigéria pendant 11,5 ans a été effectué. Résultats: Dix - huit patients avec un nombre égal d'hommes et de femmes et un âge moyen à la présentation de 42,2 ± 15,7 ans (médian de 42 ans, intervalle de 17 à 70 ans) ont été pris en charge. Tous les patients présentaient un gonflement orbital et avait l'exophtalmie non-axiale avec ferme à dur masse palpable dans le quadrant temporel supérieur de l'orbite. La durée moyenne des symptômes était de 42,2 ± 38,6 mois (médiane de 24 mois, intervalle de 3 à 120 mois). L'acuité visuelle était <3/60 à la présentation dans huit (44,4%) des yeux atteints. Treize (72,2%) patients ont subi une orbitotomie et une excision de la tumeur, tandis que cinq (27,8%) patients avaient une exentération orbitaire, dont deux (11,1%) avaient l'exentération orbitale et la craniotomie combinées. L'examen histopathologique des échantillons a révélé un adénome pléomorphe chez neuf (50,0%) patients, un carcinome muco-épidermoïde de bas grade chez trois (16,7%) patients, un carcinome muco-épidermoïde de haut grade chez deux (11,1%) patients, un carcinome adénoïde kystique chez trois (16,7%) patients et adénocarcinome "non autrement spécifié" (NOS) chez un patient (5,6%). La mortalité a été rapportée chez quatre (44,4%) des neuf patients atteints de tumeurs malignes, alors qu'aucune mortalité n'a été notée chez les patients présentant un adénome pléomorphe bénin. La période moyenne de suivi des patients était de 28,9 mois (médiane de 4,5 mois; intervalle de 2 à 140 mois). Conclusion: Le principal symptôme de présentation des tumeurs épithéliales des glandes lacrymales chez nos patients était une masse orbitale et le résultat clinique le plus courant, en plus de la masse orbitale, était une exophtalmie non axiale. Les tumeurs étaient également divisées entre les lésions bénignes et malignes dans notre population étudiée. L'adénome pléomorphe était la seule tumeur bénigne tandis que le carcinome muco-épidermoïde était la lésion maligne la plus courante. Une exentération orbitale a été réalisée chez une forte proportion de nos patients et une mortalité élevée a été notée chez les patients atteints de tumeurs malignes.

Relationship between dry eye and glycosylated haemoglobin among diabetics in Ibadan, Nigeria.

INTRODUCTION: dry eye is a fairly common ocular surface disorder which significantly affects the quality of life of patients. This study aimed to determine the prevalence, and relationship between dry eye and glycosylated haemoglobin (HbA1c) among patients with diabetes mellitus. METHODS: this was a descriptive hospital-based study conducted among patients diagnosed with diabetes mellitus and attending the Diabetic Clinic at a tertiary health facility in Ibadan, south-western Nigeria. Dry eye was assessed using the standardized Ocular Surface Disease Index Questionnaire administered to the eligible respondents on dry eye symptoms. Detailed ocular examination including the tear break-up time (TBUT) and Schirmer I test were carried out and a recent glycosylated haemoglobin value was also obtained. RESULTS: one hundred and eighty-nine Type 2 diabetic patients were studied, with 68.8% female and a mean age of 60.2 ± 10.3 years. The frequency of dry eye among patients was 21.7% (95% CI, 15.8-27.6). The most commonly reported symptoms of dry eye were "feeling of gritty sensation" (78%, 95% CI, 65.4-90.7) and "blurred vision" (73.2%, 95% CI, 59.6-86.7) while "discomfort in windy areas" (61%, 95% CI, 46.0-75.9) was the most common environmental trigger. No statistically significant correlation was noted between dry eye and HbA1c (r = 0.086, p= 0.239), and age (r = 0.096, p = 0.1). CONCLUSION: dry eye is fairly common among patients with diabetes mellitus with most frequent symptoms being gritty sensation and blurred vision. No significant correlation was noted between dry eye and glycosylated haemoglobin (HbA1c).

Delleman syndrome: A case report from West Africa - features and the challenges of management.

Delleman syndrome is a rare congenital disorder. We report an 8-month old female with a history of a fleshy mass covering the left eye since birth. Examination revealed poor vision in the left eye, an upper lid coloboma and an epibulbar dermoid with a large area of alopecia and scalp hypoplasia involving the left frontoparietal region. Transfontanelle ultrasound scan did not reveal any intracranial cyst. Cranial computerised tomography subsequently revealed characteristic cerebral malformations of Delleman syndrome. This report demonstrates clinical and computed tomographic features of a case of Delleman syndrome with emphasis on the usefulness of transfontanelle ultrasonography in assessing for life-threatening intracerebral cysts or hydrocephalus, particularly in resource-limited settings, where neuroimaging is not readily available or affordable.

Delleman-Oorthuys syndrome (oculocerebrocutaneous syndrome) in a Nigerian child: a case report.

BACKGROUND: Delleman-Oorthuys syndrome, also known as oculocerebrocutaneous syndrome, is a rare congenital anomaly with ocular, cerebral and cutaneous manifestations. So far, only 40 cases have been described. CLINICAL CASE: A 3-year-old female Nigerian child with no identifiable left eyeball, multiple left-sided facial skin defects and delayed developmental milestones but otherwise uneventful medical and family history was evaluated at the Ophthalmology and Paediatric Neurosurgery in Ibadan, Nigeria. Besides the mentioned defects that were present since birth, brain imaging revealed several brain abnormalities including intracranial cysts. Global hyperreflexia and bilateral flexor plantar response were observed upon clinical examination. Left micro-ophthalmia and orbital mass were detected. A histological assessment of the orbital mass revealed it to be rudimentary ocular tissue. The diagnosis of Delleman-Oorthuys syndrome was made based on the clinico-radiological features. The patient underwent a left-sided posterior fossa cystoperitoneal shunt. The left orbital mass was enuclated and the patient is currently awaiting left eyelid reconstruction and an orbital implant and repair of the left alar nasi cleft. CONCLUSION: To our knowledge, this is the first published report of Delleman-Oorthuys syndrome in a female child of West African descent. Given the variable manifestations of Delleman-Oorthuys syndrome, and overlap with other syndromes, the Delleman-Oorthuys syndrome may be underreported. Neuroimaging of patients with cutaneous tags, orbital cysts and micro-ophthalmia could reveal more cases.

Conjunctival melanoma in Southwestern Nigeria: a case series and review of literature.

PURPOSE: Conjunctival melanoma is a rare tumor worldwide and is extremely rare among black population. This study aims to report the demographics, clinical presentation, treatment, and outcome of patients seen in an indigenous black population in Southwestern Nigeria. METHODS: All patients histologically diagnosed with conjunctival melanoma and managed in the facility were reviewed. Their demographics, clinical presentation, treatment received, outcome of treatment, and histopathological features were analyzed. RESULTS: Six patients (males = 2) with a mean age of 49.8 years were managed over 11 years (range 25-75 years). The right eye was involved in three patients, while one patient had bilateral non-simultaneous tumor. All six patients presented with pigmented growth over the ocular surface of varying duration, confirmed as malignant melanoma at histopathology after an excision biopsy (two patients), incision biopsy (one patient), or orbital exenteration (three patients). One patient who had complete adjuvant treatment postoperatively remained alive and tumor-free at 7-year follow-up, one patient is presently on chemotherapy, one patient died while on admission, and the remaining three patients abandoned further postoperative treatment and defaulted from follow-up. CONCLUSION: Conjunctival melanoma is a rare ocular malignancy in Southwestern Nigeria, and patients present with advanced disease with potential poor outcome.

Hydatid cyst of the orbit in a young Nigerian female: a case report.

OBJECTIVE: To report an unusual case of orbital hydatid cyst successfully managed by surgical excision. CASE REPORT: A 33-year-old female presented with gradual protrusion of the left eye associated with poor vision, cosmetic embarrassment and watering. She had excision biopsy of an encapsulated cystic lesion with cheesy tissue and serous content. Orbital hydatid cyst due to echinococcosis was confirmed at histopathological examination of the excised tissue. She subsequently became pregnant hence, could not undergo post-operative antihelminthic treatment, but was managed conservatively with no recurrence after five years of regular follow-up. CONCLUSION: Orbital hydatid cyst should be considered as a differential in a young patient presenting with unilateral proptosis. FUNDING: None.

Cataract surgery in Ibadan, Nigeria: Visual outcome and post-operative refractive error

Background: Cataract is the leading cause of blindness worldwide and can be treated by various surgical techniques with good visual outcome.Objective: To describe the visual outcome and post-operative refractive status among patients who had cataract surgery in a tertiary centre.Methods: In a retrospective study, the demographic data, type of cataract, surgical procedure and complications, visual outcome and post-operative refractive status of the treated eye were retrieved from the hospital records of all adult patients who had cataract surgery.Results: Four hundred and sixty eyes of 456 patients (mean age 61.2 ± 17.3 years, Male: Female = 1.1: 1) had cataract surgery during the study period January 2012 and December 2014. The pre-operative visual acuity was < 3/60 in 415 (90.2%) eyes. All the surgeries were performed under local anaesthesia with 331 (72%) eyes undergoing extracapsular cataract extraction while 129 (28%) had small incision cataract surgery. Visual outcome in those who had a minimum of six weeks follow-up revealed unaided visual acuity of ≥ 6/18 in 185 (56.9%) eyes. Following refraction, 237 (72.9%) eyes had acuity of ≥ 6/18. Post-operative spherical refractive error ranged from ­6.75D to +4.50D (mean -1.61 ± 1.41D) while cylindrical error ranged from 0.00DC to 6.00DC (mean 2.33 ± 1.80DC). Pre-existing ocular problems contributing to poor post-operative visual outcome included glaucoma (50; 15.4%), and age-related macular degeneration (10; 3.1%). Conclusion: Extracapsular cataract extraction gave better visual outcome compared with small incision cataract surgery, but a higher incidence of post-operative cylindrical error was observed

Prevalence of congenital colour vision deficiency among secondary school students in Ibadan, South-West Nigeria.

AIM: The aim was to determine the prevalence and pattern of congenital colour vision deficiency among secondary school students in Ibadan, Nigeria. SUBJECTS AND METHODS: A descriptive cross-sectional study was conducted among students from three public secondary schools through a multi-staged sampling method. Ocular examination including visual acuity assessment and colour vision test with the Ishihara plate was performed for all students. Further assessment with the Farnsworth-Munsell D-15 panel was performed for those who failed the Ishihara test. RESULTS: One thousand six hundred and thirty-five students participated in the study. There were 769 (47.0%) males with mean age of 13.9 ± 1.9 years. The overall prevalence of congenital colour vision deficiency was 2.3% with prevalence of 3.8% and 0.9% in males and females, respectively, which was statistically significant (P = 0.00112), and equal proportion of deutans 11 (32.0%) and protans 12 (35.0%) ratio of 1:1.1. CONCLUSION: The prevalence of congenital colour vision deficiency among public secondary school students in Ibadan is comparable to findings in other parts of the country.

Dry eye disease in an adult population in South-West Nigeria.

AIM: To determine the prevalence and factors associated with dry eye disease (DED) in an adult population in south-west Nigeria. METHOD: A descriptive cross-sectional community-based study was conducted among respondents aged 40 years and above. Questionnaires were administered on symptoms of DED, followed by ocular examination to elicit signs of DED by determining the tear film break-up time, corneal fluorescein staining score, and Schirmer I tests. Dry eye was diagnosed by the simultaneous presence of at least one symptom experienced "often or all of the time" and at least one sign in either eye. RESULT: The respondents (n=363; females 188) were aged 59.1±13.1years. The prevalence of DED was 32.5% (95% CI=27.7-37.3), and the most commonly reported symptoms were grittiness (53.4%, 95% CI=44.4-62.4) and burning/stinging sensation (48.3%, 95% CI=39.3-57.3). On multivariate analysis, DED was significantly associated with age (OR 2.89, 95% C.I=1.67-4.93, p<0.001) but not use of benzalkonium containing topical medications, previous ocular surgery, household fuel use, menopausal status and presence of pterygium. CONCLUSION: The outcome of the study shows that the prevalence of DED among adults above 40 years in south-west Nigeria is 32.5% and the associated risks include older age.

Comparison of Peribulbar with Posterior Sub-Tenon's Anesthesia in Cataract Surgery Among Nigerians.

PURPOSE: To compare the akinetic and the analgesic effects of peribulbar and posterior sub-Tenon's anesthesia in patients undergoing cataract surgery. METHODS: In a hospital-based randomized comparative interventional study, patients aged 50 years and above who underwent elective surgery for uncomplicated cataract were randomized to receive either peribulbar block or posterior sub-Tenon block. Pain during injection, surgery, and after surgery was assessed using numerical reporting scale (NRS). Limbal excursion was measured with a transparent meter rule. RESULT: A total of 152 eyes of 152 patients were studied. Peribulbar and sub-Tenon regional blocks provided comparable adequate akinesia (P = 0.06) and similar levels of analgesia (P = 0.10) during cataract surgery. Both techniques also provided similar levels of analgesia to the patient during injection and in the immediate postoperative period. Ninety-two percent of patients who had peribulbar and 97% of those who had sub-Tenon blocks reported either mild pain or no pain at all during surgery (P = 0.49). There was no report of severe pain in all patients during the stages of the surgery. Occurrence of chemosis and subconjunctival hemorrhage was more common in sub-Tenon than peribulbar anesthesia. CONCLUSIONS: This study shows that peribulbar and posterior sub-Tenon routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications. Therefore, both techniques are effective and safe for cataract surgery among Nigerians.

Spindle cell hemangioma: Unusual presentation of an uncommon tumor.

Spindle cell hemangioma (SCH) is an uncommon tumor that usually presents as subcutaneous or deep dermal nodule affecting the extremities and is typically <2 cm in size. A few cases have been reported in the head and neck region. To the best of the authors' knowledge, there are no previous reports of SCH occurring in the orbit in the English literature. We, therefore, report the case of a large SCH involving the right orbit of a healthy 9-year-old Nigerian girl.

Management of bilateral congenital upper eyelid eversion with severe chemosis.

PURPOSE: To report a case of complete bilateral congenital upper eyelid eversion associated with severe chemosis in a newborn, and to describe a semi-invasive technique for its management. CASE REPORT: The patient was a four-hour-old Nigerian neonate with bilateral congenital upper eyelid eversion with severe and progressive chemosis. Conservative management failed to resolve the condition. However, compression eyelid sutures resulted in prompt and satisfactory resolution. CONCLUSION: Compression eyelid suturing is a semi-invasive technique for management of severe chemosis due to congenital upper lid eversion resulting in rapid and satisfactory resolution of the condition.

CT assessment of the nasolacrimal canal in a black African Population.

PURPOSE: Black Africans had been identified to have a lower prevalence of primary acquired nasolacrimal duct obstruction (PANDO). This has been attributed to the likely larger size of the nasolacrimal canal. However, there is paucity of studies that have quantitatively measured the dimension of the nasolacrimal canal in a homogeneous black population. The objective of this study was to determine the diameter of the bony nasolacrimal canal by CT in a normal adult Nigerian population. METHODS: The authors measured the minimum CT diameter of the bony nasolacrimal canal in 401 consecutive eligible adult patients using retrospective axial CT scans obtained between January 2006 and December 2010. The measurements were taken on axial images using a preset bone window algorithm on a standalone computer workstation with a ClearCanvas viewer (width: 2500, level: 480). The software calipers could measure up to a tenth of a millimeter. RESULTS: The CT images were made up of 378 cranial scans and 23 scans of paranasal sinuses. There were 286 male patients and 115 female patients aged 16 to 86 years with a mean age of 48.5 ± 18 years. The mean difference in nasolacrimal canal diameter of 3.52 mm in male patients and 3.36 mm in female patients was found to be statistically significant (t = 2.238, df = 400, p = 0.026). There was no significant difference in the canal diameter across age groups. In addition, there was no significant difference in the diameter between the right and left sides in the authors' study population (t = 1.551, df = 400, p = 0.122). CONCLUSIONS: The mean bony nasolacrimal canal diameter as measured by CT in Nigerians is smaller than those reported in African Americans, Asians, and Caucasians despite the reported lower prevalence of PANDO among blacks.

Giant deep orbital dermoid cyst presenting early in infancy in a Nigerian child: a case report and review of the literature.

INTRODUCTION: Dermoid cysts are the most common orbital cystic lesions seen in children. While superficial orbital dermoid cysts present early in life, deep dermoid cysts remain clinically occult until adolescence or adulthood. We here present a case of a deep orbital dermoid cyst in a Nigerian child that became symptomatic early in infancy. CASE PRESENTATION: A female Nigerian infant of Yoruba ethnicity presented at three months of age with left non-axial proptosis and a hazy cornea. A superotemporal cystic orbital mass was seen on ultrasonography, and her parents were counseled for simple tumor excision. They however defaulted, only for their child to re-present two years later with gradually progressive proptosis, an enlarged orbit and keratinized ocular surface, necessitating orbital exenteration. CONCLUSION: Deep orbital dermoid cysts may be symptomatic from birth. Late presentation may result in an irreversible loss of vision, as demonstrated in our case. The need for public enlightenment on early presentation and prompt management of such benign lesions is emphasized.

Orbital intravascular papillary endothelial hyperplasia in a Nigerian child: a case report and review of the literature.

INTRODUCTION: Intravascular papillary endothelial hyperplasia is a reactive proliferative lesion of endothelial cells in blood vessels. It typically presents as a painless, reddish purple lesion in the sites affected. The orbit remains an uncommon site of affectation of this relatively common disease. It is noteworthy that this is the first reported case, to the best of our knowledge, of orbital intravascular papillary endothelial hyperplasia in a Nigerian child. CASE PRESENTATION: The case reported here is an orbital intravascular papillary endothelial hyperplasia causing non-axial proptosis and loss of vision in a 14-year-old Nigerian boy. We describe the clinical and histological findings of intravascular papillary endothelial hyperplasia in the orbit of this 14-year-old boy. The key distinguishing features are discussed and relevant literature is reviewed. CONCLUSION: Although unusual in presentation, intravascular papillary endothelial proliferation should be considered in the list of differentials of proptosis due to mass lesion in young Nigerians and, possibly, Africans.

5-Fluorouracil versus mitomycin C as adjuncts to conjunctival autograft in preventing pterygium recurrence.

To compare the efficacy of 5-fluorouracil (5-FU) with mitomycin C (MMC) in preventing pterygium recurrence when used as an adjuvant following pterygium excision with conjunctival autograft. Low-dose MMC combined with conjunctival autograft is an effective treatment for preventing recurrence following pterygium excision, but safety, cost, and availability limit its use in developing countries. There is a paucity of data on the efficacy of 5-FU when used in Africa as an adjuvant to conjunctival autograft following pterygium excision. This is a randomized controlled prospective trial using either 50 mg/ml 5-FU or 0.01% MMC. Eighty eyes of 80 subjects were studied. Forty-six subjects with a mean age 49.8 ± 13.8 years were treated with 5-FU (USD 13.0 per unit), while 34 patients with a mean age 51.9 ± 12.1 years were treated with MMC (USD 20.0 per unit). There was no significant difference in mean age between the two groups (p = 0.48). The ratio of male to female patients in both groups was similar at 0.92:1 for the 5-FU group and 1:1 for the MMC group (p = 0.85). Mean follow-up period was 35.2 ± 29.1 weeks. Recurrence rate in the 5-FU group was 8.7% compared to 11.8% in the MMC group (recurrence risk ratio = 0.71, 95% CI 0.17-3.1, p = 0.7). One patient from the MMC-treated group had corneoscleral melting. Other complications were mild and not sight threatening. In the prevention of pterygium recurrence, 5-FU appears to compare favorably with low-dose MMC when used as an adjuvant following pterygium excision and conjunctival autograft. Further studies are required to assess the long-term effect of using 5-FU in such cases.