Ocular leprosy in Nigeria: a survey of an Eku leprosorium

To determine the ocular morbidity, visual disability and potential for blindness in leprosy patients recently released from treatment.

In-patients from Eku leprosy settlement were interviewed and examined for ocular disease from leprosy and other causes. They were examined using the Snellen's chart, pentorch, Kowa portable slit-lamp, direct ophthalmoscope and the pulsair non-contact tonometer. The patients were also refracted.

In all, 60 inpatients who were recently released from treatment, comprising 39 men (65%) and 21 women (35%), were examined. Fifty-eight patients (96.67%) had ocular symptoms, the most common being blurred vision in 23 patients (38.33%). Nine patients (15%) were blind. Cataract was the most common cause of blindness occurring in three of the nine patients (33.33%). The most common types of ocular lesions were madarosis (31.67%), lagophthalmos (16.67%) and cataract (16.67%). Potentially blinding conditions due to leprosy were seen in 42 patients (70%).

The incidence of ocular involvement, blindness and potentially blinding conditions are high in leprosy patients recently released from treatment. Regular ophthalmic evaluation and integration into Vision 2020 programmes are recommended.

Ocular disorders in stroke patients in a tertiary hospital in Nigeria

BACKGROUND

Stroke is a medical emergency of public health importance which affects the physical, mental, and emotional well-being of its victims. Management and rehabilitation are cumbersome for patients and caregivers. Ocular involvement and visual loss could further increase the burden of care.

AIM

To determine the prevalence of ocular disorders in patients with stroke in a Tertiary Hospital in Nigeria.

MATERIALS AND METHODS

A descriptive hospital-based study was performed on all consenting and conscious adult patients aged 18 years and above with a diagnosis of stroke made within 1-year who were admitted to the stroke ward or attended the stroke clinic of the Neurology Unit in the Department of Medicine, University of Benin Teaching Hospital, Benin City from October 2013 to December 2013.

RESULTS

A total of 170 eyes of 85 patients were studied with a mean age of 66.08 years ± 10.99; range 43-88 years. There was a male: female ratio of 2.6:1. Ocular abnormalities were documented in 95.5% of the patients. A presenting visual acuity of ≥6/18 was found in 66.7%. Mild ptosis and exotropia were seen in 2.9% and 0.6% of the eyes respectively. Intraocular pressure was between 10-21 mmHg in 87.7% eyes while 11.8% eyes had afferent pupillary defects. Cataract was seen in 71.8% eyes and optic nerve head changes in 48.8% eyes which includes temporal disc pallor and glaucomatous optic neuropathy in 29.4% and 14.2% eyes, respectively. Abnormalities found in the retina include retinal hemorrhages in 10.6% eyes, cotton wool spots in 2.4% eyes, and hard exudates in 7.8% eyes. Retinal vascular abnormalities were documented in 32.4% eyes. Visual complaints following stroke were documented in 9.6% of the patients.

CONCLUSION

Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke, and age-related changes. Routine ophthalmic evaluation is suggested in the management of patients with cerebrovascular accident in our environment for better quality of care.

Ocular disorders in adult patients with tuberculosis in a tertiary care hospital in Nigeria

Objectives:

To determine the ocular disorders in adult tuberculosis (TB) patients in Benin City, Nigeria.

Methods:

A prospective study of adult TB patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria, between March 2006 and October 2006 was undertaken. The patients were interviewed and examined by the authors and the ocular findings recorded.

Results:

There were 92 patients (45 males and 47 females) with mean age 37.9 years (SD±15.6). Only one (1.1 percent) was HIV positive. Among the ocular findings in patients with TB, 8 patients had monocular blindness that included cataracts in 3 (37.5 percent), glaucoma in 2 (25 percent), optic atrophy, retinal vasculitis and maculopathy accounting for one case each (12.5 percent). Ocular disorders due to TB occurred in 9 patients (9.8 percent). These include cataract in 2 cases (2.2 percent), phlyctenular conjunctivitis in 2 cases (2.2 percent), glaucoma, anterior uveitis, chorioretinitis, retinal vasculitis, maculopathy, and optic atrophy each occurring in 1 case (1.1 percent).

Conclusion:

Tuberculosis is a cause of ocular morbidity, visual impairment and blindness. Prevention, early diagnosis and early treatment of TB may prevent avoidable visual loss.

Current concepts in the diagnosis of primary open angle glaucoma

BACKGROUND

Primary open angle glaucoma is characterized by quantifiable parameters including the intraocular pressure, the aqueous outflow facility, and geometric measurements of the optic disc and visual defects. Despite this, diagnosis remains controversial.

OBJECTIVE

To review the current concepts in the diagnosis of primary open angle glaucoma and adapt them to situations where high technology facilities are lacking.

DATA SOURCE

Information was obtained from journals/medline, Hinari, the American Academy of Ophthalmology preferred practice pattern CD, and reputable textbooks using publications from 1972 to 2007.

RESULTS

The Preferred Practice Pattern Committee of the American Academy of Ophthalmology recommends that the comprehensive initial glaucoma evaluation (history and physical examination) includes comprehensive adult eye evaluation with special attention to those factors that specifically bear on the diagnosis such as the optic disc, nerve fibre layer and visual field evaluation, open anterior chamber angles on gonioscopy and absence of secondary causes of glaucoma. Intraocular pressure is no longer relied onin the diagnosis of primary open angle glaucoma. Sequential evaluation of optic disc cup and size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc haemorrhages enhance the ability to detect glaucomatous damages.

CONCLUSION

A simple systematic approach in examination of the optic discs and visual field will improve accurate diagnosis of glaucoma.

Effectiveness of intra-operative Mitomycin-C in reducing the recurrence of pterygium in Irrua, Nigeria

AIMS AND OBJECTIVES

To evaluate the effectiveness of intra-operative Mitomycin-C application after pterygium surgery in Irrua, Nigeria.

MATERIALS AND METHODS

The medical records of all patients who had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C between June 2002 and May 2007 and followed up for at least a year were reviewed.

RESULTS

Two hundred and forty three eyes (196 patients) had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C over this period. Male to female ratio was 2:1. The mean age of the patients was 47.1years (SD+ 15.4) Eleven eyes had recurrence after a minimum follow up period of one year. Six (54.5%) out of the eleven eyes that had recurrence had conjunctival granuloma and in such cases recurrence was early (between 2 to 3 months of surgery). Conjunctival granuloma was the main complication occurring in 35 eyes (14.4%). Occurrence of granuloma was significantly associated with recurrence (P =0.0006). Delayed wound healing occurred in 5 eyes (2.1%). There was no case of either scleral or corneal melting.

CONCLUSION

Intra-operative application of 0.4mg/ml Mitomycin C is very effective in reduction of recurrence of pterygium after excision. Hence patients should be given the benefit of intra-operative use of Mitomycin C during pterygium surgery.

Ultrasonographic ocular diameters in Nigerians

BACKGROUND

There is little information on the biometric ultrasonography of the eyeball, especially in Africans. The eyeball diameters form the basis for the calculation of the intraocular lens power and diagnosis of axial hypermetropia and myopia

OBJECTIVE

To determine the ocular diameters of healthy Nigerian eyes.

METHODS

Measurements of the eyeball in volunteers were taken on the B-mode image using a Medison's Sonoace 1500 ultrasound machine using a 6.5 MHz curvi-linear transducer placed over the closed eyelid. The vertical, horizontal and axial diameters of the eyes of healthy subjects were recorded. The age and sex of the subjects were also recorded.

RESULTS

Four hundred eyes of 200 subjects comprising 125 females (62%) and 75 (38%) males (38%) were studied. The age range was 3-92 years with an overall mean age of 41.48 +/- 23.26 years for both sexes. The mean axial eyeball diameter for the entire study population was 21.7 +/- 0.16 mm. There was a gradual increase in all eyeball diameters with age. The highest value for eyeball diameter (22.5 +/- 0.18 mm) was recorded for the elderly age group. The (SD) mean eyeball diameters for males were slightly higher than that for the females; mean for males, 21.8 +/- 0.13 mm, 95% CI = 21.781-21.819, vs females, 21.6 +/- 0.14 mm, 95% CI = 21.581-21.619. However, the difference was not statistically significant (p = 0.409).

CONCLUSIONS

The eyeball diameters found in this sample of Nigerians are lower than the dimensions reported in Caucasians. These values may be used as reference values for normal African eyes.

Non-traumatic Ocular Findings in Industrial Technical Workers in Delta State, Nigeria

PURPOSE

To determine the pattern of non-traumatic ocular disorders in industrial technical workers in the Delta state, Nigeria.

METHODS

A cross-sectional study of the pattern of non-traumatic ocular disorders among industrial technical workers in 3 factories in Ughelli North local Government Area of Delta state, Nigeria was conducted between February, 2002 and May, 2002. In addition to the demographic, the workers were studied for the presence of any non-trauma related ocular findings. Visual acuity of these workers was obtained as well as ocular examination was performed by using the Snellen's chart, pen torch, ophthalmoscope, Perkins hand-held tonometer, Ishihara plates. Patients were refracted if their visual acuity was less than normal.

RESULTS

Five hundred technical workers were screened that included 200 (40%) from the construction industry, 180 (36%) from the rubber factory and 120(24%) from the oil mill. All the workers studied were males. Ocular disorders were seen in 664 (66.4%) of the eyes. The most common ocular disorders were pingueculum 215 (21.5%), presbyopia 97 (9.7%), refractive error 94 (9.4%), pterygium 86 (8.6%) and chronic conjunctivitis 45 (4.5%). None of the workers was blind from non-traumatic causes. Only 36 (7.2%) workers wore any protective eye devices at work.

CONCLUSION

Non-traumatic ocular disorders are common in the industrialized technical workers in the Delta state of Nigeria. The use of protective eye devices is low in these workers and suggests that measures to implement ocular safety should be undertaken in these industries.

Ophthalmic manifestations of multiple myeloma

BACKGROUND

The ophthalmic manifestations of multiple myeloma can be seen in practically every ocular structure. Ocular findings may be the first manifestations of the disease. It may also occur as one of the extramedullary manifestations of the disease or as the first sign of insufficient chemotherapy. Multiple myeloma may cause ocular pathology by direct infiltration or as extramedullary plasmacytomas resulting in displacement or compression of tissues, by causing hyperviscosity syndrome, and by immunoglobulin light chain deposition in ocular tissues.

OBJECTIVE

To outline the ophthalmic manifestations of multiple myeloma.

METHODS

Information about multiple myeloma and ophthalmic manifestations was obtained from original journal articles, review articles, case reports and standard postgraduate textbooks.

RESULTS

Ophthalmic manifestations include proptosis, diplopia, lid ecchymosis, xanthomatosis, conjunctival and corneal crystalline and non-crystalline deposits, scleritis, episcleritis, secondary glaucoma, ciliary body cysts, ciliochoroidal effusion, uveal plasmacytoma, hyperviscosity retinopathy, retinal vasculitis, detachment of sensory retina and retinal pigment epithelium, and neuro-ophthalmic manifestations.

CONCLUSIONS

In multiple myeloma, it is necessary to take a closer look at the ophthalmic manifestations, both because of their local morbidity and because they might act as a reservoir for proliferation of myeloma cells and eventual systemic relapse. Early detection may permit safer and effective treatment. All patients with multiple myeloma should thus undergo thorough ophthalmic examination at the time of initial diagnosis and during follow-up.

Glaucomatocyclitic crisis in Edo State, Nigeria: report of two cases

OBJECTIVE

To report two classical cases of glaucomatocylitic crisis in tertiary Health Centres in Edo State, Nigeria.

METHOD

Two cases of glaucomatocylitic crisis seen at Irrua Specialist Teaching Hospital, Irrua, and University of Benin Teaching Hospital, Benin City, both in Edo State, Nigeria are reported. Diagnosis was based on typical history and findings on examination.

RESULTS

The first was a female who presented in December 2002 at Irrua Specialist Teaching Hospital and the second was a male who presented at the University of Benin Teaching Hospital, in March 2004. Both presented with blurring of vision in the affected eye and seeing halos around light. The intraocular pressures in the affected eyes were markedly elevated, there were fine keratic precipitates in the corneal endothelium of the involved eyes and the optic discs and visual fields were normal. Repeated episodes of the symptoms confirmed the diagnosis ofglaucomatocyclitic crisis.

CONCLUSION

This report shows that typical cases of glaucomatocylitic crisis occur in Nigerians but require a high index of suspicion for the diagnosis.

Ophthalmic manifestations of lymphoma

BACKGROUND

Ophthalmic involvement in lymphoma is a relatively rare condition that can result from a primary intraocular lymphoma or an intraocular manifestation of systemic lymphoma. This report reviews the ophthalmic manifestations of lymphoma.

METHODS

Review of relevant information from journal articles and Internet search.

RESULTS

Almost all the structures in the orbit, adnexiae and eye can be involved in lymphoma. Lymphoma of the eye and adnexiae are most frequently of B lineage. Most of the ocular manifestations frequently masquerade as other more benign intraocular conditions including allergic or infectious conjunctivitis, uveitis, multiple evanescent white dot syndrome, acute retinal necrosis or herpetic retinitis. Correct diagnosis thus depends on a high index of suspicion and frequently requires radiologic imaging, histologic analysis, particularly vitreous biopsy or flow cytometry, subretinal aspiration and retinal biopsy. Diagnosis is often delayed and may lead to a fatal outcome. Recognition of its modes of presentation facilitates early diagnosis and treatment that may improve prognosis.

CONCLUSIONS

It is important to review the ocular manifestations of lymphoma to assist the ophthalmologist to play a pivotal role in the prompt diagnosis and treatment of ocular lymphoma, and the haematologist/oncologist to recognize the need for a complete ophthalmic evaluation in the diagnosis, follow-up and management of lymphoma patients.

Problems of management of primary congenital glaucoma in Benin City, Nigeria

OBJECTIVES

To determine the problems encountered in the management of primary congenital glaucoma in developing countries.

METHODS

A prospective study of new patients with a diagnosis of primary congenital glaucoma attending the eye clinic of the University of Benin Teaching hospital, Benin City, Nigeria over a 5 year period, from July 2001 to June 2006. The age, sex, presenting complaints and duration were recorded. They were examined by the aid of a pen torch, hand-held slit lamp and direct ophthalmoscope. Intraocular pressure and corneal diameter were measured under anaesthesia. The patients were followed up till June 2006 and the problems encountered in management were recorded.

RESULTS

Eight children comprising 5 males (62.5%) and 3 females (37.5%) with primary congenital glaucoma were seen. All the patients (100%) presented with buphthalmos and 7 (87.5%) had corneal opacity. Four (50%) accepted surgery but only 2 (25%) eventually had surgery. Maximum follow-up was 7 months.

CONCLUSION

Presentation with features of advanced disease, poor acceptability of surgery, poor follow-up and low surgical rate are problems associated with the management of congenital glaucoma in Benin City, Nigeria.

Pattern of neuro-ophthalmic disorders in a tertiary eye centre in Nigeria

AIM

To determine the incidence and types of neuro-ophthalmic disorders at the eye clinic of University of Benin Teaching Hospital, Benin City, Nigeria.

METHODS

All the new patients presenting to the eye clinic of the University of Benin Teaching Hospital between May 2001 and April 2003 with neuro-ophthalmic disorders were interviewed, examined and investigated when possible. They were analysed in the context of age, gender, diagnosis, major clinical features and visual acuity.

RESULTS

A total of 76 patients with neuro-ophthalmic disorders were seen among a total of 1,698 new patients giving an incidence of 4.47%. The most common disorders were motor nerve palsies (27.6%), optic neuropathies (22.4%) and migraine (14.5%). The most presenting features were poor vision (39.5%), double vision (18.4%) and headache (17.1%). Twenty-nine patients (38.2%) were blind in the affected eye.

CONCLUSION

The incidence of neuro-ophthalmic disorders is relatively low but constitute a significant cause of ocular morbidity and blindness. Improvement in diagnostic facilities and awareness are required.

Maxillary herpes zoster with corneal involvement in a HIV positive pregnant woman

Corneal involvement in maxillary herpes zoster is very rare. This report presents the case of a 32 years old 7 months pregnant para2+1 female, who presented with vesiculopapular rashes with hyperpigmented crusts over the maxillary area of the face on the left side with periocular oedema, conjunctivitis and mild punctate keratitis in the left eye. She was HIV positive and was on treatment with the highly active antiretroviral therapy. She was treated with topical and systemic acyclovir with rapid resolution of the ocular features.

Ocular disorders in a petroleum industry in Nigeria

OBJECTIVE

To determine the ocular disorders in the petroleum industry in Warri, Nigeria.

METHODS

A clinic-based prospective study of the pattern of ocular disorders in workers of the Nigerian National Petroleum Corporation in Warri, Delta state of Nigeria was carried out over a 1-year period. Technical and non-technical workers were interviewed and examined using the Snellen's chart, pen-torch, direct ophthalmoscope, slit-lamp biomicroscope, Perkin's hand-held applanation tonometer, and the Kowa automatic visual field plotter where indicated.

RESULTS

A total of 154 technical workers comprising 146 males (94.8%) and eight females (5.2%), and 116 non-technical workers comprising 90 males (77.6%) and 26 females (22.4%) were seen. There was no reported case of ocular trauma. Symptoms suggestive of ocular irritation were much more common in technical workers. Allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea were significantly more common in technical workers P<0.0001.

CONCLUSIONS

Exposure to irritant chemicals in the petroleum industry makes the technical workers more prone to allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea. Protection goggles should be provided for all the technical workers.

Hereditary wide angle exotropia in a nigerian family

AIM

To present a report of a Nigerian family with wide angle exotropia resulting in amblyopia.

METHODS

A family of two wives and 12 children from Benin City, Edo State, Nigeria were interviewed and examined at the University of Benin Teaching Hospital, Benin City with the aid of a Snellen's chart, pen torch, slit lamp biomicroscope, ophthalmoscope and the pulsair non-contact tonometer.

RESULTS

There was 450 exotropia in the right eye of the 72 year old father, his 36 year old son, his 22 years old daughter and their 24 year old half sister. There was restriction of ocular motility in the right eye medially and some degree of amblyopia in the right eye of all the patients. The father and his 22 years old daughter were myopic of between -4.00 and -6.00 dioptre sphere but the son and his 24 years old half sister had -0.75 and -1.00 dioptre sphere myopia respectively. None of them presented to hospital because of the strabismus.

CONCLUSION

This report highlights the need to screen family members of patients with squint in order to detect the condition early and prevent amblyopia.

Ophthalmic mortality in a tertiary centre in Nigeria

OBJECTIVES

To determine the mortality rate of ophthalmic ward patients and the causes of death.

METHODS

A retrospective study of all ophthalmic patients admitted into the ophthalmic wards of the University of Benin Teaching Hospital, Benin City between May 1989 and April 2005 was conducted. The case records of all ophthalmic deaths were analysed. The age, sex, diagnosis and cause of death were recorded.

RESULTS

A total of 1854 patients were admitted into the ophthalmic ward comprising 1,057 males (57%) and 797 females (43%) giving a male-to-female ratio of 1.3:1. There were 7 deaths in the ophthalmic wards during the period giving a mortality rate of 3.8/100 admission. Three patients (42.8%) were being managed for orbital cellulitis, 2 patients (28.6%) had malignant tumours and the remaining 2 patients (28.6%) had cataract extraction.

CONCLUSION

The mortality rate in the ophthalmic ward was low. Deaths could be prevented by early presentation, adequate preoperative screening, good nursing care, high index of suspicion by clinicians and provision of affordable drugs for life-threatening conditions.

A review of the risk factors in primary open angle glaucoma

The aetiology of primary open-angle glaucoma is still uncertain. However certain factors are known or suspected of having an aetiologic role. These are known as the risk factors. These include higher intraocular pressures, black race, old age especially after the age of 40 years, the peculiar larger optic disc structure of black people, a positive family history, vascular factors such as systemic hypertension, perfusion pressure, vasospasm, atherosclerosis and acute hypotension which is a risk factor for normal-tension glaucoma. Others are diabetes, which is prone to selection bias, myopia, a history of typical migraine headaches, thinner central corneal thickness and the ability to taste phenylthiourea. If a particular patient is identified as having one or more of these risk factors, that patient is by definition, at greater risk of developing glaucoma than a patient who does not.

Management of optic neuritis in a developing African country

AIM

To show the value of sub-Tenon's depo-methylprednisolone acetate followed by oral prednisolone in the management of optic neuritis in African patients.

METHODOLOGY

Two female patients who presented to the University of Benin Teaching Hospital, Benin city, Nigeria and one male patient who presented to the Eye clinic of the Nigerian National Petroleum Corporation, Warri, Nigeria with optic neuritis were given a single dose of sub-Tenon's depo-methylprednisolone acetate 40 mg followed by oral prednisolone 60 mg daily and their vision monitored.

RESULTS

In all the 3 cases, there was rapid improvement in visual acuity from as low as ? light perception, counting fingers at 1 metre and at 4 metre to 6/6 within 2-3 weeks with improvement in colour vision. After 3 years and 5 years follow-up in 2 cases, there was no recurrence of optic neuritis and no neurological deficit occurred.

CONCLUSION

Sub-Tenon's depo-methylprednisolone acetate followed by oral prednisolone is a safe and effective alternative treatment for optic neuritis in black African patients.

Pattern of presentation of primary open-angle glaucoma in Benin City, Nigeria

Late presentation is a major problem in the management of patients with primary open-angle glaucoma. The aim of this study was to determine the clinical features and the degree of visual disability of glaucoma patients at initial presentation. This was a prospective study of new patients with a diagnosis of primary open-angle glaucoma seen between January 2001 and August 2002 at the University of Benin Teaching Hospital, Nigeria. The patients were analysed in the context of age, gender, geographical abode, educational and socioeconomic status and clinical presentation. The patients were examined using the Snellen's chart, pen torch, slit lamp biomicroscopy, ophthalmoscopy, tonometry, perimetry and gonioscopy. Over a 20-month period 154 patients were studied; the mean age was 52.73 years (standard deviation +/- 15.98) and the highest incidence was in the seventh decade. The male to female ratio was 2.1:1. In all, 119 patients (77.3%) presented with subjective visual loss in one or both eyes, while 57.1% dated the onset of their symptoms to 1-5 years before presentation. Overall, 38 patients (24.7%) were blind when using visual acuity as the criteria, while 87 patients (56.5%) were blind when using visual fields as the criteria. The problem of late presentation has not improved over the last two and a half decades. More measures towards early detection by extensive health education, screening programmes and training of more eye care providers need to be put in place.

An orbital masquerade syndrome: a case report

This report presents the case of a 20-year-old female who presented with features of right panophthalmitis with secondary orbital cellulitis masquerading as an orbital tumour. This presented a diagnostic difficulty to several ophthalmologists. An orbital ultrasound scan revealed an underlying orbital mass, which on histology was discovered to be a well differentiated invasive large cell keratinizing squamous cell carcinoma. This report further emphasizes the value of ultrasound scan in detecting orbital tumours.

Glaucoma in benin-city, Nigeria

AIM

To determine the contribution of glaucoma to ocular morbidity and the different types of glaucoma seen.

METHOD

Medical records of all new patients attending the consultant outpatient clinics of the University of Benin Teaching Hospital, Benin city, Nigeria, over a 2-year period were reviewed. Those with a diagnosis of glaucoma were analysed.

RESULTS

Of 1,698 new patients, 147 (8.7%) had glaucoma diagnosed. One hundred and thirteen patients (76.9%) had primary open angle glaucoma, 4 patients (2.7%) had primary angle closure glaucoma, one patient (0.7%) had congenital glaucoma, 5 patients (3.4%) had juvenile glaucoma and 24 patients (16.3%) had secondary glaucoma. Among the patients with primary open-angle glaucoma, 19 patients (16.8%) and 47 patients (41.6%) were blind using visual acuity estimation and visual field criteria respectively.

CONCLUSION

Glaucoma remains a common cause of ocular morbidity worldwide as in our centre. Primary open-angle glaucoma is the most common type while primary angle-closure glaucoma remains relatively rare. Key words: glaucoma, morbidity, types, Benin City.

A review of the choice of therapy in primary open angle glaucoma

We are in the midst of a therapeutic revolution and the choice of therapy in the management of glaucoma can no longer be based on long-held beliefs. The choice between medical, surgical and argon laser trabeculoplasty as primary therapy for glaucoma has been a matter of debate and research for many years. Arguments are based mainly on 3 factors: efficacy, safety and cost. In Africa, other factors that must be considered include acceptability of surgery, compliance with medical therapy, scarcity and expense of modern drugs, absence of laser facilities among others. It is generally accepted that trabeculectomy surgery is the most acceptable form of therapy in Africans mainly because of its efficacy, late presentation and problems encountered during medical therapy. However many African patients are reluctant to have surgery for glaucoma mainly because of fear and the fact that there will be no visual improvement after the surgery. There are now several potent modern drugs, which though expensive have acceptable safety profile, and fewer problems with compliance. The decision on the choice of therapy should be individualized and not be based on long-held beliefs.

Complications of traditional couching in a Nigerian local population

AIM

To evaluate the complications of traditional couching in a local population.

METHOD

New patients who had undergone couching and presented to the consultant outpatient clinic of the University of Benin Teaching Hospital and D.D.S. Eye clinic in Benin-city between April 2002 and March 2003 were interviewed and examined by the author to identify the complications.

RESULTS

Eighteen eyes of 14 patients who had undergone couching were seen in Benin-city over a 1 year period. The cost of couching was similar to modern cataract surgery. Ten patients (71.42%) were initially satisfied but later became unsatisfied because of the complications and 2 (14.29%) were unsatisfied with the procedure. The main reasons for opting for couching were ignorance and fear of surgery. The main complications were secondary glaucoma (61.54%), hyphaema (15.38%) and optic atrophy (15.38%). Visual acuity of no light perception was seen in 33.33 % of eyes mainly from secondary glaucoma but 50% of eyes had corrected visual acuity of 6/18 or better.

CONCLUSION

In view of the above complications, traditional couching should not be encouraged.

Bilateral total loss of vision following eclampsia--a case report

Visual loss following eclampsia is usually reported to be a result of retinopathy, exudative retinal detachment or cortical blindness. This paper reports the case of a 31-year-old para 5 + 0 housewife who developed bilateral visual loss following eclampsia and presented to the ophthalmologist four weeks later with a vision of light perception in both eyes. Examination showed evidence of hypertensive retinopathy. Convinced that the ocular findings were not responsible for such marked visual loss, she was commenced on systemic, topical and sub-conjunctival injection of steroids, acetazolamide and multivitamins. Her vision improved progressively to 6/6 right eye and 6/9 left eye after three weeks. Obstetricians are advised to refer cases of visual loss following eclampsia promptly to the ophthalmologist who should in turn manage aggressively with systemic, topical and sub-conjunctival steroids.