Cause Of Ocular Morbidity Research Articles

Unusual Intraorbital Foreign Body: A Case Report

Penetrating eye injury is an important cause of ocular morbidity in India, especially in the pediatric and adolescent age group. Sometimes these injuries are associated with retained intraorbital foreign body. We report herein for the first time a child who had an open globe injury with a retained unusually large intraorbital foreign body (iron nut).

Ocular injury in hurling

In this study, the authors describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for nonuse of protective headgear and eye wear. The case notes were reviewed of 310 patients who attended Cork University Hospital or Waterford Regional Hospital between January 1, 1994 and December 31, 2002 with ocular injuries sustained during a hurling match. A confidential questionnaire on reasons for nonuse of protective headgear and eye wear was completed by 130 players. Hurling related eye injuries occurred most commonly in young men. Fifty-two patients (17%) required hospital admission, with hyphema accounting for 71% of admissions. Ten injuries required intraocular surgical intervention: retinal detachment repair (five); macular hole surgery (one); repair of partial thickness corneal laceration (one); repair of globe perforation (one); enucleation (one); trabeculectomy for post-traumatic glaucoma (one). Fourteen eyes (4.5%) had a final best- corrected visual acuity (BCVA) of <6/12 and six (2%) had BCVA <3/60. In the survey, 63 players (48.5%) reported wearing no protective facemask while playing hurling. Impairment of vision was the most common reason cited for nonuse. Hurling related injury is a significant, and preventable, cause of ocular morbidity in young men in Ireland. The routine use of appropriate protective headgear and faceguards would result in a dramatic reduction in the incidence and severity of these injuries, and should be mandatory.—Hans E. Grossniklaus

Common eye diseases in children of rural community in Goro district, Central Ethiopia

Abstract Background: Very few reports exist regarding the causes of ocular morbidity in children of rural community in Ethiopia. Objective: To identify the causes of ocular morbidity in children of rural community. Method: A community-based cross-sectional study was conducted between January 2003 and February 2003 to identify common eye diseases in children. A cluster sample of village were randomly taken from 7-peasant association in Goro district, Southwest Ethiopia. All children (

Conjunctivitis as seen in Ile-Ife

Objective: To survey the clinical pattern of conjunctivitis with the aim of identifying the etiologic agents of bacterial conjunctivitis and their antimicrobial sensitivity pattern.Method: Patients with clinical features of conjunctivitis form the cohort of this study. A retrospective study of 3,872 patients seen at the eye clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, between January 1997 and December 2000 was undertaken. Of these, 689 patients (17.8%) had conjunctivitis. Those diagnosed as having infective conjunctivitis had conjunctival swabs taken for microscopy, culture and sensitivity tests, and were investigated by standard microbiological methods.Results: Out of a total of 3,872 new patients seen over a 3-year period, 689 (17.8%) presented with conjunctivitis. Of these, allergic conjunctivitis was the most common type, seen in 580 patients (84.2%), followed by acute bacterial conjunctivitis in 98 patients (14.2%), while conjunctivitis secondary to physical trauma and toxic etiologies were seen in 8 (1.2%) and 3 (0.4%) patients respectively. Thirty-three patients (33.6%) with infective (acute bacterial) conjunctivitis had laboratory confirmed positive culture results. Thirteen patients (13.3%) developed complications such as corneal ulceration 9(9.2%) and perforation 4 (4.1%) before they presented at the hospital. Most of the bacterial isolates were sensitive to third generation cephalosporin, especially ciprofloxacin (89.8%-97.8% sensitivity).Conclusion: Conjunctivitis due to allergy and infective causes is a major cause of ocular morbidity. The high sensitivity of the isolates to ciprofloxacin (89.8-97.8%), chloramphenicol (68.9%), and gentamicin (84.9%), supports the appropriateness of using these drugs as first line drugs in the management of bacterial conjunctivitis. Corneal ulceration (9.2%) and perforation (4.1%) are major causes of ocular morbidity and blindness (6.1%), among patients with conjunctivitis as seen in Ile-Ife. There is a need for public eye health education and early referral of all cases of eye infections to an eye specialist to prevent blinding complications.Keywords: conjunctivitis, acute, aetiology and treatmentNigerian Journal of Ophthalmology Vol. 13 (1) 2005: 21-26

Ocular injury in hurling

Objectives: To describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for non-use of protective headgear and eye wear. Methods:...

Expression of TNF inhibitor gene in the lacrimal gland promotes recovery of tear production and tear stability and reduced immunopathology in rabbits with induced autoimmune dacryoadenitis

BackgroundThe most common cause of ocular morbidity in developed countries is dry eye, many cases of which are due to lacrimal insufficiency. Dry eye affects approximately 10 million in the United States., most of whom are women. In the U.S. alone, an estimated 2 million Sjögren's syndrome patients have dysfunctional lacrimal glands and severe dry eye, and there is no satisfactory treatment. These patients would benefit if their lacrimal tissue function could be restored.MethodsThe effect of adenovirus-mediated transfer of tumor necrosis factor (TNF)-α inhibitor gene on induced autoimmune dacryoadenitis was evaluated in a rabbit model. Soluble transgene protein was detected in tears by ELISA for 7 days following transduction.ResultsTwo weeks after induction of disease with activated lymphocytes, tear production, as determined by Schirmer testing, was reduced by about 40%, while tear film stability, as measured by tear breakup time (BUT), declined by 43%. Adenovirus-mediated gene therapy using AdTNFRp55-Ig given 2 weeks after disease induction, resulted in the return of tear production to normal levels by week 4. In the treated disease group, tear BUT improved significantly by week 4. Rose bengal scores, an indicator of corneal surface defects, increased after disease induction and declined after gene therapy. In the lacrimal gland, the CD4 to CD8 T cell ratio was 4:1 in the disease group compared to 1:2 in the treated group. Infiltration of T cells and CD18+ cells was reduced approximately 50% after gene therapy.ConclusionWe concluded that therapeutic levels of soluble TNF inhibitor were achieved in the lacrimal gland and on the corneal surface. Anti-inflammatory cytokine gene expression might offer a potential therapeutic modality for the treatment of autoimmune dacryoadenitis, once suitable vectors become available.

Childhood Eye Diseases in Sagamu

Objectives: To determine childhood eye diseases in Sagamu and compare the findings with those of other centres. Method: This retrospective study covers a 3-year period (Jan 1999 – Dec 2001). Diagnoses were made by ophthalmology consultants after full examination of the eyes. A follow-up of the patients was done by ophthalmology residents Results: A total of 707 new paediatric cases presented at the ophthalmology outpatient clinic during the study period. This represents 22.51% of new cases (adults and children) presenting at the Olabisi Onabanjo University Teaching Hospital (OOUTH). The overall male-female ratio was 1.2:1. Conjunctivitis (45.97%) – in particular allergic conjunctivitis (78.76% of cases of conjunctivitis), followed by refractive error (24.61%), and trauma (11.32%) were the most common causes of ocular morbidity in children. Lid diseases (3.54%), corneal scar (2.83%) and neuro-ophthalmic diseases were found to be less common. Factors favouring allergic conjunctivitis are the agrarian occupation of the people and a dusty environment. Conclusion: The common causes of childhood ocular morbidity in Sagamu are comparable to the findings in studies conducted in some other centres. It was found that corneal scarring has reduced in children, probably due to a better awareness of measles immunization. Allergic conjunctivitis, however, has become an important cause of ocular morbidity in children. Refractive error was also found to be an important cause of ocular morbidity in this study as in other studies. This probably justifies its inclusion in the vision 2020 programme. Key Words: corneal scarring, allergic conjunctivitis, refractive error, ocular morbidity Nigerian Journal of Ophthalmology Vol.12 (1) 2004: 6-9

The Problem of Trachoma within an Onchocerciasis-Endemic Zone in Kaduna: Need for a Multilateral Approach?

Introduction: Within the mesoendemic onchocerciasis belt of Kaduna State, Northern Nigeria, there were other causes of ocular morbidity as well. We investigated the contribution of trachoma. Methods: A total of 6831 individuals were examined for eye disease, including signs of trachoma. Results: The overall prevalence of trachoma was 4.5% (577 eyes of 310 individuals), making it the second most common cause (1 in 5) of ocular morbidity after cataracts. Of the 577 eyes, 405 (70.2%) had cicatrizing disease while the rest had active disease. Overall, the prevalence of TF was 1.1% (1.3% in those < 10 years of age), TI 0.2%, TS 3%, CO 0.5% and TT 1.1% (4.3% and 3.5% in subjects aged > 55 and > 40 years, respectively). The prevalence of trachoma increased with age. The overall prevalence of blindness in the whole population was 2.7%. Trachoma accounted for 11% of this. On the other hand, onchocerciasis accounted for 3.1% of the overall ocular morbidity (less than trachoma) and 39% of the blindness. Conclusions: There appears to be a clear need to retrain middle cadre ivermectin workers in trachoma rapid assessment and SAFE strategy intervention methods in order to further impact blindness prevention in these ‘onchocerciasis-endemic’ zones.

Ocular Trauma in a Greek Population: Review of 899 Cases Resulting in Hospitalization

Purpose: To determine the annual hospitalization rate and risk factors of eye injuries requiring hospitalization in an area of Greece. Methods: Retrospective case analysis of 899 consecutive patients with ocular injury admitted at the Department of Ophthalmology, University Hospital at Patras Medical School, Greece, over a 9-year period. Results: The average annual rate of hospitalized ocular injuries was 71.0 eye injuries per 1000 admissions at the Department of Ophthalmology. The majority (80.2%) of patients were male. The average age was 35.0 years (range 6 months–98 years). Approximately half of all injuries occurred in persons younger than 29 years of age. Patients with Albanian ethnic background were at higher risk. The most common type of injury was closed-globe injury (49.5%) that affected more frequently the very young individuals (0–19 years) and persons older than 50 years of age. Open-globe injuries occurred most often in young adults, 20 to 39 years of age, and comprised over 35% of all eye injuries in this age group. Most injuries (32.8%) occurred at the workplace, most commonly during construction activities. Injuries at home approximated the work-related injuries (30.0%). A total of 398 (42.5%) eyes underwent surgical intervention on the eye globe, while 49 (12.3%) of them underwent multiple operations as part of their treatment. 18.2% of the eyes were blinded and 27.9% had significant visual acuity loss. An enucleation during the follow-up period was performed in 4 (1.0%) eyes. Conclusions: Trauma is an important cause of ocular morbidity in Greece. Risk factors include young age, male gender, Albanian ethnic background, and workplace. General safety precautions and behavior modification are indicated.

Airbag-Induced Bilateral Corneal Graft Dehiscence

To report a case of bilateral corneal graft dehiscence caused by blunt trauma. Case report of bilateral simultaneous corneal graft dehiscence with expulsion of the lens and iris as a result of airbag-induced trauma. Both corneal buttons were resutured, the prolapsed iris tissue was repositioned in the right eye, and anterior vitrectomy was performed bilaterally. Topical and systemic antibiotics, topical steroids, cycloplegic agents, and antiglaucoma drugs were initiated. Repeated B-scan ultrasound examinations demonstrated an attached retina in both eyes. Three weeks after admission, the right eye was reoperated for removal of remnant lens material and additional anterior vitrectomy. The patient was fitted with polycarbonate spectacles with an optical correction of +8 in both eyes. Visual acuity improved to 20/200 and 0.5/60 in the right and left eyes, respectively. The right corneal graft regained transparency, but the left one remained hazy. Airbag deployment during motor vehicle collisions is a significant cause of ocular morbidity. The reported risk of airbag-related eye injury is 2.5% for any eye injury and 0.4% for severe eye injury. Patients undergoing corneal surgery should be counseled about the weakness of the donor-recipient interface and should consider wearing protective glasses.

Fungal keratitis.

Throughout the world, fungal keratitis is a leading cause of ocular morbidity. The purpose of this review is to discuss the recently published literature in relation to the epidemiology, etiology, diagnosis, and therapy of fungal keratitis. Globally, the incidence of keratomycoses and systemic mycoses is rising. Current therapies are often ineffective. Ongoing research toward rapid diagnosis and specific drug therapy could minimize the morbidity caused by this preventable disease. New antifungal drugs, including voriconazole, have been applied recently for the treatment of keratomycosis. The incidence of fungal keratitis is on the rise in the densely populated continents of Asia and Africa. Filamentous fungi are the most frequently reported pathogens. Polyene antifungal antibiotics, the first-line therapy in fungal keratitis, are not effective in severe keratomycosis. Imidazole derivatives such as voriconazole and echinocandin may be the better choice in the future.

Fungal infections of the cornea.

To describe key aspects of fungal infections of the cornea, which constitute an important eye problem in outdoor workers in tropical and subtropical regions. Review of published studies and personal observations. Fungal infections of the cornea are frequently caused by species of Fusarium, Aspergillus, Curvularia, and Candida. Trauma is the most important predisposing cause; ocular and systemic defects and prior application of corticosteroids are also important risk factors. Culture remains the cornerstone of diagnosis; direct microscopic detection of fungal structures in corneal scrapes or biopsies permits a rapid presumptive diagnosis. A variety of antifungals have been evaluated in therapy of this condition. Natamycin can only be given topically, while amphotericin B, miconazole, ketoconazole, itraconazole, and fluconazole can be administered by various routes. Topical amphotericin B (0.1-0.3%) is frequently the treatment of choice for infections due to Candida and related fungi, while topical natamycin (5%) is the choice for keratitis due to filamentous fungi. Medical therapy may fail, necessitating surgical intervention. Fungal infections of the cornea continue to be an important cause of ocular morbidity, particularly in the agricultural communities of the developing world. A proper understanding of agent and host factors involved in these infections will improve the outcome of this condition.

An Eye Care Outreach Programme in the Federal Capital Territory

Objectives: To describe an eye care outreach programme in the Federal Capital Territory (FCT) and the findings therefrom. Main Outcome Measures: Causes of blindness and ocular morbidity, prevalence of blindness. Methods: The programme was sponsored largely by the Bartimaeus Trust. Eighteen communities with a total population of 1083, all within two hours or less of commuting distance to the city of Abuja, were included in the outreach programme. The communities were a mixture of urban, semi-urban and rural. The subjects were volunteers who responded to electronic, poster and other forms of publicity for free eye examinations. Findings: The programme was well received by the communities. The major causes of ocular morbidity were refractory errors (40.4%), allergic/vernal conjunctivitis (18%), pterygium (7.2%) and cataracts (3.0%). Prevalence of blindness was 2.7% among the examined population. The main causes of blindness were cataracts (37%), aphakia mainly from couching (18.5%), glaucoma (14.8%), and pathological myopia (14.8%). Conclusions: Outreach programmes are useful for the social marketing of eye care services, and to identify major eye problems within a given catchment area. Cataracts are still a major problem within the FCT and more needs to be done to reduce the backlog. The rarity of onchocerciasis is remarkable but is probably attributable to recent population influx. [Nig. J. Ophthalmology Vol.11(1) 2003: 12-15]

Naltrexone, an opioid antagonist, facilitates reepithelialization of the cornea in diabetic rat.

Ulcers and erosions of the corneal epithelium, as well as delays in resurfacing of the cornea after wounding, are major causes of ocular morbidity and visual loss in diabetes. To study whether intervention by the opioid antagonist naltrexone (NTX; 30 mg/kg, twice daily) can restore reepithelialization in diabetic cornea, we induced diabetes in rats by intravenous injection of 65 mg/kg streptozotocin. After confirmation of diabetes, 5-mm-diameter epithelial defects that did not include the limbus were created by mechanical scraping of the cornea. At 4 and 8 weeks, corneal reepithelialization was markedly subnormal, with delays ranging from 11% to 17-fold in the diabetic animals compared with control counterparts. Rats that were diabetic for 8 weeks also had a significant decrease in the incidence of complete wound closure. At 4 and 8 weeks, diabetic animals that were receiving NTX had an acceleration in reepithelialization compared with diabetic animals that were receiving vehicle and even surpassed controls. DNA synthesis in the corneal epithelium of diabetic rats was decreased up to 90% of control levels, and NTX exposure of diabetic subjects elevated the labeling index by up to eightfold from diabetic animals that were receiving vehicle. Opioid growth factor and opioid growth factor receptor distribution were comparable in diabetic and control animals. These results indicate a delay in reepithelialization that is dependent on the duration of diabetes and that intervention of endogenous opioid-receptor interfacing with an opioid antagonist can facilitate the process of wound healing.

Screening for ocular abnormalities and subnormal vision in school children of Butajira Town, southern Ethiopia

Background: As in most African countries there is no national preschool or school eye screening service in Ethiopia. The purpose of this study was to conduct school eye screening in Butajira town to identify the causes of ocular morbidity and subnormal vision in school children and suggest possible intervention strategies. Methods: A cross-sectional study of 1846 students from Mekicho (1397) and Dobo-tuto (449) junior and elementary schools of Butajira Town selected by systematic random sampling of the sections of each grade was performed from Sep.13 to Nov.11, 1999. Visual acuity and detailed ophthalmologic examinations were done. Results: One or more ocular abnormalities were found in 62.6% of the students. Trachoma was the leading cause (54%) of ocular morbidity, followed by refractive error (11.8%), strabismus (4.4%), non-trachomatous acute conjunctivitis (2.3%), corneal opacity (1.3%), Xerophthalmia (1.1%)and Vernal keratoconjunctivitis (0.7%). Refractive error was the leading cause of low vision. Conclusion: Trachoma is a public health problem in the community, hence mass mobilization and the WHO comprehensive SAFE strategy has to be implemented. Concerned government bodies as well as NGO’s should take the initiative of providing those children with refractive error with low cost eyeglasses. Health education and yearly school eye screening by local health personnel will prevent common causes of blindness and visual impairment. [Ethiop.J.Health Dev. 2002;16(2):165-171]

Locally administered ocular corticosteroids: benefits and risks.

Corticosteroids, used prudently, are one of the most potent and effective modalities available in the treatment of ocular inflammation. However, they can produce a plethora of adverse ocular and systemic events. In order to optimise and target drug delivery, whilst minimising systemic adverse effects, a diverse range of local ophthalmic preparations and delivery techniques have been developed. Topical drops and ointments remain the primary methods for administration of ocular corticosteroids. However, ocular penetration of topical corticosteroid drops depends upon drug concentration, chemical formulation of corticosteroid, and composition of the vehicle, therefore, apparently small modifications in preparations can produce a more than 20-fold difference in intraocular drug concentration. Periocular injections of corticosteroids continue to have a useful, but limited, therapeutic role and longer acting, intraocular delayed-release devices are in early clinical studies. Although newer corticosteroids with lesser pressure elevating characteristics have been developed, corticosteroid-induced ocular hypertension and glaucoma continue to be significant risks of local and systemic administration. Posterior subcapsular cataract, observed following as little as 4 months topical corticosteroids use, is thought to be due to covalent binding of corticosteroid to lens protein with subsequent oxidation. Inappropriate use of topical corticosteroid in the presence of corneal infections also continues to be a cause of ocular morbidity. Other risks of locally administered ophthalmic corticosteroids include: tear-film instability, epithelial toxicity, crystalline keratopathy, decreased wound strength, orbital fat atrophy, ptosis, limitation of ocular movement, inadvertent intraocular injection, and reduction in endogenous cortisol. This extensive review assesses the therapeutic benefits of locally administered ocular corticosteroids in the context of the risks of adverse effects.

Keratitis

Corneal inflammation or keratitis is a significant cause of ocular morbidity around the world. Fortunately, the majority of the cases are successfully managed with medical therapy, but the failure of therapy does occur, leading to devastating consequences of either losing the vision or the eye. This review attempts to provide current information on most, though not all, aspects of keratitis. Corneal inflammation may be ulcerative or nonulcerative and may arise because of infectious or noninfectious causes. The nonulcerative corneal inflammation may be confined to the epithelial layer or to the stroma of the cornea or may affect both. For clarity, this section has been divided into nonulcerative superficial keratitis and nonulcerative stromal keratitis. While the former usually includes hypersensitivity responses to microbial toxins and unknown agents, the latter can be either infectious or noninfectious. In the pathogenesis of ulcerative keratitis, microorganisms such as bacteria, fungi, parasites (Acanthamoeba), or viruses play an important role. Approximately, 12.2% of all corneal transplantations are done for active infectious keratitis. Available world literature pertaining to the incidence of microbial keratitis has been provided special place in this review. On the other hand, noninfectious ulcerative keratitis can be related to a variety of systemic or local causes, predominantly of autoimmune origin.

Secondary glaucoma

Purpose: To review the common causes of secondary glaucoma. Methods: Review of current literature. Results: Secondary open and closed angle glaucomas are an important cause of ocular morbidity and vision loss in our community. Secondary glaucoma occurs with acquired ocular diseases (pigment dispersion, pseudoexfoliation, intraocular infection, intraocular inflammation and retinal vascular disease), blunt anterior segment injury, intraocular surgery (especially corneal grafting and congenital cataract surgery) and topical corticosteroid use. The medical treatment of secondary glaucoma is different from that of primary open angle glaucoma and must be tailored for the individual patient. Surgical treatment of secondary glaucoma carries a higher risk of complications and a lower rate of success than does surgical treatment of primary open angle glaucoma. Conclusions: Secondary glaucoma occurs with a variety of intraocular conditions and after a variety of intraocular insults. Awareness of patients at high risk should enable early detection and referral for appropriate management.

Uveitis in children

PURPOSE: To summarize the prevalence and patterns of uveitis in children. METHODS: Pertinent articles were reviewed. RESULTS: Children constitute 5-10% of the patients with uveitis seen at tertiary referral centers, and girls appear to develop uveitis slightly more frequently than boys. Among all children with intraocular inflammation, anterior uveitis accounts for 30-40%, posterior uveitis accounts for 40-50%, intermediate uveitis accounts for 10-20%, and diffuse uveitis accounts for 5-10%. The most common cause of anterior uveitis is juvenile idiopathic arthritis (JIA), whereas the most frequent type of posterior uveitis is toxoplasmic retinochoroiditis. Most cases of intermediate and diffuse uveitis are bilateral, chronic, and idiopathic. The most common causes of vision loss in children with uveitis are cataract, band keratopathy, glaucoma, and cystoid macular edema. Up to one-third of the children with uveitis are left with severely impaired vision as a result of these complications. CONCLUSIONS: Uveitis is an important cause of ocular morbidity in children. Prompt diagnosis and treatment is essential to minimize the risk of long-term vision loss.

Demography and prognostic factors of ocular injuries in South India.

To evaluate the extent of visual recovery after multi-disciplinary approach of treatment in serious ocular injuries; to determine the prognostic factors associated with poor final visual outcome and suggest adequate precautionary measures. A retrospective analysis of 325 consecutive patients with direct ocular trauma who were examined and treated at a tertiary eye care centre in South India over a 3-year period was undertaken. Males (86.8%) outnumbered the females (13.2%) and children (< 16 years) constituted 46.8% of the total affected population. Anterior segment was involved in 51.1%, the posterior segment in 8.9% and both anterior and posterior segments were involved in 31.4% of patients. Prompt and meticulous surgical treatment restored useful vision (better than or equal to 6/18) in 60.5% of patients. Post-treatment, a reduction in blindness and visual impairment rates in the affected eye with respect to WHO classification was 66.7 and 54.1% respectively (P < 0.0001). Two eyes needed prompt enucleation. The factors associated with visual impairment (visual acuity less than 6/18) were poor initial visual acuity, full chamber hyphema, endophthalmitis, retinal detachment, and vitreous haemorrhage. Direct ocular trauma remains an important potentially preventable cause of ocular morbidity, but the advent of modern surgical techniques can often restore useful vision in such situations. Mandatory use of protective eye wear at work, public health education including awareness on the part of parents to the potential dangers of some childrens' toys can to an extent help reduce ocular morbidity due to direct ocular trauma.