Important Cause Of Ocular Morbidity Research Articles

An overview of neonatal conjuctivitis

Neonatal conjunctivitis has been recognized for several centuries and it is one of the most common infections occurring in the 1 st month of life and remains an important cause of ocular morbidity of great health concern especially in developing countries. This article attempts to review the current epidemiology, etiology, risk factors, pathogenesis, investigations, and treatment and offer possible preventive measures to avert this potentially crippling disease. Most epidemiological reports have focused on gonococcal and chlamydial neonatal conjunctivitis because both are associated with sexually transmitted diseases and are therefore of general public health importance. The risk of conjunctivitis in newborns depends on frequencies of maternal infections, prophylactic measures, circumstances during labor and delivery, and postdelivery exposures to microorganisms. The etiological agents implicated as causes of Neonatal conjunctivitis can be classified into chemical and infective. Laboratory studies used in the diagnosis of neonatal conjunctivitis include smears, stains, cultures, and serological tests. Current World Health Organisation (WHO) guidelines for the management of sexually transmitted infections recommend that all cases of neonatal conjunctivitis be treated for both Neisseria gonorrhoeae and Chlamydia trachomatis . Four levels of intervention can be used to prevent childhood blindness and ocular morbidity from neonatal conjunctivitis. These strategies may reduce the prevalence of sexually transmitted disease, which in turn may reduce the risk to infants of exposure to agents that cause neonatal conjunctivitis.

Bilateral Interstitial Keratitis and Granulomatous Uveitis of Tubercular Origin

Tuberculosis (TB) is an important cause of ocular morbidity. Establishing a diagnosis may be difficult in some situations especially with unusual presentation. We report case of bilateral interstitial keratitis (IK) associated with anterior uveitis as a presenting feature of ocular TB from India. A 17-year-old woman presented with diminution of vision in both eyes. Slit lamp biomicroscopy showed central bilateral IK and active granulomatous uveitis. Laboratory investigations revealed raised erythrocyte sedimentation rate (50 mm/hr) and positive tuberculin test (22 mm induration) and QuantiFERON-TB Gold test (3.34 IU/mL), with no foci of systemic infection. Presumptive diagnosis of ocular TB was made. The patient was started on antitubercular therapy and topical steroids, after which symptoms and signs resolved. There was no recurrence of the disease for 1 year after completion of antitubercular therapy. Bilateral central IK with granulomatous uveitis is probably related to the presence of tubercular antigen in aqueous humor. Positive QuantiFERON-TB Gold test is useful for initiating the antitubercular treatment where unusual presentation is encountered.

Ocular injuries from the horsewhip: A 9 years retrospective study

Background: Horsewhip is a thong made from animal hide and is commonly used among African population to strike commonly, erring children as a form of corporal punishment to correct wrong doings especially at homes and in schools'. This practice is against International law (1989, Convention on the Rights of the child, UN) which sought to protect children from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation. Its use is associated with a myriad of vision threaten conditions including ruptured globe. Aim : The aim was to evaluate the prevalence and severity of eye injuries caused by horsewhip and recommend ways to reduce it. Materials and Methods : A 9 years retrospective study of horsewhip ocular trauma was carried out. The following information were extracted from patient's medical records: Sociodemographic record, circumstance of trauma, extent of eye injury, visual acuity (VA) at admission and at the time of discharge. The data were analyzed with SPSS version 18. Results: Horsewhip ocular injuries constituted 20 of a total number of 930 cases of ocular trauma seen during the study periods . There were 13 males and 7 females. Most patients were students 15 (75%). Left eye was mostly affected 11 (55%). Half of the injuries occurred at schools 10 (50%, 8 in Quranic and 2 in formal), followed by home 7 (35%). Cornea was the most affected part by the trauma 7 (35%). At the presentation to our hospital 11 (55%) had visual acuities of 6/18 or worse in the affected eye. The overall visual outcome of the patients as at the last hospital visit shows 50% attained a VA of 6/12 or better, and 50% had VA of 6/60 or worse. Conclusion: Horsewhip ocular trauma is an important cause of ocular morbidity, and the importance of ocular health education as a form of preventive measure is underscored.

Orbital and ocular trauma at Ahmadu Bello University Teaching Hospital, Shika-Zaria: A retrospective review

Background: Orbital and ocular trauma is a major cause of monocular blindness and visual impairment worldwide. The department of ophthalmology of the Ahmadu Bello University Teaching Hospital (ABUTH) only existed at the old Kaduna hospital prior to the full functional take off at the new Shika hospital complex. With the number of orbital/ocular trauma cases and resulting complications on the increase in the eye clinic, a review to determine the incidence, as well as management protocol will lead to improvement in the treatment and visual outcomes of future cases. Aim: To determine the incidence of orbital/ocular trauma in ABUTH, Shika-Zaria. Materials and Methods: A retrospective study involving the analyses of all case files of patients who had orbital trauma and were treated at the eye clinic, ABUTH, Shika-Zaria between January 2006 and December 2007. A detailed protocol was used for data entry. Results: A total of 142 (1.8%) patients with orbital/ocular trauma were seen over a period of 2 years. The male to female ratio was 3:1. The age range was 4 months to 65 years. A unimodal age pattern was observed with peak occurrence in those 16-30 years (33.1%), closely followed by age group 0-15 years (32.4%). Individuals most commonly involved in orbital/ocular trauma were students (32.4%), while the home (42.3%) was the most common location where injury occurred. Mild blunt trauma (49.3%) was the most common diagnosis, followed by severe blunt trauma (30.3%). Severe and mild penetrating injury occurred in (16.2%) and (4.2%) of the patients respectively. Conclusion: An important cause of ocular morbidity presenting at the eye clinic of the ABUTH, Shika-Zaria is orbital/ocular trauma. Factors associated with increased occurrences of orbital/ocular trauma include younger age, male gender, being a student, and domestic and road traffic accidents. More care should be provided at school play grounds, and adequate supervision should be given to vulnerable groups in homes. Road safety rules and guidelines should be enforced on the highways.

Current status of HIV infection and ocular disease

In the present era of highly active antiretroviral therapy (HAART), the challenges that HIV/AIDS patients face with regard to ocular complications has changed immensely; nonetheless, significant ocular morbidity persists. We present an update on these challenges, focusing particularly on the relevant literature from the past 12-18 months. Although its incidence has decreased substantially in the HAART era, cytomegalovirus (CMV) retinitis remains an important cause of ocular morbidity and predictor of mortality. Presently, patients with less than 50 CD4 T-cells/μL have an approximately equal risk of developing this potentially blinding ocular complication compared with the pre-HAART era. Less is understood about the current epidemiological considerations of ocular syphilis and HIV; however, patients with HIV may have increased likelihood of posterior syphilitic uveitis. Regarding the neuroretinal disorder associated with HIV, new ophthalmic imaging modalities are helping to uncover potentially associated structural alterations. Future challenges in the fight against HIV/AIDS-related eye disease will involve identifying additional factors conferring increased risk of CMV retinitis, understanding the scope of ocular syphilis and other eye infections in HIV patients, and furthering our understanding of the structural changes in neuroretinal disorder as an indicator of other end-organ damage.

A Highly Sensitive Method for Molecular Diagnosis of Fungal Keratitis: A Dot Hybridization Assay

Fungal keratitis (FK) is an important cause of ocular morbidity, especially for people living in the agricultural communities of the developing world. Current diagnostic methods may lack sensitivity (direct microscopy) or are time consuming (culture). The aim of this study was to develop a dot hybridization assay for sensitive and rapid diagnosis of FK. Evaluation of diagnostic test or technology. Fifty corneal scrapes (49 patients) from consecutive cases of clinically suspected microbial keratitis were analyzed prospectively. Molecular detection of fungi in the scrapes was performed by amplification of the internal transcribed spacer region (ITS) that contained the target gene (5.8S rRNA gene) by polymerase chain reaction (PCR), followed by hybridization of the PCR product to a fungus-specific oligonucleotide probe immobilized on a nylon membrane. The results were compared with those obtained by gram-stain microscopy, culture, and gel electrophoresis of the PCR products. Discrepant results were resolved by cloning and resequencing of the amplified ITS fragments. Performance of the dot hybridization assay, including sensitivity, specificity, and positive and negative predictive values, was evaluated. Ten scrapes demonstrated positive results by both the dot hybridization assay and culture. However, 11 scrapes demonstrated positive results by the dot hybridization assay, but demonstrated negative results by culture, and 10 of the 11 samples were considered to be positive for FK by cloning and resequencing of the amplified ITS fragment and by a pathologic examination or clinical course review. The sensitivities for diagnosis of FK by the dot hybridization assay and culture were 100% and 50%, respectively, whereas the specificities were 96.7% and 100%, respectively. The dot hybridization assay is a highly sensitive and specific diagnostic tool for FK. The method provides a much higher sensitivity than that of culture (100% vs. 50%; P<0.001). The hybridization procedure can be finished within a working day. It is expected that the method can have an impact on the diagnosis and treatment of FK in the future. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Profile of sight-threatening infectious keratitis: a prospective study

To prospectively study patients presenting with sight-threatening corneal ulcers with a view to identify the predisposing factors, causative organisms, clinical signs and treatment outcomes. Prospectively, over 3-year period, all cases with serious infective keratitis presenting to Queens Medical Hospital in Nottingham, UK, were recruited. Detailed information on the aetiology, culture results, signs & symptoms, the treatment given and the patient's response was collected and statistically analysed. One hundred and forty-three eyes of 129 patients were enrolled. Thirty-one patients were managed as out-patients, and 98 were treated as in-patients. The mean duration of admission was 9 ± 13 days but was significantly higher in older patients and in Acanthamoeba keratitis cases. The important risk factors were ocular surface disease (32%), contact lens wear (26%) and previous ocular surgery (20%). Old age, deep infiltration, steroid use and poor initial vision were risk factors for prolonged course of treatment in bacterial keratitis. Corneal scrapings were done in 89% of the cases, but positive results were obtained only in 41.7%. Staphylococcus aureus was the most common isolated bacteria (18.8%). Acanthamoeba and Pseudomonas aeruginosa were the second and third common causative organisms (16.6% and 15%, respectively). Overall, 8.3% needed corneal grafting, which survived in 83.3% and eradicated infection in 100%. Microbial keratitis is an important cause of ocular morbidity. Previous ocular disease is an important predisposing factor. Old age, steroid use and poor presenting visual acuity are important prognostic indicators. Corneal grafting is an effective option for managing recalcitrant corneal infections.

FUNGAL PROFILE OF INFECTIOUS KERATITIS IN A TERTIARY CARE HOSPITAL - OUR EXPERIENCE

AbstractInfectious keratitis world wide are a leading cause of ocular morbidity and blindness. A large number of filamentous fungi, Yeasts and Zygomycetes have been incriminated as the causative agent of mycotic keratitis. Early diagnosis and treatment is important in preventing complications like corneal perforation, scleral spread and endopthalmitis. The present study was conducted to elucidate the epidemiological features of mycotic keratitis and study the fungal profile of mycotic keratitis of patients attending our hospital, which is situated on the coastal area of Karnataka.A total of 127 patients with infectious keratitis were investigated between January 2009 to June 2010. Corneal scraping was obtained from 127 patients under aseptic precaution. The scraping was subjected to 10% KOH wet mount, Gram's staining and culture. Of the total 127 patients suspected of having infectious keratitis, 44 (34.65%) were found to be positive for fungal aetiology. Of these, 40(90.90%) cases were positive on direct microscopy for fungal elements and 26(59.09%) cases showed growth on culture after incubation for 2-8 days. In 14 (31.81%) cases, the culture was found to be sterile despite positive direct microscopic findings, but the results were consistent with clinical findings. Positive culture was obtained in 4(09.09%) cases where direct microscopy was found to be negative. The commonest fungi isolated were Aspergillus species (61.5%)Mycotic keratitis continues to be an important cause of ocular morbidity, predominantly among rural population. Prompt diagnosis and early institution of antifungal therapy may limit the ocular morbidity and the sequelae of infectious keratitis. As the manifestation of mycotic keratitis is often confusing, a high degree of suspicion with sound knowledge of predisposing factors and microbiological confirmation is very essential to initiate appropriate therapy.

Diagnosis of fungal keratitis: current options

Fungal keratitis is prevalent in tropical regions of the world and is being increasingly recognized as an important cause of ocular morbidity. Early diagnosis and appropriate treatment are essential to avoid blindness. Clinical impression is often suggestive but clinical features may vary considerably and no one clinical feature may be pathognomonic of fungal infection. This review describes a combination of methods for the diagnosis of fungal keratitis. Both in vivo and in vitro techniques are described along with their advantages and limitations. In vivo confocal microscopy has made it easier for ophthalmologists to back up their clinical suspicion. In vitro methods include microscopy and culture for fungi. A wide range of conventional and molecular techniques are currently available that provide rapid diagnosis of fungal keratitis. Owing to the sensitivity and specificity of over 80%, when available, confocal microscopy could be useful for the diagnosis of fungal keratitis in the clinic. Among the laboratory techniques, a 10% potassium hydroxide wet mount or Gram stain are simple and sensitive enough to be adopted as office methods by ophthalmologists to rule out fungal etiology in patients with microbial keratitis. Empiric antifungal therapy is discouraged and confirmation of the diagnosis prior to institution of treatment is recommended.

Educational paper

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the premature infant with an incompletely vascularized retina. The spectrum of ophthalmological findings in ROP exists from minimal sequelae, which do not affect vision, to bilateral retinal detachment and total blindness. With the increased survival of very small infants, retinopathy of prematurity has become one of the leading causes of childhood blindness. Over the past two decades, major advances have been made in understanding the pathogenesis of ROP, to a large extent as a result of changes in clinical risk factors (oxygen and non-oxygen related) and characteristics observed in ROP cases. This article provides a literature review on the evolution in clinical characteristics, classification and treatment modalities and indications of ROP. Special attention is hereby paid to the neonatal factors influencing the development of ROP and to the necessity for everyone caring for premature babies to have a well-defined screening and treatment protocol for ROP. Such screening protocol needs to be based on a unit-specific ROP risk profile and, consequently, may vary between different European regions. Retinopathy of prematurity is an important cause of ocular morbidity and blindness in children. With better understanding of the pathogenesis, screening and treatment guidelines have changed over time and are unit specific.

Population-based prevalence of uveitis in Southern India

PurposeTo estimate the prevalence of uveitis in rural Tamil Nadu, India.MethodsCluster sampling identified a population-based sample of 5150 persons ages 40 years and older, representative of three districts in Tamil...

Formulation of Econazole Nitrate as an Ophthalmic Ointment

Background and objective: Keratomycosis is an important cause of ocular morbidity and can lead to blindness due to lack of ocular antifungal agents. The goal of this study is to formulate a stable effective formula of econazole nitrate ophthalmic ointment.Econazole nitrate has an advantage over other antifungal agents in treatment of mixed infection since it is active against both dermatophytes and candida, and also it is effective in the treatment of filamentous fungi. Methods: Econazole nitrate ophthalmic ointment of different strength were formulated and compared for their in vitro activity.The effect of different factors (light and type of container) and calculating the expiration date of the selected formula were studied. Results: Formula A (1gm Econazole nitrate in 100 gm ophthalmic ointment base) and formula B (2gm Econazole nitrate in 100gm ophthalmic ointment base) had good in vitro antifungal activity because both formula A and B inhibit the growth of the fungi used, but formula A was selected because it has the lowest concentration and the same activity. Also the results indicated that the selected formula A was affected by light and its % remaining was (96.7%), while there was no effect of the type of container used to store Econazole nitrate ophthalmic ointment.The expiration date of formula A was calculated to be (2.19) years. Conclusion: 1% Econazole nitrate ophthalmic ointment appears to be effective in vitro and should be stored in dark container .

Herpetic Eye Disease in a Public Eye Hospital in Nigeria

Objective: To determine the aetiology, pattern and complications of herpetic eye disease seen at the Guinness Eye Centre, Onitsha, Nigeria. Materials and Methods: The case files of all patients with herpetic eye disease who presented at the centre between January 1998 and December 2003 were reviewed. Information on age, sex, aetiological diagnosis, visual acuity, ocular complications and HIV status were abstracted into a standard proforma and analysed. Results: Sixty-two patients (64 eyes) – 35 male and 27 female – were seen. Age range was 14 months to 80 years. Thirtyone (50%) patients (32 eyes) had herpes simplex keratitis, 30 had cytomegalovirus retinitis. Twenty-nine patients were HIV positive. Fifty per cent of the affected eyes had low vision. Common ocular complications were: corneal opacity (20 patients); herpetic neuralgia (9 patients); uveitis (8 patients); and superimposed bacterial infections (6 patients). Conclusions: Herpetic eye disease is an important cause of ocular morbidity. Herpes zoster and cytomegalovirus infections, especially in young people, should raise the suspicion of coexisting HIV infection. Corneal scarring is the most common complication of the disease and requires keratoplasty to restore vision. Keywords: herpetic eye disease, Onitsha, NigeriaNigerian Journal of Opthalmology Vol. 15 (2) 2007: pp. 35-38

Pilzerkrankungen des Auges

Mycotic infections of the eye continue to be an important cause of ocular morbidity. Etiological factors and symptoms are useful for the diagnosis of fungal infections. Mycotic keratitis may be seen after trauma with vegetable material, or in previously diseased eyes. The most common pathogens are Candida, Fusarium, Aspergillus. Clinical features, like the pyramidal Hypopyon, can differentiate fungal from bacterial infections. Mycotic Endophthalmitis refers to intraocular inflammation caused by Candida, Aspergillus, and Cryptococcus. Exogenous mycotic endophthalmitis follows intraocular surgery or trauma. Endogenous mycotic endophthalmitis is frequently an ocular manifestation of a systemic disease. Early diagnosis should be made to ensure prompt initiation of antifungal therapy, to prevent visual loss.

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).

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

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.

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.

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.