OCULOPLASTIC TRAINING AND ITS ROLE IN EYE CARE SERVICES IN A NIGERIA TERTIARY HOSPITAL

ABSTRACT Oculoplasty subspecialty in Ophthalmology was barely 7 years in Nigeria. National statistics show an increased number of cases that should have benefitted from this expertise that is rare. As a result of this deficit, a consultant ophthalmologist was sent to Sankara Nethralaya Eye Hospital, Chennai, India for 3 months oculoplastic training with the help of International Council Ophthalmology (ICO). To evaluate the role of oculoplastic training in eye-service care in our hospital, all patients seen at our oculoplastic unit during the 8 months period from April to November 2017, had information extracted from their medical record. The data obtained was analysed using SPSS version 20. Out of 53 patients seen 30 (56.65) were males and 23 (43.4%) were females. Majority 10 (18.9%) were diagnosed with a traumatic irreparable ruptured globe, while 10 (18.9%) had congenital nasolacrimal duct obstruction. Page 7 of 23 https://mc.manuscriptcentral.com/sljbr Sierra Leone Journal of Biomedical Research Oculoplastic training and its role in eye care services in a Nigeria tertiary hospital for Review Only 2 Thirty-six (67.9%) patients had surgery and 10 (18.9%) were successfully managed with lacrimal sac massage for congenital nasolacrimal duct obstruction in children. Majority 10(18.9%) of the surgery were evisceration with primary ocular implants. One patient with clinically significant orbital floor fracture was referred. Four cases of congenital ptosis declined surgery. This expertise resulted in increased patient turnout by 30% and income to the department, while it saves cost to patients who need not be referred. The skills acquired from oculoplastic training have help in rendering oculoplastic services to the people of Kebbi State and its environs at a reduced cost. Also, there is improved internally generated revenue to the hospital. The importance of skill transfers and subspecialty training is underscored. Keywords: oculoplastic; subspecialty training; Kebbi State; tertiary hospita

Subspecialty training in Ophthalmology; How far?

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Facial and eye injury following a fridge cylinder gas explosion

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Medical ethics in sub-Sahara Africa: closing the gaps

Background: Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices. Objectives: To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria. Methods: A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues. Results: A total of 307(76.2% ) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether \u201cEthical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to \u201cpatient\u2019s wishes\u201d, on the other hand over two-third of the respondents 211 (68.7%) agreed that \u201cdoctor should do what is best\u201d irrespective of the patient\u2019s opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues. Conclusion: This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals

Blindness and scalp haematoma in a child following a snakebite

Background: Snake envenomation is a major public health problem of the Savannah regions of West Africa. Ocular manifestations of snakebites are rare with few reports documenting blindness as a complication. Objective: To highlight an unusual manifestation of snake bites and its attendant problems Methods: A report of scalp haematoma and blindness in a 10 year old child presenting 2 weeks after a snake bite (presumably carpet viper) is a rare manifestation. Local swelling, epistaxis, bilateral proptosis, exposure keratopathy and use of traditional eye medications were associated findings. Anti-venom though administered late saved the child\u2019s life but blindness could not be reversed. Results: Ocular ultrasonography revealed layered retrobulbar collection in the left eye, presumably due to hemorrhage. The skull x-ray showed a soft tissue swelling and aspirate from scalp swelling was bloody. Cranial Computed Tomography (CT) scan done late detected no abnormalities. Conclusion: Snakebite is associated with lifelong morbidity. Ocular manifestations must be treated as emergency. This case highlights the effect of ignorance and poverty in a setting of a common medical emergency leading to blindness and reduced quality of life

Nigerian neonatologists perception and experience with retinopathy of prematurity

Background: Retinopathy of Prematurity (ROP) is an avoidable condition that affects premature infants exposed to oxygen stresses at or soon after birth. In low- and middle-income countries, like Nigeria, neonatal mortality rates are high and very few infants live to develop ROP. With recent better care, ROP is now being diagnosed. Objective: This study aimed to characterize what Nigerian neonatologists understand about ROP. Methods: At a joint meeting of Nigerian pediatric ophthalmologists and neonatologists in Kebbi State held 26-29 July 2018, questionnaires collected attendees’ perspective and experience with ROP including causes, risk factors and experiences. Results: Fifty-one neonatologists out of 71 returned a completed questionnaire (response rate: 71.8%). The male:female ratio was 1:1.8, and approximately 40% were aged 41-50 years (n=20, 39.22%). Only 3 (6.39%) had experience managing infants below 500g that survived. A majority managed babies with a mean weight of 913g ± 300.37 and age of 27.87 weeks ±2.37. Most had no access to oxygen monitors (n=39,78%). Most had 10 babies to one monitor and used average settings of 90- 95%. One third had seen a case of ROP (n=15,29.41%). Only 5.88% (n=3) were unaware of uncontrolled oxygen use as a risk factor. Only 4 (8.89%) had a functional screening team. None were aware of local screening guidelines. Conclusions: Regular educational programs, collaborative clinical presentations and webinars about ROP targeted at the neonatologists and parents, including establishment of screening programs across country will likely help reduce the burden of ROP blindness in Nigeria

Importance of ultrasonography in evaluating eye injuries: data from Birnin Kebbi, Nigeria

Background: Ocular trauma remains an important cause of poor vision and blindness world-wide. Management of ocular trauma with haze media poses a great challenge to ophthalmologist. However the potential role of B scan ultrasonography in the diagnosis and management of a patient with hazy or non-visible posterior segment following ocular trauma has not been fully explored. Objective: To describe the use of B scans ultrasound (US) in the diagnosis and management of posterior segment ocular trauma in patients with media opacities. Methods: This was a 5-year retrospective study of patients with ocular trauma who presented at the Department of Ophthalmology Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria and sent for B scan US because of hazy or non-visible fundus. The ultrasound diagnosis was compared with clinical diagnosis. The data were analysed with SPSS 20 Version. Results: A total of 119 patients with ocular trauma had B scan US; 62.2% were male; the mean age was 34.2±20.1years. Patients were either students (27.7%) or full-time housewives (27.7%). Ocular injury was unilateral in 103 (86.6%) participants and bilateral in 13 (13.4%) participants. The right eye, 75 (63%) was most affected by the trauma. Most of the trauma 116 (97.5%) were due to closed eye injury. Ocular B scan was normal in 3 (2.5%) of the patients. The correlation between clinical diagnosis and B scan US diagnosis was 58.9%. Conclusion: B scan ultrasonography enabled diagnosis of 97.5% of ocular injuries not diagnosed at clinical examination due to haze media. Therefore the importance of B scan ultrasonography in the management of ocular trauma with hazy media is underscored

Uniocular Blindness Following Thermal Injury

A hot water burn is a thermal injury that results in cell death. Thermal eye injury triggers inflammatory processes, including inflammatory cell influx and/or the activation of various inflammatory cells, which result in the rapid accumulation of extravascular fluid in the ocular tissue. The ocular effect depends on the temperature of the water, and the final visual outcome depends on the severity of the damage to the intraocular structures. We report a 23-year-old woman who experienced a facial hot water burn that resulted in blindness. The patient presented late to the hospital after the unsuccessful use of traditional medication. Facial burns are a known cause of blindness. Public health education on prompt hospital presentation, and resistance to the use of potentially harmful traditional medicine in facial burns is suggested

Case Report: Facial and eye injury following a fridge cylinder gas explosion

Fridge cylinders contain liquefied petroleum gas (LPG), an inflammable gas of mixture of propane and butane [1]. It’s colourless but odourised to give warning during leakage. Injury from accidental fridge cylinder explosion is similar to any other blast injuries in terms of the release of hot gases, blast wave and metal fragments resulting in extensive skin burns, abrasions, penetrating injury and tissue loss [2-4]. Ocular trauma following gas cylinder explosion is rare however, Babar et al reported 20% of ocular trauma to be secondary to gas cylinder and battery explosion [2]. To our knowledge, this is the first case of facial and eye injury following a fridge cylinder gas explosion reported in the literature

Traumatic Enucleation and Bilateral Colles’ Fracture in a 70 Year Old Farmer

Purpose: To report a case of traumatic enucleation and Colles’ fracture in a 70-year-old male farmer following a fall from a height. Design: A case report. Findings: Enucleated right eye and bilateral Colles’ fracture. Practical implications: The attending health care personnel should do a complete assessment of a patient with a history of fall from a height to avoid missing important bodily injuries. Fall from height is a cause of avoidable blindness. Originality: Rare original case of traumatic enucleation after a fall