Orbital Loiasis Masquerading as Orbital Cellulitis: A Case Series

Background: Orbital loiasis is a rare ocular disease which is sparsely reported in the literature. It is caused by the human filarial parasite, Loa loa, which is rarely found in other continents except in Africa and among African immigrants. The ocular presentation of orbital loiasis is similar to orbital cellulitis, thus, a high index of suspicion is required to make a diagnosis. Methods: A retrospective description of the patients diagnosed and treated for orbital loiasis in a tertiary health facility in Ogun State, Nigeria between 1998 and 2013 was done. Data on the demographic characteristics, place of residence of the patients, symptoms, signs, and results of ancillary investigations were retrieved from the records. Result: Three cases of presumed orbital loiasis were seen within the study period. All the patients presented with sudden onset of ocular pain with proptosis without the history of shifting body or facial swellings or visible worm in their eyes. Other features recorded in all the three patients included severe axial proptosis, eyelid oedema with mechanical ptosis, conjunctival injection with chemosis and restriction of ocular motility in all positions of gaze. Full blood count revealed eosinophilia while the radiological investigation was neither in keeping with sinusitis, thyroid-related orbital disease or orbital pseudotumor. Treatment was switched to Diethylcarbamazine when there was no satisfactory clinical response to the initial antibiotics and all the patients had a good outcome. Conclusion: Orbital loiasis should be suspected when orbital cellulitis cases appear to be recalcitrant to treatment with antibiotics, particularly when there is eosinophilia on peripheral blood film

Bilateral visual loss from sphenoidal sinus Aspergillosis

Sphenoidal sinus aspergillosis is a rare disease which is difficult to diagnose due to its protean presentations. This report aims to describe bilateral loss of vision in a woman with insulin-dependent diabetes mellitus following aspergillosis of the right sphenoidal sinus. A 59-year old woman with insulin-dependent diabetes mellitus presented with a right-sided frontal headache of sudden onset which was associated with blurring of vision, all of two days duration. Her vision with correction was initially normal at 6/9 in each eye and funduscopy was normal. Two weeks into the illness, the vision became nil perception of light in the right eye. The persistence of a headache coupled with loss of vision in the left eye five months later led to neurosurgical evaluation and subsequent craniotomy. At craniotomy, pus and inflammatory tissue were found matting together the optic nerves and chiasma. Histology of the specimen showed features of aspergillosis. This case was instructive due to the rarity of sphenoidal aspergillosis/fungus ball involving the sellar/parasellar region. Delay in management can lead to blindness from optic nerve/chiasma involvement. Therefore, a high index of clinical suspicion is required although CT scan and MRI are the ultimate diagnostic tools

Quality of Sleep and Psychological Distress in Glaucoma

Background: People living with glaucoma are psychologically burdened because of the threat of visual loss. Therefore, understanding the psychosocial issues and quality of sleep holds important implications for the recognition, prevention, and treatment of emotional problems among people with glaucoma. This study investigated the quality of sleep and psychological distress among people with glaucoma. Methods: This was a cross-sectional study of adults recruited over a period of 12 weeks from a glaucoma clinic of a Teaching Hospital in south-west Nigeria. The quality of sleep and psychological distress were evaluated using the Pittsburgh Sleep Quality Index and General Health Questionnaire respectively. Results: Ninety-three adults with glaucoma participated in the study. The mean age was 62.33 ± 15.25 years. Fifty-seven (61.3%) of the subjects were poor sleepers while 27 (29.0%) were psychologically distressed. Psychological distress correlated with global sleep score (r = 0.399, p = 0.000), subjective sleep quality (r = 0.341, p = 0.001), sleep latency (r = 0.245, p = 0.018) and sleep disturbance (r = 0.279, p = 0.007). Conclusion: Psychological distress and sleep disturbances were common among patients with glaucoma. Concerns about these issues should be incorporated into routine clinical evaluations of patients with glaucoma

Ankyloblepharon Filiforme Adnatum in an African Baby – A case report

Ankyloblepharon filiforme adnatum is a congenital malformation of the lid margins, wherein the lids are connected by fine strands of extensible tissue. It can occur sporadically or be inherited as an autosomal dominant gene with variable penetrance. The abnormality is easily amenable to surgical lysis, but it is important to examine the baby for other congenital abnormalities. We present a two-week-old baby with this condition, who like other associated ankyloblepharon-ectodermal dysplasia clefting syndrome (AEC) has severe skin desquamation. Key Words: congenital anomaly, congenital ankylobepharon, lid malformation Nigerian Journal of Ophthalmology Vol.12 (1) 2004: 29-3

Ocular Myiasis in a Nigerian Adolescent: A Case Report

Ocular myiasis is a rare condition with varying consequences, from mild to life threatening condition. This case of ocular myiasis is presented to highlight the challenges in making a clinical diagnosis. The study is a case report of a 16-year old female pupil who presented with five months history of “extrusion of worms” from her left eye. An initial assessment of loasis was made until she brought a sample of what she called “worms.” Laboratory examination of the specimen using a magnifying glass revealed a larva. The girl was treated conservatively with a combination of topical antibiotic and topical non-steroidal anti-inflammatory drugs after trimming the eyelashes. On immediate follow up, the girl had no residual visual challenges. Although ocular myiasis is rare, a high index of clinical suspicion is required and myiasis should be considered a differential diagnosis of loasis

Causes Of Blindess Among Blind Students In Ogun State, Nigeria

A total of 28 blind students in 3 schools for the handicapped and 3 regular secondary schools were studied between October 1996 and May 1997. They comprised of 21 (75%) males and 7 (25%) females. Eleven (39.3%) were of primary education level, 13 (46. 4%) in secondary schools and the remaining 4 (14.3%) in vocational training. The main causes of blindness were; corneal scarring/ staphyloma 11(39.3%), catarract / aphakia / couching 4 (14.3%), cortical blindness 2 (7.1%) and retinitis pigmentosa 2(7.1%). Eleven of the students with corneal blindness admitted to having measles prior to blindness. 6 (21.4%) of the students examined had conditions needing treatment i.e cataract, aphakia subtotal corneal opacities. From the study preventable and treatable conditions are responsible for over 70% of case of blindness in the schools studied. To reduce the burden of childhood blindness in the state relevant recommendations were made KEY WORDS: Blindness, blind students, causes, prevention Nigerian Journal of Clinical Practice Vol.6(1) 2003: 17-1

Nasopharyngeal Malignancy Presenting as Proptosis in Children

Nasopharyngeal malignancy is potentially devastating with a high mortality especially if there is delay in diagnosis or late presentation. Nasopharyngeal carcinoma (NPC) presenting with proptosis as a major symptom to an Ophthalmologist is uncommon especially in the paediatric age group. It is against this background we present these patients to share our experience. We retrospectively reviewed cases of nasopharyngeal cancer in children who first presented to the Ophthalmologist at the Olabisi Onabanjo University Teaching Hospital [OOUTH] Sagamu between 2008 and 2010.Three paediatric patients presented at the eye clinic of OOUTH Sagamu. Two of the patients presented with severe uniocular proptosis and the third with bilateral proptosis. The patients also developed reduced hearing, epistaxis, severe and disturbing headache and neck swelling. There was profound vision loss in three eyes of the three patients. Their eyeballs showed restricted ocular movements. Radiological imaging showed features suggestive of nasopharyngeal cancer involving the nasopharynx, sinuses and orbit. One had Fine Needle Aspiration Cytology [FNAC] from the cervical gland confirmatory of Burkitt's lymphoma. The other two cases were worked up for biopsy from the nasopharynx but discharged against medical advice. The patient with bilateral proptosis died shortly after. The ophthalmologist may bethe first to be consulted in cases of a nasopharyngeal cancer with ophthalmic manifestation. Diagnosis is usually difficult to make except with a high index of suspicion. For this reason it is imperative for the ophthalmologist to be familiar with this subject matter.Key words: Proptosis, nasopharyngeal malignancy, ocular presentation, childre