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Acta Scientific Ophthalmology (ISSN: 2582-3191) Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria

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Acta Scientific Ophthalmology (ISSN: 2582-3191) Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria

Abstract

Keywords: Oculoplastic Disorders; Pattern; University of Port Harcourt Teaching Hospital
Acta Scientific Ophthalmology (ISSN: 2582-3191)
Volume 3 Issue 3 March 2020
Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria
CS Ejimadu, AA Onua* and EA Awoyesuku
Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Nigeria
*Corresponding Author: AA Onua, Department of Ophthalmology, University of
Port Harcourt Teaching Hospital, Nigeria.
Research Article
Received: February 13, 2020
Published: February 27, 2020
© All rights are reserved by AA Onua., et al.
Abstract
Keywords: Oculoplastic Disorders; Pattern; University of Port Harcourt Teaching Hospital
Introduction
Aim: To ascertain the presentation pattern of oculoplastic-related disorders in University of Port Harcourt Teaching Hospital Port
Harcourt.
Methods: A retrospective hospital-based Study of patients presenting to the oculoplastic unit of the University of Port Harcourt
Teaching Hospital between January 2017 and December 2019. Records of patients were retrieved, entered into Excel sheet, cleansed
and analyzed using Statistical Package for Social Sciences (SPSS) version 25.
Results: The commonest case was Chalazion (32%) followed by Ocular Surface Squamous
Neoplasia (8.9%), Thyroid Eye Disease, Ectropion and Nasolacrimal Duct Obstruction contributing 5.7% each. There were 49 (39.8%)
males and 74 (60.2%) females. The male to female ratio was 2:3. The commonest affected age group was 21-30 years (33.3%), fol-
lowed by 31 - 40 years (15.5%). The least affected age group were those that were above 70 years which constituted 2.4%.
Conclusion: Female gender and the age group of 21-30 were seen more with oculoplastic conditions probably due to the more sen-
sitivity of females and also of these young adults to cosmetic blemishes posed by oculoplastic related cases.
Very often than not, oculoplastic disorders present in various
forms in the General Out-Patient department and the ophthalmol-
ogy clinics. Congenital and acquired disorders of the eyes abound.
Of these, the orbital, ocular, lacrimal, lid, paranasal and ocular
adnexal lesions are among the commonest presentation of these
diseases [1]. The associated visual impairment could result in
anatomical and functional disability, cosmetic deformation, psy-
chosocial stigmatization, economic and educational deprivation
[1,2]. The problem is however worse in the developing countries
where contributing factors include ignorance, infections, malnutri-
tion and lack of adequate eye care services especially in the ru-
ral population are prevalent [3]. The serious misfortune of losing
one’s eyesight or having a cosmetically unacceptable deformity is
further worsened by poor rehabilitative and supportive measures
in developing countries [4,5].
There are often serious economic implications in such instances,
often leading to social dependence, lack of access to education, loss
of productivity and income [5]. Quality of life of affected patients
also tends to decline in the presence of ocular deformities. The Ocu-
loplastic surgeon is therefore saddled with the responsibility of re-
storing function and structure of the eyelids, adnexa, and orbit and
by extension quality of life. Prevalence of Oculoplastic disorders
[1]. To the best of
our knowledge there is no data on pattern of Oculoplastic disorders
in our region. The study aims to determine the presentation pat-
tern of oculoplastic disorders in University of Port Harcourt Teach-
ing Hospital Port Harcourt within two years of running a specially
designated oculoplastic clinic weekly.
Materials and Methods
This was a retrospective hospital-based Study of patients pre-
senting to the oculoplastic unit of the University of Port Harcourt
DOI: 10.31080/ASOP.2020.03.0099
Citation: AA Onua., et al. Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria”. Acta Scientific Ophthalmology 3.3 (2020): 01-04.
Teaching Hospital between January 2017 and December 2019. The
university of Port Harcourt Teaching hospital is a tertiary Health
Care institution in the Niger Delta region of Nigeria. The various
ocular disorders in the hospital are routinely entered into oculo-
plastic register, in the department of ophthalmology from where
the data were extracted. Relevant records of patients including
socio-demographic data, diagnosis on presentation were retrieved,
entered into Excel sheet, cleansed and analyzed using Statistical
Package for Social Sciences (SPSS) version 25.
Results
A total of 124 clients participated in the study, 74 (59.7%) were
females. Male to female ratio was 1:1.5. The mean age of the study
participants was 31.9 ± 13.6 years; with age range of 6 - 81 years.
Age group (21 - 30 years) had the highest proportion of partici-
pants (33.1%). The differences in the proportion of age groups be-
  -
cant (p = 0.633).
Age Group
(Years) Male (n) % Female (n) % Total (n) %
0-10 6 4.9 7 5.6 13 10.5
11-20 7 5.6 5 4.0 12 9.6
21-30 14 11.3 27 21.8 41 33.1
31-40 10 8.1 9 7.3 19 15.4
41-50 7 5.6 10 8.1 17 13.7
51-60 3 2.4 8 6.5 11 8.9
61-70 2 1.6 5 4.0 7 5.6
>70 1 0.8 3 2.4 4 3.2
Total 50 40.3 74 59.7 124 100
Pearson’s Chi-Square = 5.223 p-value = 0.633
Table 1: Socio-demographic Distribution of the Study Population.
Oculoplastic Disorders
Orbit/Onchology Frequency Per cent
Thyroid Eye Disease 7 5.7
Karposi Sarcoma 1 0.8
Ocular Surface Squamous 11 8.9
Cyst of Zeis 2 1.6
Dermoid Cyst 5 4.1
Cyst of Moll 6 4.8
Lipodermoid 1 0.8
Sebaceous Cyst 1 0.8
Empty Socket 3 2.4
Conjunctival Mass 2 1.6
Phthisis Bulbi 2 1.6
Orbital Malignancy 4 3.2
Proptosis 4 3.2
Implantation Cyst 1 0.8
Total 50 40.3
Dacryology
Nasolacrimal Duct obstruction 7 5.7
Dacryocystitis 1 0.8
Chronic Canaliculitis 1 0.8
Lacrimal Gland Tumour 1 0.8
Total 10 8.1
Facial Aesthetics
Chalazion 40 32.0
Ptosis 3 2.4
 2 1.6
Crouzon’s Syndrome 1 0.8
Ectropion 7 5.7
Capillary Haemangioma 2 1.6
Essential Blepharospasm 1 0.8
Trichiasis 2 1.6
Lid deformity 1 0.8
Ankyloblepharon 2 1.6
Symblepharon 2 1.6
Dry Eye Secondary to Facial
Nerve Palsy
1 0.8
Total 64 51.6
Grand Total 124 100.0
Table 2: Distribution of oculoplastic, Dacryological and Disorders
in the Study Population.
Socio-demographic data
Discussion
The socio-demographic identities of patients presenting in ocu-
loplastic clinics vary widely. In this study, a total of 124 clients par-
ticipated, 74 (59.7%) were females. Male to female ratio was 1:1.5;
with mean age of 31.9 ± 13.6 years and age range of 6 - 81 years
(Table 1). In contrast to a study by Anunobi., et al. the commonest
age group was that of children under 15 years with a frequency of
02
Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria
Citation: AA Onua., et al. Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria”. Acta Scientific Ophthalmology 3.3 (2020): 01-04.
40.6% [6]. In a similar study by Bekibele., et al. in Ibadan Nigeria,
50% of cases were children and young adults from 0 to 20 years
old [7]. However, in a study in Pakistan, Asad Aslam Khan., et al.
observed a predominance of adults with 57.47% of cases [8] while
Balogun., et al. had two peak age groups of 0 - 9 years (22.7%) and
20 - 29 years (19.3%) [1].
Our study also revealed that the age group (21 - 30 years) had
the highest proportion of participants (33.1%) (Table1). The differ-
ences in the proportion of age groups between the male and female

been varying results on gender distribution in oculoplastic cases.
There was male predominance in a study by Assavedo., et al. with
males constituting 60.8% of study population [9]. This was similar
et al. [10] who had 60.4% of male subjects.
Anunobi., et al. [6] in Nigeria also reported a male predominance
in 56.0% of cases. Balogun., et al. found a female predominance in
their study in Lagos Nigeria [1].
Distribution of oculoplastic disorders
In this study, the commonest oculoplastic disorder was Chala-
zion (32%) while about 8.9% was Ocular Surface Squamous, Thy-
roid Eye Disease, Ectropion and Nasolarcrimal Duct Obstruction
   
of Odugbo., et al. in Jos, Nigeria, and Akinsola., et al. in Lagos, Nige-
ria [11,12]. It was observed that fewer oculoplastic cases visit the
specialist hospitals in our locality because majority of the cases are
deemed minor and are therefore either managed at home, chemists
or in peripheral clinics and fail to reach the tertiary centers [13].
The role of poverty and ignorance of the consequences of oculo-
plastic disorders are probably factors that need to be investigated.
Other oculoplastic disorders observed in our study were: Cyst

4.6% and 4.1% respectively. Proptosis, Orbital Malignancy, Empty
Socket and Ptosis are 3.2%, 3.2%, 2.4% and 2.4% respectively. In-
dividually, Cyst of Zeis, Trichiasis, Lid Deformity and Conjunctival
Mass, Symblepharon and Ankloblepharon account were 1.6% of
Oculoplastic Disorders. Lastly, Dry eye secondary to facial Nerve
Palsy, Lacrimal Gland Tumour, Implantation Cyst, Lid Deformity,
Chronic Canaliculitis, Dacryocystitis, Lipodermoid. Sebaceous Cyst,
Essential Blepharospasm, Crouzon's Syndrome, Kaposi Sarcoma
were 0.8% respectively (Table 2).
Conclusion
Chalazion, ocular Surface Squamous neoplasm, thyroid eye dis-
ease, ectropion and nasolacrimal duct obstruction were the most
common oculoplastic-related disorders presented in the oculo-
plastic unit of University of Port Harcourt Teaching Hospital Port
Harcourt during the period under review. The female gender and
the age group of 21 - 30 were seen more probably due to the more
sensitivity of females and also of these young adults to cosmetic
blemishes posed by oculoplastic related cases.
Consent and Ethical Approval
As per university standard guideline participant consent and
ethical approval has been collected and preserved by the authors.
Competing Interests
Authors have declared that no competing interests exist.
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Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria
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Audit of Oculoplastic Presentations in a Tertiary Niger Delta Hospital, Nigeria
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Conjunctival masses are growth on the surface of the outer eye; which may represent benign or malignant transformations. To determine the pattern of presentation of conjunctival masses at the Guinness Eye Centre (GEC), Lagos University Teaching Hospital (LUTH) Idi-Araba over a 13 year period (Jan 1995-Dec 2007). A retrospective review of the clinical notes of all patients that presented to GEC with conjunctival masses during the study period was carried out. The bio-data, clinical features, stage, laterality and associated features of the masses were noted. The diagnosis, treatment and complications of treatment were also recorded. Case notes of 612 eyes of 393 patients were included in the study. There were 219 (55.7%) males, 174 (44.3%) females with ages ranging from 4-85 years with a male to female ratio of 1.26: 1. Three hundred and eighty-eight patients (98.7%) presented as elective cases to the outpatient department while 5 (1.3%) presented as emergencies on account of associated ocular inflammation. There were 220 (56%) bilateral masses while 44% were uniocular. Pterygium was the leading conjunctival mass affecting 548 eyes (89.5%) of 329 patients. Pingueculae occurred in 53 eyes (8.7%), conjunctival cysts in 5 (0.8%) eyes, neoplastic growths in 3 (0.5%) eyes, conjunctival granulomas in 2 (0.3%) eyes and limbal teratoma in 1 (0.2%) eye. Most of these patients defaulted from surgery as only 141 eyes (23%) of 121 patients had surgery. Post-operative complications occurred in 33 eyes (5.4%) of 30 patients. The commonest postoperative complication was pterygium recurrence which occurred in 18 eyes of 15 patients. Pterygium was the commonest conjunctival mass and preventive strategies need to be advocated. Prevention of recurrence remains a challenge in the management of pterygium as recurrence after surgical excision occurred in 13.2% of eyes. Our study however did not confirm outdoor occupations as a risk factor for pterygium.
Article
ButLe but de cette étude est de déterminer les fréquences hospitalières des différentes affections de l′orbite.Patients et méthodesUne étude rétrospective allant de janvier 1981 à décembre 1989 a été menée au CHU de Brazzaville. En 9 ans, 704 patients atteints d′affections orbitaires ont été examinés. Nous avons utilisé la classification recommandée par Rootman qui prend en compte les renseignements cliniques, physiopathologiques et les données de l′imagerie. Elle permet de classer les affections orbitaires en 5 groupes : « les inflammations », « les traumatismes et les malformations », « les affections vasculaires et hématologiques », « les dégénérescences » et enfin « les tumeurs ». Les critères d′inclusion des dossiers comprenaient l′examen clinique, les explorations paracliniques, les radiographies classiques et le scanner selon les cas. Les fréquences et l’homogénéité des données ont été analysées avec le test de χ2.RésultatsLa fréquence des affections orbitaires a représenté 7,04 ± 0,02 % de l’ensemble des pathologies oculaires. 60,4 % des patients étaient des hommes (p < 0,05). La répartition des patients en fonction des tranches d′âge s′est traduite par une courbe bimodale avec un pic dans la très jeune enfance et un autre aux 3e et 4e décennies (p < 0,05). Les principales formes symptomatiques constatées étaient la cellulite, l′exophtalmie, les troubles sensitifs et les altérations de la vision. Les affections inflammatoires et les orbitopathies dysthyroïdiennes représentaient 61,7 % des cas, les anomalies structurelles traumatiques et malformations 24,7 % des cas, les affections dégénératives 3,7 % des cas, les tumeurs 3,7 % des cas, les affections vasculaires et hématologiques 2,4 % des cas et les formes indéterminées 3,7 % des cas. Les inflammations et les traumatismes se rencontraient beaucoup plus chez l′homme et les exophtalmies chez la femme (p < 0,05). Les pathologies les plus fréquentes entre l′âge de 0 et 20 ans étaient les inflammations, les traumatismes et les malformations, entre l’âge de 21 et 60 ans les inflammations, les traumatismes et les affections dégénératives et au-delà de 60 ans les inflammations, les affections dégénératives et les tumeurs.DiscussionLes inflammations, les traumatismes et les tumeurs sont les affections de l′orbite les plus diagnostiquées. Les différences de fréquences observées avec les données des pays européens et nord-américains sont liées au manque de disponibilité des examens complémentaires spécialisés dont notamment les examens biologiques, l′anatomopathologie et l′imagerie, mais aussi l′inaccessibilité aux soins de qualité dans nos régions.PurposeThe aim of our study was to determine the occurrence of different orbital diseases.Patients and methodsThe authors report the results of a retrospective survey of 704 patients examined over 9 years, from January 1981 to December 1989. We used J. Rootman's physiopathologic classification. The inclusion criteria included clinical examination, essential paraclinical explorations, and X-rays. Data frequencies and homogeneity were analyzed with the χ2 test.ResultsOrbital diseases made up 7.04±0.02% of the eye pathologies found. A male prevalence was noted (p<0.05). The distribution according to age groups was characterized by a bimodal curve with a peak at very early childhood and another at the 30s and 40s (p<0.05). Etiologies were as follows: inflammatory diseases and exophthalmia (61.7%), trauma and structural lesions (24.7%), degenerative diseases (3.7%), tumors (3.7%), and blood and vascular diseases (2.4%). Inflammations and orbital injuries occur more often among men and exophthalmia among women (p<0.05). According to age, inflammations, injuries, degenerative diseases, and malformations occur between 0 and 20 years, and inflammations, degenerative diseases, injuries, and tumors occur with greater frequency after 20 years (p<0.05).DiscussionInflammations, injuries, and tumors are the principal diseases of the orbit diagnosed. The different occurrences of tumors and specific inflammations observed in this study are related to the inadequate means of complementary examinations and the difficult access to health care centers in African countries.
Article
To describe the pattern of ocular diseases seen during the study period. Retrospective review of surgical pathology and cytology records from January 1991 to December 1999. Reference was also made to case notes where necessary. A total of 225 orbital and ocular surgical pathology specimens were reviewed. One hundred and twenty-five (56.8%) were from males and 100 from females (ratio: 1.3:1). Over 50% of the specimens were obtained from children and young adults less than 20 years of age. There were 168 tumours, with malignancies accounting for 73.8% of all tumours. Other pathological lesions included, inflammatory conditions, benign tumours, and degenerative conditions, which represent 21.8%, 19.6%, and 2.2% of all lesions respectively. Retinoblastoma accounted for 57.3% of all malignancies, the age range was 3 months to 12 years, mean 2.65 years. The modal age was 2 years. Squamous cell carcinoma of the conjunctiva, accounting for 12.1% of all malignancies was the commonest malignancy seen in the adult age group. Malignant melanoma was rare and no case of Kaposi's sarcoma was seen. Commonest non-neoplastic lesions resulting in enucleation of the eye were panophthalmitis and endophthalmitis. Human immunodeficiency virus screening was only done in 3 of 8 patients with squamous cell carcinoma and was positive in 2 of them. Malignancies of the eye and orbit continue to make up majority of orbit and ocular pathologies requiring enucleation in children and young adults. Despite an observed increase in the frequency, insufficient information precludes evaluation of a link between HIV and squamous cell carcinoma as well as other obito-ocular lesions such as Kaposi sarcoma.
Blindness and Poverty
  • Z H Awan
Awan ZH., et al. "Blindness and Poverty". Pakistan Journal of Ophthalmology 27.3 (2011):144-148.