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Background: Dry eye disease (DED) is a frequently encountered ocular morbidity seen among adult patients attending ophthalmic clinics in Nigeria. It can be assessed using different methods although there is differing consensus on reliable tests for accurate diagnosis. Aim: The aim of this study was to assess DED using Schirmer 1 without anaesthesia among adult patients attending the Eye Clinic in a tertiary hospital in Calabar. Methodology: This was a cross sectional study among adult patients who attended the Eye Clinic of University of Calabar Teaching Hospital who were recruited consecutively from January 1st to March 31st, 2019. All consenting participants had comprehensive eye examination and were assessed for DED using the Schirmer 1 Test. Test values of less than 10mm were diagnostic of aqueous tear deficiency. Initial data categorization yielded frequencies, percentages and proportions. Categorical variables were analysed using Chi-square test and continuous variables using Student’s t-test. Statistical significance was found where p-values were

Egbula Nkanu Eni,1 Bassey Eyo Edet,2 Affiong Andem Ibanga,3 Roseline Ekanem Duke1 1Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria; 2Federal Neuropsychiatric Hospital, Calabar, Nigeria; 3Department of Ophthalmology, University of Calabar, Calabar, NigeriaCorrespondence: Egbula Nkanu EniDepartment of Ophthalmology, University of Calabar Teaching Hospital, Calabar, NigeriaTel +234 7035252071Email egbulaeni@gmail.comPurpose: The major objective of this cross-sectional study was to examine the coping strategies of glaucoma patients at a secondary eye care unit with a view to deciding whether an intervention programme would be justified.Patients and Methods: The coping styles of 130 consenting adult glaucoma patients aged 18 years and above who were being treated for glaucoma in the Cross River State Eye Care Programme clinic in Calabar, Nigeria, were investigated by means of the 28-item Brief-COPE inventory in this descriptive cross-sectional study.Results: The mean age of the participants was 54.2 years (± 14.3) while almost three quarters (73.8%) of them were married. About four out of every five persons examined (81.5%) had a minimum of primary education. “Substance (alcohol and other drug) use”, “self-blame” and “behavioural disengagement” are coping styles that were reported by 33%, 42% and 42% of the participants, respectively. This group of patients should be identified in the clinic for appropriate psychological intervention.Conclusion: The present study confirms previous findings and contributes additional evidence that suggests that coping strategies should be considered in the holistic management of glaucoma patients. The information from the current study can be used to develop targeted interventions aimed at improving the coping styles of glaucoma patients.Keywords: adults, coping styles, Brief-COPE inventory, Cross River State

Background: Strabismus is a potential cause of ocular morbidity., Objective: The aim of this study was to determine the frequency, types of manifest strabismus and co-morbidities among patients attending a referral paediatric ophthalmology and strabismus clinic in Calabar, Nigeria., Methods: A retrospective review of case-notes of patients attending the paediatric ophthalmology and strabismus clinic from January 1, 2017 to December 31, 2019 was done. Collected data was analyzed using chi square test (or Fisher's Exact Test) and multivariate binary regression. A p-value of <0.05 was considered statistically significant., Results: Of the 4644 patients reviewed, 169 patients (3.6%) had strabismus during the study period but only 136 (80.4%) met the eligibility criteria for inclusion into this study. Most patients (89.0%) were aged below 16 years. Females (52.2%) were proportionately more. Sixty-three (46.3%) had one ocular comorbidity, 56(41.2%) had two while 16(11.8%) had three. The most common ocular comorbidity was amblyopia (31.6%), followed by hypermetropia (27.7%). Twenty-nine (21.3%) had systemic comorbidities. Sensory and infantile esotropia were the most common types; 35.3% and 32.4% respectively. Others included intermittent exotropia (16.2%) and sensory exotropia (6.6%). Primary strabismus was more common among those aged 16 years and above compared with those aged below 16 years (66.7% versus 57.0%), p=0.475. There were statistically significant relationships between strabismus and cataracts, retinoblastoma, hypermetropia, astigmatism among others. Amblyopia (AOR: 3.339; 95% CI: 1.100-10.131), hypermetropia (AOR: 10.615; 95% CI: 2.393-47.077), and myopia (AOR: 0.109; 95% CI: 0.016 to 0.732) were predictors of strabismus., Conclusion: The prevalence of strabismus in this study revealed a higher burden than previously reported in Nigeria. Some comorbidities serve as predictors of strabismus, and their presence may aid timely case finding. Treatment of causes of secondary strabismus may reduce the burden of avoidable causes of strabismus and associated visual loss., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Aim: To evaluate the quality of life (QOL) and level of depression among participants with high myopia in Nigeria and the demographic factors associated with these outcomes., Methods: This cross-sectional study was conducted on 100 adult participants with high myopia (defined as refractive error ≤-5.00 D or worse, and uncorrected visual acuity worse than 6/18 in the better seeing eye) attending ophthalmology centres in Nigeria from 2 October 2021 to 30 August 2022. The means and standard deviations were calculated for each of the four domains of World Health Organization Quality of life scale (WHOQOL-BREF) using the transformed scores. The Beck Depression Inventory (BDI) scale was used to assess the level of depression., Results: The highest and the lowest mean scores of WHOQOL-BREF domains were found for the psychological and physical health domains (mean percentage scores were 67.0 [95% confidence intervals (CI) 64.1-68.9] and 55.3 (95%CI 51.8-58.8, P <0.001), respectively. One-way analysis of variance (ANOVA) revealed significant differences in physical health with educational status (higher among those with tertiary education: mean difference 0.9, 95%CI -0.2-2.1; P =0.049), differences in psychological health with working status (higher among those who were working 1.2, 95%CI 0.3-2.1; P =0.012). Also, the result showed a statistically significant association between environmental health and marital status (higher among non-married: 1.7, 95%CI -0.9-2.3; P =0.012) while overall health was associated with place of residence (higher in urban areas: 2.3, 95%CI 1.2-3.5; P =0.024). For depression, one in every nine participants reported major depressive symptom, mostly younger people (aged 16-29 vs 30-49y: 17.0% vs 0, P =0.019), and slightly more women than men (14.3% vs 0, P =0.064). There were significant negative correlations between the depression scores and psychological health ( r =-0.48, P <0.001), physical health ( r =-0.29, P =0.002), social and relationship ( r =-0.49, P <0.001), environmental ( r =-0.48, P <0.001) and overall health ( r =-0.49, P <0.001)., Conclusion: People with high myopia have a relatively moderate QOL, but poor physical health, particularly the younger age group, and women who are more likely to experience clinically relevant depression. Eye care professionals should consider possible referrals for counselling for people with high myopia., (International Journal of Ophthalmology Press.)

Purpose: Despite the human ocular surface being easily accessible, ocular drug delivery can be challenging. When applied improperly, topical medications, the most popular first-line treatment used to treat glaucoma, can have a very brief contact time with the ocular surface and may not have the desired therapeutic impact. Drug delivery devices are gadgets that can address some of these problems. This study aims to determine patients' opinions on ocular drug delivery devices used in the treatment of primary open-angle glaucoma (POAG)., Methods: A pretested interviewer-administered questionnaire was used in a cross-sectional study of 115 POAG patients recruited from outpatient clinics in two Nigerian tertiary health institutions. Participants were asked about their understanding and acceptance of five Ocular drug delivery systems (ODD), namely drug-emitting contact lenses (CL), punctual plugs, subconjunctival injections, intracameral implants, and trabecular meshwork micro-stents, for the treatment of POAG., Results: Sixty (52.2%) participants, whose average age was 50 ± 9.8 years, were men. Self-pay was used for eye health treatments by 65% of participants. Of the participants, 68.7% admitted to using eye drops on their own. 57% of people were said to take their glaucoma medications consistently. CL and subconjunctival implants were seen to be most acceptable according to 39% and 30% of participants, respectively. Major factors determining the acceptability of ODD for POAG treatment were observed to be cost and effectiveness., Conclusion: Patients in our cohort who are being treated for POAG have a fairly positive attitude towards ODD. The prospective use of these devices for POAG treatment in Nigeria will depend on their efficacy and cost, as well as how ophthalmologists will weigh ODD options., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Middle East African Journal of Ophthalmology.)

Aim: To determine the causes of tractional retinal detachment (TRD) in Nigerians., Materials and Methods: A prospective, multicentre study evaluating eyes diagnosed to have TRD. History, clinical examination (including visual acuity, intraocular pressure measurement, anterior segment examination and dilated fundoscopy) and systemic evaluation (including previous diagnosis of diabetes, hypertension, sickle-cell disease and others) were performed in TRD eyes out of a cohort of retinal detachment eyes., Results: The prevalence of TRD of the 237 patients diagnosed with RD within a one-year study period was 25.7% (61 patients). Eighty eyes were diagnosed with TRD. Thirty-eight eyes of nineteen patients (31%) were bilateral, and 42 (69%) were unilateral. There were 38 male patients (62.3%) and 23 female patients (37.7%). The mean age was 52.3 ± 12.7 years (11-69 years). 88.5% of all TRD patients had an associated systemic disease, diabetes being the most common disease in 88.8% of them. Proliferative diabetic retinopathy was the most common cause of TRD (77.5%) and the most common cause of bilateral TRD. Both trauma and proliferative sickle-cell retinopathy occurred in 3.8% of the eyes. 68.8% of TRD eyes were blind at the presentation. However, the causes of TRD did not show any significant association with blindness ( P = 0.819)., Conclusion: Proliferative diabetic retinopathy poses a significant threat to vision, being the most common cause of TRD. Early detection and treatment of proliferative retinopathy in diabetes and sickle-cell disease, and trauma prevention will significantly reduce the burden of blindness due to TRD., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of the west African college of surgeons.)

Background: Exudative retinal detachment (ERD) is a rare type of retinal detachment (RD), and information on its causes and presentation in Nigerians and Black Africans is scarce., Aim: To report the prevalence, vision at presentation, and causes of ERD in a cohort of RD patients., Materials and Methods: A prospective, multicentre, hospital-based study. We examined consecutive eyes diagnosed with ERD in ophthalmic patients seen within 1 year in four ophthalmic hospitals in Nigeria. The patients had a complete eye examination, including visual acuity, intraocular pressure measurement, slit lamp examination of the anterior segment, dilated fundus examination, and other ancillary investigations. Statistical analysis was done using SPSS version 22.0., Results: Nine out of 237 patients were diagnosed with ERD, giving a hospital-based prevalence of 3.8% of RDs. The mean age of patients was 45.8 ± 21.6 years (6 months-80 years), male:female = 2:1. ERD was bilateral in one patient and unilateral in eight patients. There was no gender association ( P = 0.84), but systemic disease was associated with a risk of ERD ( P = 0.001). Five out of 9 (55.6%) patients had an associated systemic disease. The systemic diseases include two patients (40%) who had chronic renal failure, two patients (40%) who had systemic hypertension, and one patient (10%) who had lung cancer. Other ocular causes of ERD include post endophthalmitis, coats disease, and age-related macular degeneration in one eye each. 80 % of eyes were blind at presentation., Conclusion: ERD is a rare form of RD in Nigerians and is associated with systemic diseases. There are inflammatory, neoplastic, vascular, and degenerative causes of ERD. At presentation, most eyes are blind. Early presentation will be beneficial in salvaging vision. Also, awareness of the occurrence and causes of ERD should be created amongst eye care practitioners., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of the west African college of surgeons.)

Objective: To assess the level of satisfaction of patients who access the Ophthalmic counselling services anchored by trained social workers of the University of Calabar Teaching Hospital, Calabar, Nigeria., Methods: A cross-sectional study of serial consenting participants was done. Ethical approval was obtained from the University of Calabar Teaching hospitals' ethics committee. Data was obtained using a semi-structured interviewer-administered questionnaire. Data were collated and analyzed using the SPSS for Windows (version 20, SPSS inc. Chicago, IL, USA). Modified Likert scale (very satisfied, satisfied and not satisfied) was used to rate the satisfaction level., Results: A total of 120 respondents met the inclusion criteria and were enrolled into the study. Majority of the respondents (60%) were male with an overall mean age of 45.32± 1.82. Over a quarter (28.3%) of the respondents were in the age bracket of 41-50. Glaucoma (48.3%) was the most common eye condition of the respondents. Seventy-five percent of the respondents were satisfied with the average time spent for the counselling services while 76.7% were satisfied with the overall ophthalmic counselling services they received with 46.7% believing that the service was provided by a social worker., Conclusion: Majority of the Patients were satisfied with the Ophthalmic counselling services mainly anchored by social workers. Training and retraining of allied support staff to render ophthalmic counselling services in order to ease the workload of the Ophthalmologist should be encouraged in resource-limited settings., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Health-seeking behavior is important as it reveals the preventive, curative, and rehabilitative actions taken by individuals to rectify perceived ill-health., Aim and Objectives: To identify existing eye health-seeking behavior, factors influencing such behavior, and suggest ways in which the system can respond to the needs of the target population in order to reduce visual impairment and blindness., Methods: This was a descriptive cross-sectional study; 600 respondents were interviewed using a semistructured pretested questionnaire administered to every fifth new patient attending the eye clinic of University of Calabar Teaching Hospital (UCTH) for a period of 5 months by a single interviewer. People unable to respond appropriately were interviewed alongside their caregivers., Results: Poor distant vision was the most frequent ocular complaint in this study. The mean duration of complaint before presentation to any health facility was 370.65 ± 889.48 days with a range of 0-9,125 days. Nature of eye complaint was the most significant factor that determined how early respondents sought help (P < 0.001). Place of residence, nature of eye complaint, and employment status were significant determinants of the choice of place of first presentation for ocular complaints., Conclusion: There is need for improved eye health education and awareness for prompt presentation to an appropriate eye care professional at the onset of symptoms and even case finding for potentially blinding eye conditions., Competing Interests: None

Ecthyma gangrenosum (EG) is a rare, infective skin disease, predominantly but not exclusively caused by Pseudomonas aeruginosa . It is often seen in individuals with immunosuppression, although it has also been reported among previously healthy individuals. It was initially thought to be pathognomonic of P. aeruginosa septicemia, but this assertion was discarded following several reports on EG without bacteremia and EG with varied bacterial and fungal etiologies. There are scant reports of its association with human immunodeficiency virus (HIV) infection, while ocular involvement is extremely rare. An extensive search of the literature also found no report on EG, nor its relationship with HIV/acquired immunodeficiency syndrome (AIDS) from Sub-Saharan Africa. We hereby present a fatal case of multiple EG lesions in a 44-year-old Nigerian female with AIDS in the absence of bacteremia and review the literature of its association with HIV/AIDS and its concurrent orbital involvement., Competing Interests: There are no conflicts of interest.

Objective: The objective of this study was to determine visual status of children with special needs attending special schools in Calabar, Cross River State, Nigeria., Subjects and Methods: A cross-sectional study of all children with special needs attending special education schools in Calabar Municipal Local Government Area, Cross River State, was performed. Data were obtained using interviewer-administered questionnaires on the caregivers and ocular examination of the children which included visual acuity, refraction, ocular alignment and motility tests and funduscopy. Data analysis was performed using the Statistical Package for the Social Sciences version 20., Results: A total of 161 children with special needs out of the 176 enrolled were examined yielding a 91.5% response rate. The male-to-female ratio was 1.2:1. Their age range was 5-17 years with the mean age of 12.9 ± 3.3 years and a modal age group of ≥13 years. Twenty (12.4%) had visual impairment (VI). Uncorrected refractive error accounted for 12 (60%) of the VI. Children with learning disability (odds ratio [OR]: 3.28 and 95% confidence interval [CI]: 1.73-6.36) and developmental disability (OR: 1.90 and 95% CI: 1.10-3.20), respectively, had significantly higher occurrence of VI. Of the 161 children examined, only 11 (6.8%) have had their visual status assessed in the past., Conclusion: Children with special needs had higher prevalence of VI; however, only a few have had an assessment of their visual status in the past., Competing Interests: There are no conflicts of interest