Glaucoma adversely affects the visual function, impacting negatively on the individual with glaucoma (IWG)’s flourishing life. This work argues for the public funding of glaucoma. The arguments consider the plausible glaucoma’s harm to the IWG through impaired visual function, especially its adverse effects on their daily activities, health, education, work, economy and overall harm to Nigerian nation.

Healthcare resources are finite commodities, yet have to appease competing healthcare demands. Unless healthcare resources are fairly distributed, most indigent Nigerians, who have glaucoma, would continue to suffer visual impairment and a worsened social life. This work categorizes healthcare resource allocation and provides justice-based arguments for funding glaucoma treatment by Nigeria. The arguments considered approaches to justice, especially Hippocrates, Marx, Rawls, Aristotle, utilitarianism, egalitarianism, communitarianism, capability theory, well-being, and fair opportunity rule. Finally, justice-based healthcare rationing and two-tiered healthcare model are discussed. A proposal for general health insurance funded tier 1 of the two-tiered health care that provides universal cost-free basic health care for diseases of public health importance, including glaucoma, is made.

Global studies indicate glaucoma treatment can preserve valueable vision, especially when commenced in its early stage and sustained. Despite glaucoma being responsible for blindness in thousands of Nigerians and accompanying disruption of their flourishing lives, Nigeria’s funding glaucoma would not be easy to accomplish. This essay analyses opponents’ arguments against Nigeria’s funding glaucoma treatment. These include an inherent complexity of glaucoma, inadequate healthcare resources, the individual with glaucoma factor, and economic reason.

Objectives: To determine the normal conjunctival flora and the effect of povidone–iodine on the flora in adult patients at the Guinness Eye Centre Onitsha Nigeria. Materials and Methods: Each randomly recruited new adult patient had conjunctival swab taken from one eye; then a drop of 5% povidone–iodine solution was instilled on the conjunctiva. Conjunctival swabs were taken at 1, 5, and 10 min after povidone–iodine instillation. The swabs were smeared on glass slides and also inoculated unto MacConkey, chocolate, and nutrient agar. Microbial study of the specimens was undertaken. Results: Of the 250 eyes of the 250 patients, 164 (65.6%) were culture-positive. A total of 225 organisms were isolated from the 164 culture-positive specimens as follows: Pseudomonas aeruginosa was isolated in 142 (63.1%), Staphylococcus epidermidis in 79 (35.1%), and Staphylococcus aureus in four (1.8%). Among the 61 specimens that grew more than one organism, 59 (96.7%) had a mixed growth of P. aeruginosa and S. epidermidis and 2 (3.3%) grew both S. epidermidis and S. aureus. Povidone–iodine significantly reduced the mean bacterial colony count in all bacterial isolates 10 min after instillation, that is: 114.4 to 35.7 for P. aeruginosa (P < 0.05), 71.7 to 15.8 for S. epidermidis (P < 0.05), and 45.5 to 3.0 for S. aureus (P < 0.05). Bacterial colonies persisted in seven (2.8%) eyes 10 min after instillation of 5% povidone–iodine. Conclusion: The normal conjunctiva of some patients harbor virulent bacteria, which load 5% povidone–iodine greatly reduced. These facts should be taken into consideration when planning intraocular surgery as part of the efforts to prevent endophthalmitis.

Aim: To compare the efficacy and safety of medial canthus single injection with the classic double injection peribulbar anaesthesia (PBA) technique for cataract surgery. Materials and Methods: A prospective, randomised, controlled, double-masked study was conducted at National Eye Centre, Kaduna, Nigeria between October and December 2012. One hundred patients with age-related cataracts were allocated into two equal groups. Anaesthesia was administered by an anaesthetic nurse using a mixture of xylocaine 2% + adrenaline 0.125 mg/ml + hyaluronidase 15 IU/ml with a 23G, 32 mm needle. Group 1 received a single injection into the inferomedial orbital quadrant, whereas Group 2 received two injections into the inferotemporal and superonasal quadrants. Primary outcome measures were time to achieve adequate akinesia; supplementary injections; pain of injection and surgery. Secondary outcomes were number of injections; volume of anaesthetic; complications; surgery duration; surgeon’s satisfaction. Data were analysed using the Statistical Package for the Social Sciences version 16.0 software (SPSS Inc., Chicago). Results: In each group, 82% of patients achieved adequate akinesia within 10 min of the initial injection(s). No pain was felt during the injection by 40 and 50% of patients in Groups 1 and 2, respectively; and by 96% in both groups during surgery. Chemosis occurred in 14 patients in Group 2 and none in Group 1 (P ≤ 0.001). Mean number of injections in Group 2 was 2.18 ± 0.39 versus 1.18 ± 0.39 in Group 1 (P ≤ 0.001). Median score for surgeon’s satisfaction was ‘excellent’ for both the groups. Conclusion: Single injection PBA was as good as the double injection technique in providing adequate conditions for surgery; while reducing the risks of needle-related complications.

Purpose: This study compared the akinetic properties and anaesthesia-related complications of cataract surgery under peribulbar and subtenon’s anaesthesia. Setting: Department of Ophthalmology, Lagos State University Teaching Hospital, Lagos, Nigeria. Design: Randomized, single-blind controlled clinical trial. Materials and Methods: A total of 100 patients above 18 years with uncomplicated cataract were randomized into the subtenon’s and peribulbar groups. Subtenon’s and peribulbar blocks were achieved with 5 ml of a combination of lidocaine 2% (2.5 ml), bupivacaine 0.5% (2 ml) and 15 IU/ml of hyaluronidase (0.5 ml). Globe akinesia and lid akinesia were assessed at 2, 5 and 10 min after the administration of anaesthesia using a 12-point scale. Chemosis, subconjunctival haemorrhage and other anaesthetic-related complications were also assessed in both the groups. Results: About 77% of the patients in the peribulbar group had successful lid akinesia at 2 min compared with 48.9% in the subtenon’s group (P = 0.007). However, at 5 and 10 min, there was no significant difference in the lid akinesia in both the groups (P > 0.05). The proportion with the globe akinesia in the subtenon’s and peribulbar groups was 14.9 and 48.1% (P = 0.0005) at 2 min, 53.2 and 90.4% (P = 0.0001) at 5 min and 83.0 and 98.1% (P = 0.012) at 10 min, respectively. Chemosis and subconjunctival haemorrhage occurred more in the subtenon’s group, whereas one patient in the peribulbar group had retrobulbar haemorrhage. Conclusion: Even though patients in the subtenon’s group took longer to achieve akinesia of the globe and lids, the absence of a sight-threatening complication makes it generally safer than peribulbar anaesthesia.

Objective: The objective is to determine the availability of phacoemulsification cataract surgery, its role in the management of cataracts among ophthalmologist and the barriers to its use in Nigeria. Materials and Methods: Ophthalmologists who attended the opening ceremony 2016 of the Annual General Meeting and Scientific Conference of the Ophthalmological Society of Nigeria in August 2016 at Port Harcourt, Nigeria were asked to participate. The study was a cross-sectional study in which responses were obtained from participants using convenient sampling technique. Result: A total of 71 ophthalmologists participated in the study. Of this, 48 (67.6%) were males and 23 (32.4%) were females. The mean age was 43.6 years (standard deviation ±8.5). Most participants 44 (62.2%) do not have a phacoemulsification machine in their centers, whereas 27 (38%) had. Manual small-incision extracapsular cataract surgery (MSICS) was the most commonly performed surgery 33 (46.5%), followed by extracapsular cataract extraction (ECCE) 11 (15.5%) and phaco 7 (9.9%). A total of 11 (15.5%) of participants perform a combination of ECCE and MSICS, whereas nine (12.7%) are beginners or perform the phacoemulsification technique infrequently. Some of the barriers to the use of phacoemulsification included cost of machine 51 (71.8%), surgical consumables 33 (46.5%), high level of training to attain competence 39 (54.9%), no need for phacoemulsification 14 (19.7%), and administrative bottlenecks 16 (22.5%). Conclusion: Phacoemulsification cataract surgery is seldom practiced in Nigeria. Many Nigerian Ophthalmologists are willing to undergo training in phacoemulsification technique but the high cost of equipment and consumables as well as administrative bottlenecks among other factors have hindered the widespread use of this procedure.

Aims: To assess (i) the efficacy of conjunctival autograft with fibrin glue in the management of pterygium, (ii) graft-related complications and (iii) recurrence rates over a 6-month follow-up period. Settings and Design: The study was conducted at the Orbit Thelish Eye Hospital in joint association with Dr. Agarwal Eye Hospital, Kaduna, Nigeria. This prospective study included 30 consecutive patients who underwent surgery of the pterygium using conjunctival autograft with fibrin glue by a single surgeon between August 2015 and July 2016. Inclusion criteria were primary pterygium and recurrent pterygium. Exclusion criteria were pseudopterygium, moderate-to-severe dry eye and patients with lid deformity. Materials and Methods: A total of 30 eyes with primary nasal pterygium were subjected to conjunctival autograft surgery that used fibrin glue. The outcome of surgery was noted on the 1st day, 1st week, 1st month, 3rd month and 6th month. Parameters analysed were subjective symptoms, refraction, graft status and recurrence. Statistical analysis used included the following: Student t-test and Fisher’s exact test. Results: The mean age of the patients was 43.7 years. The time of surgery was 15–20 min. During the postoperative course, 60% of the patients felt pain initialy and 25% had an initial sensation of a mild foreign body, which almost subsided in 1 week. No sutures were used. Only one case of pterygium regrowth was noted. Conclusion: Our findings demonstrate the safety and efficacy of Tissucol Duo^® (Baxter AG, Vienna, Austria) as a conjunctival adhesive for autograft surgery of the pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery and avoids complications derived from sutures in the eye following surgery.

Aims: To report the outcome of trabeculectomy with and without small incision cataract surgery (trab-SICS) in the patients with primary open-angle glaucoma. Study Design: Retrospective study. Materials and Methods: This is a retrospective study of all eligible cases of trabeculectomy with and without SICS performed by a single surgeon. The case notes of the patients were reviewed; demographic data and clinical information were extracted. The primary outcome was intraocular pressure (IOP) at 15 months after the surgery. Success was defined as IOP <21 mmHg which can be complete if no medication is used and qualified if medication is used. Statistical Analysis: Statistical significance difference was tested using paired Student’s t test and chi-square test. The P-value of 0.05 was considered significant for this study. Results: One hundred and twelve patients who had trabeculectomy as a single procedure and combined trab-SICS were studied. The mean age of the trabeculectomy group was 42.3 years, whereas that of trab-SICS was 61.7 years. Success (IOP <21 mmHg with and without medication) was achieved in 97.4 and 94.1% of the patients after trabeculectomy and trab-SICS, respectively. There was no significant difference in success rate between the two procedures within the study period. Conclusion: Trabeculectomy with or without SICS is an effective surgical procedure for IOP control. We recommend the use of the two procedures in eligible patients.

Background: Provision of affordable eye care including eye surgery is one of the cardinal programs of the Osun State government of Nigeria. The objective of this study is to assess the pattern of eye surgeries performed in a secondary specialist hospital, Osogbo over a 4-year period. Materials and Methods: Hospital records of patients who had eye surgery from May 2006 to July 2010 were reviewed and the results analyzed with the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, United States). Results: A total of 434 patients were operated at the center during the period under review. The mean age was 59.6 (standard deviation 18.9) with age range from 5 to 99 years. There were 221 (50.9%) males and 213 (49.1%) females. In addition, 362 (83.4%) were blind, 40 (9.2%) visually impaired, and 32 (7.4%) were of normal vision. Although 384 (88.5%) were admitted for surgery only 50 (11.5%) had their surgery performed as a day case. Most, 420 (96.8%), were performed under local anesthesia, whereas 14 (3.2%) had general anesthesia. The most common diagnosis necessitating surgery was cataract with senile cataract accounting for 65% (282), presenile cataract 10.6% (46), complicated cataract 2.3% (10), and congenital cataract 2.1% (9). Pterygium and glaucoma also accounted for 9.0% (39) and 3.9% (17), respectively. Expectedly, extracapsular cataract extraction with posterior chamber intraocular lens implantation accounted for the greatest number of surgery performed (333 (76.7%)). This was followed by pterygium excision with primary closure with 26 (6.0%), trabeculectomy 17 (3.9%), and pterygium excision with conjunctival auto graft 11 (2.5%). Evisceration was the least performed surgery (1 (0.2%)) at the center. Conclusion: Preventable causes of blindness were quite common among the patients; hence, there is need for the government to make these sight saving/restoring surgeries more accessible to the populace by making more facilities available and subsidizing the cost of surgery.

Context: Regular eye screening of people with diabetes is highly recommended globally to prevent avoidable blindness. Aims: To determine the frequency of referral, factors affecting referral and uptake of patients with diabetes in Calabar for the Calabar diabetes retinopathy screening service. Settings and Design: Cross-sectional descriptive study conducted among physicians in Calabar, Nigeria in the month of May 2016. Materials and Methods: A self-administered questionnaire was given to 97 physicians practicing in Calabar. This assessed their knowledge of the Calabar diabetic retinopathy (DR) screening service, referral pattern, and factors that affect referral behavior. Statistical Analysis Used: Statistical Package for Social Sciences version 24.0 software (SPSS Inc., IBM SPSS, IBM Corp, Armonk, NY, USA). Results: Regarding awareness, 57% of physicians knew of the DR screening service at the Calabar Teaching Hospital but only 41% sometimes referred patients to the center. There was a significant relationship (P = 0.000) among location of practice, awareness of DR service at University of Calabar Teaching Hospital, and frequency of referral. Only 57% of the physicians felt that it was important to refer patients for screening; in spite of that, 40% of the physicians did not refer due to lack of awareness of the service. Barriers to the uptake of referral were long waiting time (58%), financial cost (44%), and availability of service (42%). Conclusion: Many physicians in this study did not refer patients with diabetes to avail the free Calabar DR screening service, although those physicians were aware of the importance of screening. Their reasons for lack of referral and uptake of service were lack of awareness of the service, perceived long waiting times, and erroneously imagined cost implications to patients, although the services have been actually free.

Purpose: To determine the subspecialty preferences of ophthalmology resident doctors in Nigeria as well as the factors influencing the choice with a view to provide useful insight into the future of ophthalmic practice in Nigeria. Materials and Methods: A descriptive, cross-sectional study was conducted among consenting ophthalmology residents in all the 23 accredited training institutions in Nigeria between July, 2015 and June, 2016. A semi-structured questionnaire with consent form was used to obtain information concerning socio-demographics, residency training information, awareness of ophthalmology subspecialties, subspecialty preference, and the reason for the choice as well as future practice plan. Results: A total of 198 (66.2%) out of the expected 299 ophthalmology resident doctors participated in this study. Their ages ranged from 27 to 51 years with a mean age of 34.4 ± 4.5 years. One hundred and ten (55.6%) participants were females and 157 (79.3%) were married. Anterior segment (including cornea and refractive surgery) and vitreoretinal surgery were the two most preferred subspecialties. The two most important reasons that influenced the choice of subspecialty were personal interest and desire to acquire special skills documented in 81 (48.2%) and 51 (30.4%) respondents, respectively. Younger (P = 0.03) and single (P = 0.04) respondents were more likely to prefer vitreoretinal surgery, while married respondents were more likely to choose anterior segment relative to other subspecialties (Fischer exact P = 0.02). Only 62 (31.3%) respondents had undergone stereopsis test. Conclusion: Anterior segment (including cornea and refractive surgery) and vitreoretinal surgery were the two most preferred subspecialties by Nigerian ophthalmology resident doctors.

Objectives: The aim of this article is to determine the prevalence and causes of visual impairment among teachers in Onitsha, Nigeria. Materials and Methods: Teachers were selected by multistage random sampling from 10 secondary schools in Onitsha. A pretested, self-administered questionnaire was used to elicit information on each participant’s sociodemographic characteristics and ocular health. Ocular examination included distance and near visual acuity tests, external eye examination, refraction, and funduscopy. Results: Three hundred forty teachers consisting 63 males (18.5%) and 277 females (81.5%) were studied. The age range was 24 to 60 years; mean − 45.2 ± 7.4 years. The prevalence of visual impairment was 11.2%. None of the teachers were blind. The most common causes of visual impairment were uncorrected refractive error (55.2%), cataract (15.8%), diabetic retinopathy (7.9%), and hypertensive retinopathy (7.9%). Near vision impairment from presbyopia occurred in 79.1%. Conclusion: Presbyopia and refractive errors were the common causes of near and distance visual impairment, respectively, in the teachers. Annual eye examination of teachers will help detect early and treat the ocular problems that may militate against effective performance. The ocular health needs of teachers should, thus, be well accommodated in the school eye health program to ensure optimal productivity of teachers in the education sector.

Objectives: The aim of this article is to determine the common indications for cranial computed tomography (CT) scanning in ophthalmology at the University of Benin Teaching Hospital Nigeria and to compare the CT findings with the clinical indication. Materials and Methods: A retrospective analysis of CT imaging requisitions from the Department of Ophthalmology to the Department of Radiology of the hospital from February 2009 to October 2013 was performed. Data on age, gender, clinical symptoms, clinical signs, diagnosis, and the radiologic findings were retrieved and analyzed using IBM Statistical Package for the Social Sciences version 21. Descriptive analyses were used and Fisher’s exact test was used as a test of statistical significance. Results: A total of 112 patients were included in the study. There were 48 males and 64 females. The mean age was 33 ± 19.1 years (range 5 months–82 years). Visual loss 36 (32.1%), proptosis 25 (22.3%), and headache 22 (19.6%) were the most common symptoms documented, whereas optic atrophy 16 (14.3%), optic disc swelling nine (8%), and proptosis nine (8%) were the most common signs. The CT finding was related to the clinical information in 67 (59.8%) cases. Conclusion: CT is a useful tool in the evaluation of orbital and neuro-ophthalmic diseases. It aids in the diagnosis and localization of lesions in ophthalmology.

Objective: Orbital cellulitis is an infection of the soft tissues behind the orbital septum. This study aims to determine the presentation, management and outcome of cases of orbital cellulitis managed at a tertiary health facility in Ibadan, South-Western Nigeria. Materials and Methods: Prospective study of all cases of orbital cellulitis managed during a 7-year period was conducted. The patients’ demographics, clinical findings, management, outcome of treatment and complications were analyzed. Results: Sixty-three patients were managed during the period with mean age of 20.3 ± 20.1 years, and average duration of symptoms 7.9 days (Interquartile range, 4 days). The right eye was affected in 30 (47.6%) patients, while four (6.3%) patients had bilateral involvement. There was history of trauma in 19 (30.2%) patients whereas 13 (20.6%) patients had paranasal sinus infection. The corrected visual acuity at presentation was >6/18 in 30 (44.8%) eyes and <3/60 in 16 (23.9%) eyes; and at last follow-up, >6/18 in 31 (46.3%) eyes and <3/60 in 5 (7.5%) eyes. Surgical procedures performed in 15 (29%) patients included incision and drainage of preseptal and orbital abscess in six (9.5%) patients and evisceration in four (6.3%) patients. Complications of orbital cellulitis seen included orbital abscess in seven (11.1%) patients, and panophthalmitis in three (4.8%) patients, while the average patient follow-up period was 24.4 days (IQR, 25.5 days). Conclusion: Complete resolution of the acute infection with few complications was observed in this study. Prompt in-patient treatment of this infective disease could possibly preserve vision and prevent life-threatening complications.

Background: Orbital infections could have untowards associated ocular and systemic morbidity. There is a need to reduce these complications to the barest minimum. Objectives: To improve outcomes of orbital cellulitis in Osogbo and suggest how to prevent complications. Materials and Methods: A 10-year retrospective study was conducted between 2003 and 2013 on cases admitted to the eye wards of LAUTECH Teaching Hospital, Osogbo, Nigeria. Clinical and sociodemographic data were extracted from the case notes. Data were entered into and analyzed with SPSS version 17 using descriptive statistics. Result: Of the 31 patients admitted for the treatment of orbital cellulitis, 20 (64.52%) were males and 11 (35.48%) were females. The age ranged between 2 and 85 years with a mean of 18.4 + 9.21 years, with 18 (56.06%) aged less than 20 years. The predisposing factors were mainly sinogenic, 18 (58.06%). Maxillary sinus constituted six (33.3%) whereas trauma and local spread constituted six (19.1%) each. Staphylococcus aureus was the only organism cultured in three (42.86%) whereas the remaining (57.14%) showed no growth. Complications recorded were orbital abscess in four and three each of panophthalmitis and optic atrophy. No death was recorded. Commonest surgery performed was bilateral intranasal anthrostomy in eight (25.8%) and drainage of orbital abscess. Visual acuity improved in four cases after treatment from blindness and visual impairment category to normal vision. Conclusion: The commonest cause of orbital infections was from adjacent sinus-related diseases. The problem of negative cultures still persists possibly due to indiscriminate use of antibiotics by the patients. Early presentation, effective antibiotics, and comanagement with other specialists improved outcome. No mortality was recorded.

Arachnoid cysts and oculomotor palsy are rare occurrences in children. This report describes a case of acquired third cranial nerve palsy in a child, caused by compression of the oculomotor nerve by an arachnoid cyst. Nineteen-month-old female child presented with a history of squinting in the right eye. Magnetic resonance imaging (MRI) of the brain showed a small cystic lesion immediately adjacent to the cisternal segment of the oculomotor nerve. Immediate surgical intervention was deferred. Follow-up after 6 months showed progression of third nerve palsy with no change in size of the cyst. This case highlights the importance of performing neuroimaging to rule out the presence of compressive lesions in children with abnormal ocular motility and pupillary findings. Small insignificant lesions on MRI need to be followed up in such cases to explain the findings as in our case.

Sympathetic ophthalmia (SO) is a rare bilateral panuveitis that follows a surgical or penetrating injury to one eye. The use of systemic corticosteroids and immunosuppressive drugs has greatly improved the outcome of this potentially blinding condition. It may, however, rarely run an aggressive course despite medical treatment with grave consequences. Herein, we report a severe case of SO in a 64-year-old man induced by the spontaneous perforation of a staphylomatous left eye. He presented with left panophthalmitis following a spontaneous perforation of the globe, and subsequently he had an evisceration. He, however, presented 18 days later with features of SO in the right eye. He was placed on systemic corticosteroid and immunosuppressive therapy but failed to respond to treatment and the eye eventually became phthisical.

Acute invasive fungal rhinosinusitis with orbital abscess (rhino-orbital mucormycosis) is viewed by ophthalmologists and otorhinolaryngologists with a lot of concern because of its poor prognostic outlook. Surgical techniques and therapeutic approaches have witnessed improvement in recent times and newer strategies have been proposed. This case study was conducted on a middle-aged male patient newly diagnosed with diabetes, who recovered considerable vision in the affected eye and resumed his routine activities within 3 months of the onset of his illness.