Background: Ethics, as a branch of both philosophy and theology, is a systematic study of what is right and wrong with respect to conduct and character. As an intellectual discipline, ethics seeks to provide good reasons for our moral choices. Aim: The aim was to discuss common plausible clinical scenarios that pose ethical questions in typical ophthalmic set-ups in Nigeria and suggest modalities of resolving them. Methods: Involved extensive literature search on ethics and medical jurisprudence. Result: There is hardly an area in medicine that does not have an ethical aspect. For example, there are ethical issues relating to abortion, organ donations, birth control, euthanasia, etc., Ethics in Ophthalmology have not been the focus of scholarly articles particularly in our African environment. Yet there is increasing consciousness of patients' right to self-determination that cuts across all areas of human endeavors. Conclusion: Ethics, and not the law, establishes the ultimate standard for evaluating conduct. Still, there is a moral obligation to obey the law, and thus ethical analyses need to take into account the relevant statutes and court decisions.

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Objectives: The aim was to determine the hospital incidence, pattern and clinical presentation of retinal detachment at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Case files of all retinal detachment patients seen at the Guinness Eye Center Onitsha between June 1997 and May 2012 were reviewed. Information on age, gender, symptoms duration, type and anatomic location of detachment, presenting visual acuity, and predisposing factors were analyzed. Results: A total of 93 patients (99 eyes) were seen with a male preponderance (M:F = 2:1) and age range 10-89 years; median - 61 years; mode - 55 years; incidence - 0.13%. Rhegmatogenous retinal detachment comprised 93.6%. Symptoms duration was 5 days to 8 years; median - 9 months; mode - 6 months. All the affected eyes had low vision with 79.8% blind; of the unaffected eyes, 40.2% had low vision with 24.7% being blind. Trauma was the precipitating factor in 33 (35.5%) patients. Proliferative vitreoretinopathy, 19 (19.2%) eyes, and lattice degeneration, 13 (13.1) eyes, were the commonest ocular risk factors. Common ocular co-morbidities in the affected eyes were cataract, 13 (13.1%) eyes; uveitis, 9 (9.1%) and glaucoma, 6 (6.1%) eyes. Supero-temporal, subtotal and total detachment constituted 84.8%; the macula was detached in 91.4%. The tears in eyes with rhegmatogenous detachment ranged from 1 to 6, with 51 (54.8%) having multiple tears. 10 (10.8%) eyes had giant tears; 6 (6.5%) had dialysis and 3 (3.2%) had coexisting macula holes; in 73.1% the tears were located in the superior retina. Conclusions: Retinal detachment incidence is low in our hospital; most patients presented late with severe visual loss. A community-based study will provide more information on the magnitude of the problem. Education of the public on retinal detachment symptoms, the predisposing/precipitating factors and the need for early reporting to hospital are required.

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Traumatic paralytic esotropia due to 6th nerve palsy is not uncommon but difficult to manage. We reported a case of 38‑year‑old male who sustained head injury in road traffic accident 15 years ago and inward deviation of his left eye. His vision in right eye was 20/20 and counting fingers at one foot in the left eye. He had >70 prism diopters esotropia in the left eye with restriction of movements in all directions of gaze except adduction. His forced duction test was positive. Examinations of the anterior and posterior segments of both eyes were within normal limits. Magnetic resonance imaging suggested old traumatic insult in the left eye. Diagnosis of left eye traumatic 6th nerve palsy with medial rectus contracture was made. Left medial rectus recession with hangback sutures and Hummelsheim procedure were performed. Postoperatively, the patient's vision in the left eye had improved to 20/80 the esotropia had reduced to 15 prism diopters (delta).

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Aim: The aim was to report on the prevalence of monocular blindness/monocular severe visual impairment (MB/MSVI) in children found in Cross River State Nigeria, using the key informant method (KIM). Settings and Design: A cross-sectional study using the KIM. Patients and Methodology: Key informants were trained to identify children with vision problems through recognition of pictures of disease conditions, observation of behavior of the child and discussion with villagers during house to house visits, school visits, church visits, or market visits. They were instructed to bring the children to a predetermined health center for examination by a pediatric ophthalmologist led team. The children were examined, and findings recorded on the World Health Organization/prevention of blindness and low vision recording form for children. Statistical Analysis Used: Data were entered into MS Excel, transferred and analyzed with STATA 11. Results: Among 994 children with suspected visual impairment, 21.5% were diagnosed as MB/MSVI, with a population prevalence of 0.18/1000 children in the state. Males accounted for 61%. The leading anatomical causes were the cornea in 41%, the whole globe in 20%, and lens-related in 19%. Boys were 2.6 times (95% confidence interval: 1.4-4.7, P = 0.002) more likely to have trauma as an etiology compared with girls. Conclusions: Monocular blindness/monocular severe visual impairment children are essentially "one-eyed" children at risk of becoming blind individuals. The prevalence of MB/MSVI is 2.25 times that of bilateral blindness and severe visual impairment in children in this population. The main anatomical causes, as well as ocular trauma, are largely avoidable. Trauma that is avoidable was a significant etiology in boys compared with girls. MB/MSVI adds to the burden for child eye care services.

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Aim: The aim was to determine the competence of medical students in performing direct ophthalmoscopy. Materials and Methods: It was a cross-sectional study whereby year 5 medical students were assessed during Objective Structure Clinical Examination (OSCE) at the end of 4 weeks clinical rotation in ophthalmology. Every student had 5 min in each OSCE station, including the station for direct ophthalmoscopy. The correctness or otherwise of students' quantitative assessment of cup-disc ratio (CDR) was analyzed using Statistical Package of Social Sciences (SPSS, USA) version 20.0. Result: A total of 96 students were assessed in 6 groups over a 6 months period; age range was 20-33 years and a mean age of 24.8 ± 3.2. There were 57 males and 39 females (M:F = 1:0.25). Seventy-eight (81.3%) were satisfied with teachings and tutorials on direct ophthalmoscopy. Eighty-nine (92.7%) admitted visualizing the disc in the course of tutelage while 7 (7.3%) had never seen the disc with the direct ophthalmoscope. The retinal vessels were seen with the ophthalmoscope by 93 (96.9%). Direct Ophthalmoscopy was not considered to be difficult by 87(90.6%). Forty-six (47.9%) got CDR correct on the right eyes while 50 (52.1%) got it correct on the left eyes. There was statistically significant relationship between the group students belonged and performance with χ² = <0.001. Conclusion: Based on the CDR benchmark, students' performance was not satisfactory.

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Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign clinical entity characterized by the presence of a variable number of papules, plaques or nodules of the dermis and subcutaneous tissues. ALHE shows a predilection for the head and neck area. Orbital involvement is unusual. A 20-year-old male presented with a 4-month history of swelling of the upper lid of right eye. Magnetic resonance imaging orbit revealed altered signal density seen in supero-medial aspect of right eyeball with adjacent inflammatory changes. The patient underwent anterior orbitotomy and excision biopsy of the mass under general anesthesia. Histopathology of the mass showed vascular proliferation and chronic inflammation accompanied by infiltration of eosinophils, which confirmed the diagnosis of ALHE. The patient recovered both functionally and cosmetically and had no signs of recurrence after 6 months. Angiolymphoid hyperplasia with eosinophilia with orbital involvement in males is a rare clinical entity, and further work is required to accurately describe its incidence, etiology and presentation. ALHE can be diagnosed and differentiated from Kimura's disease (KD) on histopathological grounds. The presence of vascular hyperplasia with plump of endothelial cells protruding into the lumen is the most important discriminator in establishing the diagnosis of ALHE. Such distinction is crucial for the patient because ALHE is not associated with any of the systemic manifestations present in KD.

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Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. The visual system may be affected with variable intensity. Bilateral, serous, nonrhegmatogenous retinal detachment is a rare complication of toxaemia of pregnancy, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. In the vast majority of the cases, the detachment occurs concomitantly with hypertensive retinopathy. The majority of patients have a complete recovery of vision with clinical management and surgery is unnecessary. This is a case report of a 23-year-old patient who developed the severe form of preeclampsia and hemolysis, elevated liver enzymes and low platelets syndrome in her third pregnancy. She had progressive blurred vision, until she could see fingers up to 3 meter. Ophthalmic examination diagnosed bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision.

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Ocular myiasis is uncommon in developed countries but this is common in underdeveloped area of world where standard of living and hygiene is comparatively low. This article presents a very rare case of external ophthalmomyiasis. A 10-year-old boy came with the complaints of pain, burning irritation, redness, foreign body sensation, tearing and itching in right eye. On slit lamp biomicroscopic examination larvae of the parasites were seen moving over the bulbar conjunctiva, which were removed with spatula and confirmed as the larvae of Oestrus ovis by the microbiological slide examination report. Ophthalmomyiasis is a rare diagnosis and high index of suspicion is needed for its diagnosis. Meticulous removal of all visible larvae is important to prevent penetration of globe by larvae and to prevent further blinding complications like endophthalmitis.

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A 14-year-old boy was admitted for paraplegia, acute urinary retention, and a sudden reduction in the visual acuity of both eyes. Fundus examination revealed bilateral optic neuritis with large subhyaloid hemorrhage in left eye. Cerebrospinal fluid examination showed mild pleocytosis and absence of oligoclonal band. Magnetic resonance imaging (MRI) revealed hyper intensity in T2-weighted images along the spinal cord. No abnormality was detected in brain MRI. Visual evoked potentials were suggestive of bilateral optic neuropathy. He received intravenous pulse corticosteroids (methyl prednisolone) for 3 days followed by oral prednisolone. There was improvement in both the visual acuity and the systemic manifestations. We diagnosed the case as neuromyelitis optica (NMO) based on the examination and investigation findings. NMO or Devic's syndrome is an uncommon clinical syndrome associating unilateral or bilateral optic neuritis and transverse myelitis. Subhyaloid hemorrhage, as an ophthalmic feature of NMO, has not been reported till date. We report this case so as to alert the clinician about this unusual presentation of NMO.

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Traumatic paralytic esotropia due to 6 ^th nerve palsy is not uncommon but difficult to manage. We reported a case of 38-year-old male who sustained head injury in road traffic accident 15 years ago and inward deviation of his left eye. His vision in right eye was 20/20 and counting fingers at one foot in the left eye. He had >70 prism diopters esotropia in the left eye with restriction of movements in all directions of gaze except adduction. His forced duction test was positive. Examinations of the anterior and posterior segments of both eyes were within normal limits. Magnetic resonance imaging suggested old traumatic insult in the left eye. Diagnosis of left eye traumatic 6 ^th nerve palsy with medial rectus contracture was made. Left medial rectus recession with hangback sutures and Hummelsheim procedure were performed. Postoperatively, the patient's vision in the left eye had improved to 20/80 the esotropia had reduced to 15 prism diopters (delta).

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