Corneal Ulcers at the University of Calabar Teaching Hospital in Nigeria - A Ten Year Review

Abstract

Aim: To review the pattern, trend, predisposing factors, characteristics and visual outcome of corneal ulcers at the University of Calabar Teaching Hospital (UCTH) between January 2003 and December 2012 with a view to providing improved quality patient management. Study Design: Retrospective. Place and Duration of Study: Department of Ophthalmology from January 2003 to December 2012. Methodology: A review of medical records of patients diagnosed with corneal ulcers and treated in the Ophthalmology Department of the University of Calabar Teaching Hospital, Calabar. Results: One hundred and fifty-eight (158) patients with corneal ulcer visited the Department of Ophthalmology from 2003 to 2012 but only one hundred and one (101) patient records could be retrieved. Of this number, 69(68%) were suppurative ulcer, 5(5%) Mooren’s ulcer, 10(10%) viral, 1(1%) shield ulcer while 16(16%) of the cases were indeterminate. Most patients with corneal ulcer (56, 77.78%) were classified as blind according to the World Health Organisation and at discharge 49 individuals (68.05%) remained blind. This difference was not statistically significant (p-value 0.26). Unilateral presentation was most common 66 (95.65%) during the study period. The age group mostly affected was 41- 60years.  Suppurative corneal ulcer was more common (42, 60.87%) among male patients. The majority (20, 28.99%) of the people were farmers while (13, 18.84%) were students. Trauma (agricultural) (34, 49.28%) was the most common predisposing factor in suppurative corneal ulcer with vegetative/agricultural related materials as the most frequent causative agent. Another cause was harmful traditional medication (HTEM) (5, 7.25%).  A significant number of patients (52, 75.36%) would have received some form of treatment prior to presentation at the hospital and this included use of licensed drugs and/or HTEM (68, 98.55%). Very few patients (18, 26.09%) had microbiological assessment. Organisms isolated were aspergillus species (18, 26.09%) and Staphylococcus aureus (3, 4.35%). Conclusion: Suppurative corneal ulcer remains a significant cause of corneal ulcer in a developing country like Nigeria with potentially devastating visual impairment and significant cost to the public health system. Massive public education programmes and strengthening of existing health systems to enhance its management including rehabilitation will go a long way in the fight against corneal blindness.