Spontaneous acute-onset proptosis accompanied with inflammatory signs in children is commonly caused by orbital cellulitis/abscess; however, the clinician should always be alert to the possibility of other causes such as neoplastic: Orbital rhabdomyosarcoma (RMS), traumatic, and iatrogenic factors. This is a case report of an 11-year-old boy presenting with an acute-onset non-axial proptosis of the left eye without a history of trauma, sinus disease, or systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital RMS. However, the final diagnosis was orbital cellulitis with abscess. The purpose of the study was to report a case of “cold” orbital abscess that clinically mimics orbital RMS. An 11-year-old boy presented with a 2 weeks history of painless, rapid-onset non-axial proptosis in the left eye. It was associated with periorbital edema, and mild conjunctival hyperemia. There was no preceding or associated history of fever, trauma, upper respiratory tract infection, sinusitis, or immunosuppression. An initial clinical diagnosis of RMS, with orbital cellulitis as a differential diagnosis, was made delaying commencement of antibiotic therapy. Following the drainage of greenish tinged purulent matter growing Staphylococcus aureus on culture, the diagnosis of orbital cellulitis with abscess was made. A broad-spectrum antibiotics and subsequent adjunct anti-inflammatory therapy yielded excellent clinical resolution. The case demonstrates the pitfalls/challenges in differentiating orbital space occupying lesions manifesting with inflammatory features on the basis of clinical findings alone. This is particularly relevant in a busy triage ophthalmic clinic in a low resource environment without easy access to any form of orbital imaging. In addition, the case highlights that green tinged purulent matter can be found in infections from a myriad of organisms aside from the popularly known Pseudomonas aeruginosa.
Objectives: Self-reported vision-related quality of life (VRQOL) allows us to assess the effect of disease and treatments from the patient’s perspective, focusing on an individual’s subjective satisfaction and functional ability. The previous studies mostly focused on the impact of visual function deficits on VRQOL in patients with visual impairment. This study seeks to investigate the influence of sociodemographic characteristics on VRQOL in visually impaired patients. Material and Methods: This prospective cross-sectional study included consecutive adult patients with visual impairment at the University of Calabar Teaching Hospital eye clinic. All patients had presenting visual acuity worse than 6/18 in the better eye. VRQOL was assessed by the validated English version 25-item National Eye Institute Visual Functioning Questionnaire. Sociodemographic characteristics and ocular parameters were recorded. Sociodemographic characteristics were evaluated based on age, sex, area of residence, marital status, religion, educational attainment, and monthly income. Each characteristic was stratified into groups or levels. Analysis of variance, including post hoc analysis was used to evaluate the association between sociodemographic characteristics and VRQOL. Results: A total of 270 patients were enrolled. After adjustments for category and causes of visual impairment, older age (P < 0.001), rural dwellers (P < 0.001), widowhood (P = 0.006), and no formal education (P < 0.001) were significantly associated with low mean visual function (VF) scores. Similarly, older age (P < 0.001), rural dwellers (P < 0.001), widowhood (P = 0.003), and no formal education (P < 0.001) were significantly associated with low mean QOL scores. The difference in the mean score of VF and QOL by religion, sex, and monthly income was not statistically significant. Conclusion: Besides the degree of visual impairment, the interplay of certain social and demographic factors plays a remarkable role in determining the QOL in visually impaired patients. Therefore, an individualized management plan, including psychosocial therapy is imperative in the care of visually impaired patients.
Introduction: Good ocular health is paramount for optimal childhood development. Vision, which is the primary function of the eyes, plays a fundamental role in the acquisition of skills such as language, interpreting facial expressions and skills requiring hand-eye coordination.In every child, much of knowledge and skills are obtained through the senses of sight and hearing.For children with disabilities, vision has been noted to play an integral role in their psychosocial development, as well as compensates for certain impaired functions.The objective of this study was to determine ocular status of children with disabilities other than visual disabilities attending special schools in Calabar, Cross River State, Nigeria. Subjects and Methods: A cross-sectional study on the ocular status of children with disabilities other than visual disabilities attending special education schools in Calabar Municipal Local Government Area, Southern district, Cross River State, Nigeria 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, 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 disabilities (other than visual disabilities) 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. The common types of disability encountered were hearing disability 45 (28%), developmental disability 38 (24%) and multiple disabilities 35 (21.9%). 71% of the children had at least one form of ocular disorder. The most common ocular disorders seen in these children were refractive errors (46.1%) and optic atrophy (12.0%). Of the 161 children examined, only 11 (6.8%) have had ocular evaluation in the past. Conclusion: Ocular disorders are common in children with other disabilities. However, only a few are opportune to have ophthalmic evaluation. Therefore, strategies regarding increasing awareness, mandatory ocular examination and early detection as well as treatment of the ocular disorders are urgently needed.
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