The Ocular Pathology of the Child: About 751 Cases in Teaching University Hospital of Brazzaville, Congo

  

    
Anatomical structures 
    
diseases 
    
Numbers 
    
Percentage 
  
  

    
Attachments
    
LCET
      
Conjunctivitis
      
chalazion
      
blepharitis
      
Traumatic edema palpebral
      
Orbital cellulitis
      
Subconjunctival hemorrhage
      
Palphaloplasty
      
Bullous drug
      
Pelvic foreign body
    
210
      
108
      
16
      
14
      
8
      
8
      
5
      
4
      
4
      
2
    
27.9
      
14.4
      
2.1
      
1.8
      
1
      
1
      
0.6
      
0.5
      
0.5
      
0.2

  
  

    
Previous segment
    
Corneal wound
      
Cataract
      
Corneal opacity
      
keratitis
      
uveitis
      
Cornealdystrophy
      
hyphema
    
8
      
8
      
6
      
5
      
4
      
2
      
2
    
1
      
1
      
0.8
      
0.6
      
0.5
      
0.2
      
0.2
  
  

    
Posterior segment
    
Tumor
      
Glaucoma
      
Opticneuropathy
    
10
      
7
      
2
    
1.3
      
0.9
      
0.2
  
  

    
Other
    
ametropia
      
Strabismus
      
Albinism
      
Cortical blindness
      
microphthalmos
      
ICHT
      
Normal ophthalmicexamination
    
287
      
14
      
3
      
2
      
2
      
1
      
9
    
38.2
      
1.8
      
0.4
      
0.2
      
0.2
      
0.1
      
1.1
  
  

    
TOTAL 
    
 
    
751
    
100
  

Table 2: Distribution by sex and age group.

Orbitopalpebral disorders were found in 56 cases (7.4%).It was about chalazion 16 cases (2.1%), blepharitis 12 cases (1.8%), traumatic edema palpebral 8 cases (1%), orbital cellulitis 8 cases (1%), 4 palpebral wounds (0.5%), 4 cases of bullous toxin (0.5%) and 2 cases of palpebral foreign bodies (0.2%).

The conjunctival pathology was composed of the LCET found in 210 cases (27.9%): 114 boys (15.1%) and 66 girls (8.8%) (p<0.05); the age range of 6-10 years with 112 cases (14.9%) was most frequent. Infectious conjunctivitis was found in 108 cases (14.4%) dominated by acute bacterial conjunctivitis 70 cases (9.3%), subconjunctival hemorrhage in 5 cases (0.6%).

We found 21 cases of corneal disorders (2.8%) made of keratitis in 5 cases (0.6%), corneal opacities 6 cases (0.8%), corneal wounds 8 cases (1%) and corneal dystrophy 2 cases (0.2%).

Among crystalline and uveal pathologies, we found: 6 cases of traumatic cataracts and 2 cases of bilateral congenital cataracts (1%); four cases of uveitis including 2 cases of indeterminate uveitis (0.2%), one case of traumatic uveitis and one case of uveitis in juvenile arthritis (0.1%).

Glaucoma was present in 7 cases (09%), including 5 juvenile cases and 2 congenital cases.

Retinoblastoma was found in 8 cases (1%), optic neuropathies 4 cases 0.5%, strabismus 14 cases 1.8% dominated by bilateral convergents (1.3%), microphthalmia found in embryofoetopathies 4 cases (0.5%), oculocutaneous albinism 3 cases (0.4%), cortical blindness 1 case (0.1%) as well as intracranial hypertension 1case (0.1%).

The frequency of binocular blindness was 9 cases (1.2%) and low vision 6 cases (0.8%). The causes of binocular blindness were bilateral congenital corneal dystrophy (2 cases); optic neuropathy (2 cases) retinoblastoma in its bilateral form (2 cases); bullous toxidermia (2 cases); cortical blindness after meningitis (1 case); while the low vision was due to bilateral congenital cataract (2 cases), embryofoetopathy (2 cases) and oculocutaneous albinism (2 cases).

Discussion

Ophthalmological conditions occurring in children occupy a significant place in daily practice. They interest all the tunics of the eye. Indeed, ametropia is the most common pathologies reported by most authors [1-3]. For some, these refractive errors constitute the first reason for ophthalmological consultation in schoolchildren [3,9]. The hospital frequency of ametropia of 38.2% observed in our environment is comparable to that found by Omgbwa in Cameroon (43.1%) [1]. the prevalence of refractive errors varies among studies. It is high for Ayed et al [2] in Tunisia and for Maul et al [10] in Chile respectively estimated at 57.2%, 56.3%. On the other hand, it is low, of 8.1% reported by Nepal et al [11] in Nepal and 10.6% by Sounouvou [12] in Benin. This disparity in frequency could be explained by ethnic and genetic factors rather than by environmental factors [2]. We did not note any predominance of sex as well as in Cameroon and Tunisia [1,2]. Astigmatism is the most common ametropia (29.9%), followed by myopia (5.6%) and hyperopia (2.7%). These results are comparable to those in Benin [12] where astigmatism dominates with a frequency of (91.9%) followed by myopia (4.5%) and hyperopia (3.6%).

LCET is the second pathology encountered. Its frequency is 27.9%, similar to that obtained in a previous study where it was estimated at 30.3% [13], comparable to that reported by KOKI et al. (31.5%) [14] in Cameroon and Chenge et al in Democratic Republic of Congo (32.9%) [15] for the same age group. This relative frequency is variously appreciated by some authors such as Dialloet al (80 to 90%) [16], Ayenaet al (12.2%) [17]. Several authors testify that the LCET is a disease of young children [1,13-17] and poses a real challenge for ophthalmologists in sub-Saharan regions because of relapses and sequelae.

Infectious conjunctivitis is present in 108 cases (14.4%), dominated by acute bacterial conjunctivitis with 70 cases (9.3%), those due to chlamydia trachomatis (n=8) and gonococcus (n=2).

Orbitopalpebral pathology included chalazion in the 6 to 15 age group, followed by eyelid trauma, blepharitis, and cellulitis. Omgbwa et al in Cameroon [1] reported a prevalence of 2.8% for chalazion and 1.9% for cellulite.

Corneal pathology was dominated by corneal wounds (1.3%). Mayouegoet al noted that the cornea was the predominant seat of traumatic lesions [18]. The opacities and corneal dystrophies in our series were due to measles lesions.

Cataract is an important cause of blindness and visual impairment [6,19]. She was more traumatic than congenital; even operated certain authors claim to be confronted with problems of amblyopia [20,21].

Uveitis was rare in our study (0.5%); Omgbwa et al in Cameroon found a frequency of 2.8% [1]. They testify that these with severe prognosis were related to post-traumatic endophthalmitis hence the need for early education of children on ocular trauma and promote their rapid and adequate management to reduce the sequelae.

Glaucomatous pathology was observed in 0.9% of cases with a predominance of juvenile glaucoma in 0.7%. BellaHiag in Cameroon in a larger series notes a frequency of 5.8% [22].

The strabismus (1.8%) in our series is also observed in 1.22% by EbanaMvogo [23]. Retinoblastoma is common as reported in a previous study in children aged 0 to 14 years with a frequency of 25.3% [24].

The main causes of binocular blindness were optic neuropathy, bilateral and congenital corneal dystrophy, retinoblastoma in its bilateral form, bullous toxidermia, and cortical blindness after meningitis. We found the same causes of binocular blindness as Omgbwa in Cameroon [1] apart from retinoblastoma. In some countries, such as Mongolia [25] and Malaysia [26], lens pathology remains the leading cause of blindness, with 35.6% and 23%, respectively. As for low vision, bilateral congenital cataract and albinism are the main causes found in our study as in that of Omgbwa in Cameroon [1].

Conclusion

The pathology of the child is very diverse in our environment. It is dominated by refractive errors, conjunctivitis with LCET as the lead. Traumatic pathology is not uncommon. The high prevalence of ametropia and LCET show the need for adequate management to improve the ocular health of the child.

References

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