Orbito–Oculoplastic Diseases in Lagos: a 4‑Year Prospective Study

Original Article

Orbito–Oculoplastic Diseases in Lagos: A 4‑Year Prospective Study

Bolanle G. Balogun, Bola J. Adekoya, Modupe M. Balogun, Olufunke A. Ehikhamen

ABSTRACT Access this article online Website: Aims: To determine the prevalence of orbito‑oculoplastic diseases and thereby contributing www.meajo.org a data base to the emerging orbito‑oculoplastics subspecialty in the sub‑Saharan region. DOI: Settings and Design: A tertiary eye care centre. 10.4103/0974-9233.134678 Materials and Methods: A descriptive prospective study was done in a tertiary eye care center. Quick Response Code: Demographic and clinico‑pathological diagnoses of 269 patients presenting to the oculoplastics clinic over a 4‑year period (January 2008 ‑December 2011) were collected at entry and during follow‑up visits. These were patients referred from the general ophthalmology clinics of the study center, secondary eye care centers within and from neighboring states. Patients were categorized based on the primary diagnosis after examination by the oculoplastics surgeon. Ethical issues were considered though data collection did not involve direct patient participation. Statistical Analysis Used: Microsoft Excel 2007 software. Results: Two hundred and sixty‑nine patients were seen with 141 (52.4%) females. Leading etiological factors were trauma; 81 (30.0%), congenital anomalies 55 (21.0%) and tumors 44 (16.0%). Eyelid diseases were the most frequent 115 (42.8%), with ectropion 36 (31.0%) and ptosis 33 (29.0%) being the most common. Orbital and peri‑orbital lesions 44 (16.4%) were mainly dermoids 12 (27.3%) and capillary heamangioma 4 (9.1%) in the pediatric age while thyroid orbitopathy 11 (25.0%) was predominant in adults. Ocular and degenerative diseases were retinoblastoma in 4 (16.7%) and phthisis bulbi in 10 (33.3%). Contracted socket was 22 (84.0%) of socket pathologies. Primary conjunctival diseases occurred less often, rather Stevens‑Johnson syndrome in 9 (30.0%) and its ocular complications were more frequent. Conclusions: It is expected that this survey will provide a database for oculoplastics surgeons and ophthalmologists in an emerging subspecialty and thus enhance training focus and equipment acquisition.

Key words: Congenital Eye Diseases, Ectropion, Orbito‑Ocular Tumors, Orbito‑Oculoplastics Diseases, Prevalence, Ptosis, Trauma

INTRODUCTION Common lesions such as ectropion and entropion have been mainly a disease of the elderly.1,2 Large population‑based studies rbito‑oculoplastic diseases present as orbital, ocular and reported (2.9‑3.9%) of ectropion1,2 and (2.1%) entropion.1 The Oadnexal lesions. They may arise from congenital anomalies, global prevalence and incidence of ptosis is not clearly defined due involutional changes, trauma, metabolic diseases and tumors. to insufficient data.3 Of all orbito‑ocular tumors, retinoblastoma The resulting visual dysfunction, anatomical disfigurement have been found to have a prevalence rate ranging between 38.1% and cosmetically unacceptable appearance predispose to and 57.3%.4‑6 Askira7 et al. recorded 1.4% incidence. A majority of psychosocio‑economic isolation and educational deprivation. studies have focused on individual disease entity. To our knowledge

Department of Surgery, Ophthalmology Unit, Lagos State University Teaching Hospital/College of Medicine, 1‑5 Oba Akinjobi Street GRA Ikeja, Lagos, Nigeria Corresponding Author: Dr. Bolanle G. Balogun, Department of Surgery, Ophthalmology Unit, Lagos State University Teaching Hospital/College of Medicine, 1‑5 Oba Akinjobi Street, GRA Ikeja, Lagos, Nigeria. E‑mail: [email protected]

236 Middle East African Journal of Ophthalmology, Volume 21, Number 3, July - September - 2014 Balogun, et al.: Orbito‑Oculoplastic Diseases in Lagos, Nigeria there have been no studies on the prevalence of orbito‑oculoplastic Ocular and degenerative diseases diseases in our environment. The purpose of this study therefore Few cases of primary ocular lesions attended clinic during the is to determine the prevalence of orbito‑oculoplastic diseases in study period, mainly retinoblastoma 4 (13.3%), while phthisis a young oculoplastics unit, over its 4‑year period of existence bulbi 10 (33.3%) was the most common degenerative ocular and to provide a database in this region where oculoplastics as a disease. sub‑specialization is in its formative years. Orbital and peri‑orbital diseases MATERIALS AND METHODS Affected 44 (16.4%) as shown in Table 1. The majority of orbital lesions [Table 2] were dermoid cyst (orbital and peri‑orbital) All patients referred from the general ophthalmology clinics in 12 (27.3%) and the second most common was thyroid of the study tertiary eye center and secondary eye care centers orbitopathy 11 (25.0%). within and from neighboring states were included in the study. Demographic data and clinico‑pathological diagnoses were Socket disorders collated at entry and during follow‑up (prospective studies). Contracted socket, 22 cases (84.6%), was the most common The primary diagnosis of each patient was selected. Disease conditions were analyzed along an etiological and anatomical distribution pattern. Ethical issues were considered, though data collection did not involve patients’ direct participation. Statistical analysis was done using the Microsoft Excel 2007 software. RESULTS

Two hundred and sixty‑nine (269) patients presented during $JHLQ

Eyelid disorders [Figure 3] constitute 115 (42.8%) of all diseases; Figure 2: Aetiological pattern with ectropion as the most common clinical disorder constituting 36 (31.0%) of all eyelid lesions. Ptosis was the second most Junconal Blepharospasms naevus common 33 (29.0%) with a large proportion being congenital in 2% Dermatochalasis 2% onset. The third common disorder was lid tumors 20 (17.0%). 1%

Lacrimal system disorders Trichiasis Eyelid tumors Ectropion The most frequent occurrences were epiphora in 6 (30.0%) and 1% 17% 31% congenital nasolacrimal duct obstruction in 4 (20.0%). Punctal Lid laceraon 3% stenosis and dacryocystitis affected 3 (15.0%) each. Lid coloboma 9%

Diseases of the conjunctiva Entropion Conjunctival diseases comprised 11.2%. Stevens‑Johnson Ptosis 5% 29% syndrome was most prevalent affecting 9 (30.0%). There were 4 (13.3%) cases of squamous cell carcinoma. Figure 3: Diseases of the eyelid

Middle East African Journal of Ophthalmology, Volume 21, Number 3, July - September - 2014 237 Balogun, et al.: Orbito‑Oculoplastic Diseases in Lagos, Nigeria

Table 1: General anatomic distribution pattern and peri‑orbital] and capillary hemangioma (9.1%) were the Eyelid diseases 115 42.8% predominant benign early childhood tumors [Table 2]. This is Conjunctival diseases 30 11.2% again much higher than 5.2% dermoids recorded in a survey of Lacrimal diseases 20 7.4% childhood diseases carried out in a similar tertiary center serving Ocular diseases 30 11.2% 9 Socket disorders 26 9.7% a much smaller population. Diseases of the eyelid constituted Neurogenic diseases 4 1.5% 115 (42.8%) of all lesions [Table 1]. This is significantly Orbital and periorbital lesions 44 16.4% much higher than (7.9%) occurrence8 in a similar geographic Total 269 100.0% environment and could be due to the fact that this study was carried out on patients presenting specifically to the oculoplastics Table 2: Orbital and periorbital diseases subspecialty clinic in a more densely populated state. The most Orbital cellulitis 1 2.3% frequent eyelid disease was ectropion 36 (31.0%). Ectropion Dermoid 12 27.3% may allow for ocular exposure with the risk of potentially Pseudo tumors 2 4.5% vision‑threatening sequelae. Al‑Yousuf10 noted that 5% of his Rhabdomyosarcoma 1 2.3% Mucocele 2 4.5% study population had abnormal lid position as risk factor for Thyroid orbitopathy 11 25.0% microbial keratitis. Ptosis 33 (29.0%) is the second leading Optic nerve glioma 1 2.3% cause of eyelid diseases, with a risk of amblyopia in the pediatric Men ingioma 1 2.3% age. It contributed 38.2% of all congenital lesions. Epiphora, Histiocytosis 1 2.3% Capillary hemangioma 4 9.1% 6 (30.0%), and nasolacrimal duct obstruction, 4 (20.0%), Cavernous hemangioma 2 4.5% among the adult and pediatric age groups, respectively, were Orbito‑palpebral cyst 2 4.5% the main lacrimal system diseases. Lacrimal system diseases Subconjunctival orbital fat prolapsed 4 9.16 Total 44 100.0% comprised (7.0%) of all pathologies in contrast with the findings of Suppapong et al.,11 who recorded (45%) in all patients presenting with acquired lacrimal duct obstruction. This could cause of acquired socket lesion while microphthalmia and be ascribed to the difference in the anatomical structures of the anophthalmia 2 cases (7.7%), were the congenital causes. nasolacrimal passages, the black race having wider and shorter nasolacrimal duct which facilitates tear drainage.12‑14 DISCUSSION Conjunctival diseases A variety of orbito‑oculoplastics diseases presented during Occurred less commonly, with Stevens‑Johnson syndrome as the the study period. These diseases and deformities tend to most prevalent 9 (30.0%). Stevens‑Johnson syndrome carries impact negatively on the psycho‑social, economic as well as high risk of permanent visual loss from chronic and progressive the educational achievement of affected persons. Quality of life dry eye and corneal vascularization. It has been documented to also tends to decline. The threat to vision is also enormous. It is account for blindness in 35% of affected patients.15 important to note that there were slightly more females (52.4%) than males and this is not unexpected in view of the imposed Ocular and degenerative eye diseases cosmetic disfigurement to which females are more sensitive. Phthisis bulbi (33.3%), painful and unsightly blind eye, Two peak age groups were noted: at 0‑9 years when parents 11 (23.3%), and anterior staphyloma, 5 (16.7%), were the are critical of congenital anomalies and 20‑29 years when the major degenerative ocular disorders. This is similar to the young adult is easily embarrassed by deformities that make findings of previous authors who have reported these as major socio‑economic integration difficult. indications for evisceration16,17 in patients who sought relief and improved cosmesis. Etiological factors Trauma 81 (30.0%) was the leading etiological factor, usually Orbital and periorbital diseases following severe facial injury and this is responsible for the These were the second most common diseased conditions high prevalence 36 (31.0%) of ectropion in this study. This seen during the study period constituting 44 (16.4%). Major differs from the findings of earlier authors who reported that childhood neoplasia was dermoid cyst and capillary hemangioma ectropion occurs more commonly due to involutional changes.1,2 whereas thyroid orbitopathy18 and subconjunctival orbital fat Congenital anomalies 55 (21.0%) were the second leading prolapse were the prevailing orbital diseases of adulthood. reason for seeking oculoplastics care and this is of higher The prevalence of thyroid orbitopathy (25%) is noted in this prevalence compared to the findings of (14.0%) and (13.3%), study and this could be explained by the fact that thyroid eye respectively, from previous studies.8,9 Tumors, the third most disease is one of the major leading causes of orbital disease. common etiological factor, made up 44 (16.0%) [Figure 2] while Orbital tumors when malignant could be life‑threatening 20 (17.0%) of all eyelid diseases [Figure 3] were tumors mainly while proptosis resulting from orbital tumors and thyroid neurofibromatosis in 11 (9.6%). Dermoids 12 (27.3%) [orbital orbitopathy are possible contributory factors to visual loss from

238 Middle East African Journal of Ophthalmology, Volume 21, Number 3, July - September - 2014 Balogun, et al.: Orbito‑Oculoplastic Diseases in Lagos, Nigeria optic nerve compression and associated exposure keratopathy. 5. Kumar R, Adhikari RK, Sharma MK, Pokharel DR, Gautam N. Capillary hemangioma, though present in only 4 (9.1%), is a Pattern of Ocular Malignant Tumors in Bhairahwa, Nepal. Int J significant congenital anomaly. This is because the presence Ophthalmol Vis Sci 2009;7:1. 6. Bekibeli CO, Oluwasola AO. A clinico‑pathological study of of massive capillary hemangioma of the eyelid obstructing the orbito‑ocular diseases in Ibadan between 1991‑1999. Afr J Med visual axis predisposes an infant to amblyopia and astigmatism, Sci 2003;32:197‑202. thereby impairing visual development at the early years, if left 7. Askira BH, Nggada HA. Orbito‑ocular malignancies in unattended. 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