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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 17  |  Issue : 4  |  Page : 154-157

A case series of harmful eye practices following trauma seen at Lagos University Teaching Hospital


Department of Ophthalmology, Lagos University, Teaching Hospital, Lagos, Nigeria

Date of Submission29-Sep-2019
Date of Acceptance01-Jul-2020
Date of Web Publication19-Oct-2020

Correspondence Address:
Dr. Olubanke T Ilo
Department of Ophthalmology, Lagos University, Teaching Hospital, PMB 12003 Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_65_19

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  Abstract 


A case series which highlights the different harmful eye practices which are still being practiced by individuals even following an initial ocular trauma in an Urban City like Lagos in Nigeria. Three cases of patients with vision loss/blindness, following instillation of harmful substances into the eyes, are presented. The first is a 24-year-old female undergraduate who applied her urine and “holy water” into both eyes, following an initial bilateral blunt ocular injury with resultant bilateral corneal abscess. The second is a 54-year-old male auto-electrician who applied his urine and then alum solution into his left eye, following trauma to the eye with resultant anterior staphyloma. In the third case, olive oil and kerosene were applied into the right eye of a 5-year-old male pupil, following accidental application of super glue into the eye, with resultant ankyloblepharon and vision loss. Harmful eye practices and poor health-seeking behavior still remain a challenge in the 21st-century Nigeria. There is a need for more awareness and information dissemination programs, which can be instituted to help reduce needless vision loss/blindness resulting from harmful eye practices.

Keywords: Blindness, eye injury, harmful eye practices, urine, vision loss


How to cite this article:
Ilo OT, Adenekan AO, Aribaba OT, Oduneye FC. A case series of harmful eye practices following trauma seen at Lagos University Teaching Hospital. J Clin Sci 2020;17:154-7

How to cite this URL:
Ilo OT, Adenekan AO, Aribaba OT, Oduneye FC. A case series of harmful eye practices following trauma seen at Lagos University Teaching Hospital. J Clin Sci [serial online] 2020 [cited 2020 Nov 29];17:154-7. Available from: https://www.jcsjournal.org/text.asp?2020/17/4/154/298460




  Introduction Top


The World Health Organization and the International Agency for the Prevention of Blindness inaugurated VISION 2020 with the aim of eliminating avoidable blindness by the year 2020.[1] In 2020, the use of traditional eye medication (TEM) is still a common practice, as a significant proportion of individuals in Africa consult traditional healers (culturally accepted health-care providers throughout Africa and much of the developing world)[2] before presentation to a hospital.[3],[4],[5],[6],[7],[8] It could be because these healers are closer to the people in the community. Many of them also enjoy the trust of the people, and they seem to bridge the gap between the community and orthodox services.[9]

Traditional medicine (also known as indigenous or folk medicine) dates back to the era before modern medicine with long-standing remedies passed on and practiced by laypeople.[10]

A traditional healer is a recognized member of a community who may attempt to provide health care (traditional medicine) using vegetable, animal, and mineral substances as well as certain other methods based on the social, cultural, and religious background of the community.[11] He/she also relies on the knowledge and beliefs that are prevalent on the community regarding physical, mental, and social well-being and the causation of disease and disability.[2] Traditional healers are numerous and are culturally accepted health-care providers throughout Africa and much of the developing world.[2]

These healers use a variety of products to make concoctions for facial washing, “fume baths,” and for direct application to the eye. Many elderly people might be labeled as traditional healers since they have some knowledge of how to treat common ailments using herbs.[9] They may prefer to use substances that cause irritation and pain, as this is perceived by the healers and patients as more potent. Such substances may be acidic or alkaline resulting in ocular burns. No particular attention is paid to the mode of action (antibiotic or steroid), concentration, or sterility as often, these concoctions (a mixture of various substances which may be plant or animal extracts) are made without regard for hygiene including using contaminated water, local gin, saliva, or even urine.[6],[11]

People living in communities with scarce or inaccessible appropriate eye care services are inclined to look for alternatives,[12] hence reducing avoidable blindness is a challenge. These unhealthy practices following trauma worsen the visual prognosis and may eventually lead to blindness. These case series aim at discussing the harmful eye practices following trauma with a view to bringing to fore the importance of sensitization and advocacy needed to mitigate a needless cause of blindness.

Three cases and their clinical photographs were included in this series after they had given their consent.


  Case Reports Top


Case 1

A 24-year-old female undergraduate of the National Open University of Nigeria, who resides in Lagos, Nigeria, presented through the accident and emergency with complaints of sudden, painful loss of vision in both eyes following a case of assault during an attempted rape.

She was repeatedly punched on both eyes following which patient noticed sudden, painful loss of vision in both eyes. She was discovered some days later and subsequently presented to Lagos University Teaching Hospital (LUTH).

Ocular examination [see [Figure 1]a revealed a visual acuity (VA) of ½ meter counting finger in the right eye (RE), severe lid edema, discharge, conjunctival chemosis and hyperemia, and central corneal opacity not staining with fluorescein and no red reflex [see [Figure 1]b. VA in the left eye (LE) was no perception of light (NPL), with proptosis, limited extraocular muscle motility in all positions of gaze, conjunctival hyperemia, discharge, and necrotic tissue on the conjunctiva; cornea was desiccated with total opacity [see [Figure 1]c. Brain computerized tomography scan revealed left orbital blow out fracture with inferior rectus muscle entrapment. A diagnosis of bilateral blunt ocular injury with left orbital wall fracture, left proptosis, and exposure keratopathy was made. Moxifloxacin, fluconazole, hypromellose, and tropicamide eye drops and ointment tobramycin were given to the patient. She was also placed on tablet chymotrypsin for the lid edema, vitamin C, and analgesics. Following treatment, she clinically improved after 1 week on admission and was discharged to follow-up in the clinic. VA on discharge was 6/18 in the RE and NPL in the LE.
Figure 1: (a) On examination. (b) Right eye. (c) Left eye

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Two months after discharge, the patient presented with bilateral ocular pains, discharge, and loss of vision in both eyes, following the instillation of her early morning urine and “holy water” into both eyes which was given to her by her religious leader. Examination showed bilateral corneal abscess with impending corneal perforation. Conjunctival swab and patient's urine microscopy, culture, and sensitivity (MCS) were done. Urine MCS yielded Acinetobacter baumannii, sensitive to doxycycline and gentamicin. Conjunctival swab yielded no growth. The patient was placed on oral doxycycline, topical medication including fortified genticine, cirofloxacine and tobramycin ointment. The patient was comanaged with the psychiatrist and clinical psychologist for supportive psychotherapy.

On discharge from the hospital, her VA was hand movement (RE) and NPL (LE). The patient has been counseled for penetrating keratoplasty to improve vision in the RE.

Case 2

A 54-year-old male auto-electrician from Agbara Community, Lagos, presented with a history of sudden, painful loss of vision in his LE of 26-day duration. The patient was poked in his LE with a finger during a fight and immediately noticed a reduction in vision with profuse tearing, pain, and redness. He subsequently instilled his urine into the eye on the second day following advice from elders in his neighborhood. On the 5th day post trauma, symptoms became worse with the development of purulent discharge and photophobia, and he was further advised to instill a solution of alum into the same LE.

The patient presented to LUTH thereafter for expert management as symptoms were getting worse. On examination, presenting VA in the RE was 6/18 from uncorrected refractive error, while other findings in the RE were normal. Presenting VA was light perception in the LE, with lid edema, injected conjunctiva, extensive corneal melting and descemetocele, and no fundal view.

A diagnosis of left anterior staphyloma, with panophthalmitis, was made [see [Figure 2]. He subsequently had an evisceration with the insertion of an orbital implant and conformer in the said LE.
Figure 2: Corneal melting with anterior staphyloma following instillation of urine and alum water

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Case 3

A 5-year-old boy, who resides with his parents in Lagos, Nigeria, presented through the emergency unit with a history of accidental instillation of superglue into the RE, with subsequent adhesion of the upper and lower lids 6 h before presentation. The patient's mother had rinsed the RE with water and instilled olive oil into the eye immediately after the incident, then took him to a “private hospital” where cotton wool soaked in kerosene was also applied to the eye. When there was no improvement in symptoms, mother decided to present to LUTH for “expert management.” On examination, VA could not be assessed in the RE. There was complete ankyloblepharon of the right lids, with no further view. The VA of the LE was 6/5, and the other ocular findings were essentially normal. A diagnosis of ankyloblepharon secondary to chemical injury was made. The patient's eyelashes were subsequently trimmed, and the patient had ankyloblepharon release [see [Figure 3]. Immediate postoperative VA in the RE was 6/9, while other findings were essentially normal. The patient and his relatives were counseled before the hospital discharge.
Figure 3: Immediately after the ankyloblepharon release

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  Discussion Top


Patients such as in the above series could have had a better visual outcome but for their intervention with various harmful/TEM. It suggests that traditional eye medication is still being utilized in the semi-urban population in Lagos state and in Nigeria at large.

Studies have looked into the patient's use of unorthodox health care before presenting to a tertiary health facility.[8],[13],[14],[15] Although the percentages in these studies suggested an underestimation because people tend not to report their use of traditional medication to health providers.

Unorthodox type of health care consists of traditional medication which can be delivered through traditional medical practitioners (as seen in Case 1 and 2) or nontraditional medical practitioners (case 3) who could be the patient, relatives, or friends.[8],[11] TEM is used for a variety of reasons and indications. In a study done in Owo, Southwestern Nigeria, people that used TEM stated various reasons for using these substances which included – eye complaint not severe enough to warrant a visit to the hospital, lack of readily available ophthalmic services, financial constraints to accessing hospital care, ignorance of potential side effects of these substances, certainty of efficacy of self-medication used, and lack of an escort to facilitate access to care at a hospital.[16]

Reported efficacy from previous users and belief in potency were the main reasons (as where the reason for use in these cases studied in the report) for using these TEMs.[9] The ingredients commonly used range from dissolved sugar in water, plant extracts, and urine as seen in the first two case series. Other less common constituents used for their eye complaints include kerosene, olive oil (as seen in case series 3), breast milk, kerosene, beach water, onions, petrol, and oranges. The choice and constituent of these remedies differs from place to place.

It has been observed that, in Africa, many people rely on traditional medicine for their health needs.[16] It is possible to find traditional healers in each village and town in Africa, and the estimated healer population ratio is 1:350.[17] In contrast, in Africa, there is approximately one ophthalmologist per 1 million population and fairly few trained ophthalmic nurses and ophthalmic assistants.[6]

There are relatively few reports about the positive effects of TEM.[18] People are also usually psychologically satisfied with their engagement with a traditional healer irrespective of the outcome. Most of the time, the reports on TEM use are coming from ophthalmologists, but patients managed successfully by a traditional healer do not come to their attention. Sometime after treatment from a traditional healer, the patient may be cured or the disease itself may have resolved spontaneously.[6]

Jimba et al. revealed that 81% of patients attending orthodox hospitals in Nepal would have initially gone to the traditional healers.[ 19] Ajite and Fadamiro reported that 3.4% of all the patients attending the eye clinic at Ekiti State University Teaching Hospital, Ado-Ekiti, instilled various TEM s, of which 10.8% instilled personal urine and 25% instilled kerosene into their eyes.[20]

Previous studies[15],[21] have suggested that individuals without any formal education were more likely to use TEM,[15],[21] and that the common reason for the use of TEM ranged from trauma (as in cases 1 and 2) acute conditions in (conjunctivitis, corneal ulcers), chronic loss of vision (cataract, glaucoma), for trauma and posterior segment disease.[21]


  Conclusion Top


The use of TEMs is still being practiced among individuals, especially less educated individuals those living in a semi-urban population in Lagos State. Proper health education of the public and traditional healers will help in reducing this trend. A standard protocol between the Western-trained doctors and traditional healers is highly necessary to curb the unnecessary complications and blindness from harmful eye practices.[8]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https://www.who.int/blindness/partnerships/vision2020/en/. [Last accessed on 2020 Jun 15].  Back to cited text no. 1
    
2.
Courtright P, Chirambo M, Lewallen S, Chana H, Kanjaloti S. Collaboration with African Traditional Healers for the prevention of blindness. World Scientific 2000, ISBN 981-02-4377-4(pbk) pp 4-6.  Back to cited text no. 2
    
3.
Klaus V, Adala HS. Traditional herbal eye medication in Kenya. World Health Forum 1994;15:138-43.  Back to cited text no. 3
    
4.
Baba I. The red eye –First aid at the primary level. Community Eye Health 2005;18:70-2.  Back to cited text no. 4
    
5.
Klauss V, Schwatz EC. Other conditions of the outer eye. In: Johnson GT, Minassian DC, Weale R, editors. The Epidemiology of Eye Disease. 1st ed. Philadelphia: Lippincott Raven Publishers; 1998. p. 155-8.  Back to cited text no. 5
    
6.
Mselle J. Visual impact of using traditional medicine on the injured eye in Africa. Acta Trop 1998;70:185-92.  Back to cited text no. 6
    
7.
Adefule-Ositelu AO. Ocular drug abuse in Lagos. Nigeria. Acta Ophthalmol (Copenh) 1989;67:396-400.  Back to cited text no. 7
    
8.
Eze BI, Chuka Okosa CM, Uche JN. Traditional eye medication use by newly presenting ophthalmic patients in a teaching hospital in South Eastern Nigeria: Sociodemographic and clinical correlates. BMC Complement Altern Med 2009;9:40.  Back to cited text no. 8
    
9.
Ntim-Amponsah CT, Amoaku WMK, Ofosu-Amaah S. Alternative eye care services in a Ghanian district, Ghana Medical Journal March 2005;39:19-23.  Back to cited text no. 9
    
10.
Available from: Wikipedia – www.wikipedia.com Traditional medicine. [Last accessed on 2020 Mar 31].  Back to cited text no. 10
    
11.
Osahon Al. Consequences of traditional eye medication in University of Benin Teaching Hospital, Benin City. Nigerian J Ophthalmol 1995;3:51-4.  Back to cited text no. 11
    
12.
Nigerian national Blindness Survey. Available from: http://iceh.lshtm.ac.uk/nigeria-national-blindness-and-visual-impairment-survey/. [Last accessed on 2020 Mar 31].  Back to cited text no. 12
    
13.
Goyal M. Hogeweg M. Couching and cataract extraction, a clinical based study in Northern Nigeria. J Comm Eye Health 1997;10:6-7.  Back to cited text no. 13
    
14.
Ukponmwan CU, Momoh N. Incidence and complications of traditional eye medications in Nigeria in a teaching hospital, Middle East African J Ophth 2010;17:315-9.  Back to cited text no. 14
    
15.
Nwosu SN, Obidiozor JU. Incidence and risk factors for traditional eye medicine use among patients at a tertiary eye hospital in Nigeria. Niger J Clin Pract 2011;14:405-7.  Back to cited text no. 15
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16.
Omolase CO, Afolabi AO, Mahmoud AO. Ocular self medication in Owo, Nigeria. Niger J Postgrad Med 2008;1:1.  Back to cited text no. 16
    
17.
Poudal B. Traditional healers as eye team members in Nepal. J Comm Eye Health 1997;10:4-5.  Back to cited text no. 17
    
18.
Foster A, Johnson GG. Traditional eye medicines--good or bad news? Br J Ophthalmol 1994;78:807.  Back to cited text no. 18
    
19.
Jimba M, Poudyal AK, Wakai S. The need for linking healthcare-seeking behavior and health policy in rural Nepal. Southeast Asian J Trop Med Public Health 2003;34:462-3.  Back to cited text no. 19
    
20.
Ajite KO, Fadamiro OC. Prevalence of harmful/traditional medication use in traumatic eye injury. Glob J Health Sci 2013;5:55-9.  Back to cited text no. 20
    
21.
Mutombo TK. Assessing the use of traditional eye medication in Bukavu district eye hospital, Congo. Community Eye Health J 2008;21:64-6.  Back to cited text no. 21
    


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