Article Type: Research
Received : 16/11/18
Accepted : 27/11/18
Published : 05/12/18
*Correspondence to: Dr Bile Philippe E F K, Maitre-Assistant, Medecin Ophtalmologiste, Université Alassane Ouattara,
Email : firstname.lastname@example.org
Article Type: Research
Received : 16/11/18
Accepted : 27/11/18
Published : 05/12/18
Objective: Ocular pathologies are all diseases linked to the involvement of one or more constituents of the eyeball. They have peculiarities in children because they occur on an organ as immature as fragile. The purpose of this study was to evaluate the main pediatric pathologies observed in our central region of the country.
Patients and Method: Analytical cross-sectional study was carried out at the ophthalmology department of the University Hospital of Bouaké for a period of 5 years.
Results: The prevalence of pediatric ocular pathologies was 12.57% of all ocular pathologies. The average age was 7 years old. The male gender was predominant (51%). The students were the most numerous (78%). The clinical examination returned uncorrected visual acuity between [7 / 10-10 / 10e] with 53% at the OD and 52% at the OG. Conjunctival hyperemia accounted for 23% of clinical manifestations. Anterior segment examination was normal in the majority of patients The majority of patients had no lens abnormalities. In contrast, cases of cataract were observed (2.81%). Most of the fund us examination made were normal. They were inaccessible in 2,81% of cases. Infectious and inflammatory pathologies were the most common eye conditions in children (60.48%). Hyperopia was the dominant ametropia with 60% of our patients. Medical treatment was administered to almost all patients in the study (99.7%). Post-treatment evolution was good in the majority of cases
Conclusion: Pediatric ocular pathologies, although diverse and varied, do not differ fundamentally from those of adult.
Keywords: evaluation, ;pathologies ; pediatric ;ocular
Pediatric ocular pathologies are all of the conditions associated with the involvement of one or more constituents of the eyeball in children. They are generally responsible for visual disturbances and have the same clinical characteristics as in most pathologies in adults . It is important to emphasize, however, that the ocular involvement of the child, by these various diseases, has peculiarities because they occur on an organ as immature as fragile.
The problem of ocular pathologies in children is structural and functional.In general, they pose problems as to the child's ability to continue and normal schooling and on his future insertion. In current practice, the ocular pathologies of the child are most often curable.This makes it possible to avoid arriving at stages of blindness.In our underdeveloped country conditions. This care is confronted with particularities of infrastructures that do not exist or are unsuitable for the child.This poses a problem of support for and future insertion.his is a research article made in view is therefore to have a better knowledge of morbidity factors of the child to guide the planning of the prevention strategy and the establishment of a structure adapted to the reality of childhood.
2. Patients and Method
Retrospective descriptive study that took place in the ophthalmic department of the Hospital and University Center of Bouaké from 1 January 2011 to 31 December 2015 or 5 years. It focused on children who came to the ophthalmology department for whatever reason. Included were all patients aged 0 to 15, with a complete and exploitable medical record. Data collection was done on structured and anonymous survey sheets. sion, origin), clinics (reason for consultation, history, ophthalmological examination (visual acuity measurement, slit lamp examination, intraocular pressure measurement, fund us examination), the treatment and evolution of pediatric ocular pathologies.The study was carried out with the agreement of the establishm+++
ent’s ethics committee and in confidentiality by assigning an anonymity number to each file.
Duration of the study period, 2216 children consulted out of a total of 17621 patients who came for consultation, a prevalence of 12.57%. The average age was 7 years with extremes of 02 days and 15 years. However the age range between [5-10 years] came to the fore with 35.60%. The male gender was predominant (51%) with a sex ratio of 1.04. The students were the most numerous (78%). The decrease in acuity was the most frequent reason for consultation with 38.62% followed by eye pruritus (24.18%) (Table I). The consultation period of less than 1 week was the most frequent (20%). 2.5%. Clinical examination found visual acuity uncorrected between [7/10e -10/10e] with 53% in the right eye and (ER) 52% in the left eye (LE) (Table II). At the appendix level, palpebral swelling was the most represented with 6.29% of cases. Conjunctival hyperemia accounted for 23% of clinical manifestations. Anterior segment examination was normal in the majority of patients. However, cases of corneal ulceration (3.81%), hyphema (0.67%), iris hernia (0.34%), and pupillary deformities (0.5%). patients had no lens abnormalities. In contrast, cases of cataract were observed (2.81%). Fundus exploration was only performed in 54% of patients. Most of the eyes were made. In contrast, they were inaccessible in 2.81% of cases. Hyalites (0.2%) and cicatricial chorioretinites (0.3%) were found. At the level of the optic disc large (1.5%) and pale (1.3%) were present. The abnormalities of the macula were marked by the absence of reflection (1.1%) and the presence of exudate (0.8%). Intraocular pressure measurement was performed in 8.79% of patients. The paraclinical assessment was performed by 2.65% of the patients.Infectious and inflammatory pathologies accounted for the most common eye disorders in children (60.48%) followed by refractive disorders at 24.17%. Ocular allergy was the most common infectious and inflammatory pathology (65%). Hyperopia was the dominant ametropia with 60% of our patients.Medical treatment (local and / or general) was administered to almost all patients in the study (99.7%). The medical treatment was, in 17% of the cases, associated with a physical treatment (an optical correction) and 2% of the cases with a surgical treatment. Post-treatment evolution was good in the majority of cases where it was specified (57%).
The ocular pathologies of the child accounted for 12.5% of all consultations in the ophthalmology department. This low prevalence was found by Abiose in Nigeria  who found a frequency of 16.4% of pediatric ocular pathologies. The age group between [5-10 years] was predominant with 35.6%. Ayena in Burkina Faso  found 45.1% of children between 5 and 9 years old. This age group corresponds to the beginning of the school age. It is marked, in the child, by a pronounced taste for the discovery of its environment and its exploration. This can lead to household accidents or games that may occur in the playground. This is in addition to the health policy of our various countries where ophthalmological examination is not systematic in early childhood, unlike in industrialized countries.The male gender is predominant with 51%, and a sex ratio of 1.04. This predominance is also found in the study of Zaghoul  in Casablanca. However, studies like Sanford  in Nigeria have reported a fair distribution between the two genders. Mumbere  and Chenge  in Democratic Congo in their respectives studies found no significant difference between thegender. In our study, students came to the fore with 71%. This percentage is comparable to that of Ayed  in Tunisia which finds respectively 86.23%. The high proportion of students would be explained by the choice of our study sample which is based mainly on children coming from the urban environment especially in school activity. The decrease in visual acuity (DVA) was the most frequent reason for consultation with 38.62% followed by eye pruritus (24.18%). These data are consistent with those of many authors including Eballé  who find similar figures (34.8%). The DVA remains the main reason for consultation in ophthalmology. For authors such as Koki  in Cameroon, Mumbere  and Chenge  in the Democratic Republic of Congo, pruritus predominates with 89.1% 86% and 60.90% respectively. The observed pruritus is due to the climate of the study area (savanna region with a long dry season and a lot of dust during the harmattan period); by the clinical manifestation of certain pathologies including conjunctivitis evolving in an endemic-epidemic mode. But also by the immaturity of the structures of the eye not having defenses still seasoned. The clinical examination found visual acuity without correction between [7/10e -10/10e] with 53% at RE and 52% at LE is good visual acuity. This is a visual acuity deemed good according to WHO criteria (DVA greater than 3/10e). These results of visual acuity confirm that ocular pathologies which, although they are responsible for a decrease in visual acuity, do not systematically cause ocular functional impotence. However visual acuity was not achieved in 31.95% of cases at the RE and 30.96% at the LE. This could be explained by some age groups (newborn, child) who can not speak, read and especially recognize the drawings.Regarding the examination of the appendices, conjunctival hyperemia with 22.84% was the lesion coming to the fore. Conjunctival hyperemia is indicative of inflammation of the conjunctiva. It is an alarm sign frequently observed in ophthalmologic emergency in eye diseases that develop in an acute mode .Anterior segment examination was normal in the majority of patients. The lesions observed were mainly due to ocular trauma. The majority of patients had no lens abnormalities. On the other hand, cases of cataract were observed (2.81% at the RE and 2.81% at the LE). The presence of opacification of the crystalline lens is explained by the fact that some embryofoetopathies where other acquired pathologies of a general or local nature (ocular trauma, infection, diabetes, uveitis) are likely to lead to a modification of the crystalline structures with the appearance of a decrease of the visual acuity important to see of blindness.Eballé in Cameroon found 1.2% (five cases) of cataract including four post-traumatic and one case of bilateral congenital cataract . Intraocular pressure measurement was not performed in 91.21% of our patients. Some difficulties were encountered in carrying out this examination. They were linked on the one hand to inappropriate equipment (lack of pulsed air tonometer or Perkins).On the other hand, the measurement of the intraocular pressure was not systematic in the child, in the absence of signs of calls. However intraocular pressure achieved in 7.79% of patients was found to be normal. Fundus exploration was only performed in 54% of patients. However in 42.38% of the cases, difficulties encountered during its realization did not allow to do it. Most of the eyes were made. In 2.81% of cases, however, they were inaccessible because of opacification of the lens. Lesions observed at the posterior pole are not typically observed in children and are infrequent. Which would be related to our study population which is young and growing. The paraclinical assessment (biological, imaging and functional exploration) was not prescribed in almost all of our patients (97.35%). This could be explained by the fact that the diagnostic procedure of the ophthalmological affections of the child is mainly clinical. The achievement of the paraclinical assessment is generally a function of the diagnosis.Infectious and inflammatory pathologies accounted for the most common eye conditions in children (60.1%) followed by refractive disorders at 24.1. For Ayed, Eballé, and Maul in Chile, [7, 8, 11], the most common pathologies in this age group are refractive errors 43.1% 57.2% 56.3% (Table III) . The high rate of infectious and inflammatory pathologies in our study could be explained by the immaturity or fragility of the eye in the child in the presence of infectious agents. Which would expose him to infections. In addition, the level of hygiene of our countries would not be foreign to this important frequency. Ocular allergy was the most common infectious and inflammatory pathology (65%). Our results are higher than Koki  in Cameroon which found 31.55%. This high frequency of allergies would be a reflection of our weather conditions where dry, dusty winds of the harmattan associated with a sunny climate are responsible for longer conjunctival irritation.This treatment has no difference with that prescribed in adult eye diseases. The medical treatment was, in 17% of the cases, associated with a physical treatment (an optical correction) and 2% of the cases with a surgical treatment. This low rate of surgical treatment could be explained by the operating theater of the service unsuitable for surgical interventions in children because of the impossibility of performing general anesthesia in cases of post-traumatic wounds (corneal repair ...).The post-therapeutic evolution was good in half of the cases where it was specified 57%. The different modalities of favorable evolution make it possible to see that this one was done with cure without anatomical and functional sequels in 93% of the cases In 40% of the cases, the evolution could not be specified because of the lost ones of view of the system (the patient does not honor the appointment of control) for various reasons.
At the end of this study, we can say that pediatric ocular pathologies, although diverse and varied, do not differ fundamentally from those of adults. However, they have certain clinical peculiarities.
5. Limitations of the study
The study presents biases due to clinical examinations that could not be performed in some children and the number of lost patients observed at the end of the survey.
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