JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

SEARCH ARTICLES

Table of Contents

2020 Month : May Volume : 7 Issue : 18 Page : 909-912

Ocular Morbidity among Paediatric Population at a Tertiary Eye Care Hospital in Southern Odisha

Rutayani Dash1, Shagufa Jamal2, Radhakanta Bhoi3, Suchitra Dash4


1. Final Year Postgraduate, Department of Ophthalmology, MKCG Medical College & Hospital, Berhampur, Odisha.
2. Second Year Postgraduate, Department of Ophthalmology, MKCG Medical College & Hospital, Berhampur, Odisha.
3. Assistant Professor, Department of Ophthalmology, MKCG Medical College & Hospital, Berhampur, Odisha.
4. Professor, Department of Ophthalmology, MKCG Medical College & Hospital, Berhampur, Odisha.

Corresponding Author

Dr. Rutayani Dash,
Email : rutayanidash@gmail.com

Abstract

Corresponding Author:
Dr. Rutayani Dash,
Plot No. 1181A,
Near Axis Bank, Bomikhal,
Bhubaneswar- 751010, Odisha.
E-mail: rutayanidash@gmail.com

ABSTRACT
BACKGROUND
According to world health organisation childhood blindness is a priority and significant component of its vision 2020 programme. It has been estimated that there are 1.4 million blind children worldwide. This study aimed to identify the causes of ocular morbidity in children attending a tertiary eye centre in southern Odisha.

METHODS
This is a retrospective study conducted in our hospital between August 2017 and July 2018. A total of 636 patients was evaluated, and the data were tabulated in MS Office Excel and analysed. All children who attended the OPD during the study period were included and children whose parents did not give consent for examinations were excluded.

RESULTS
Refractive error was found to be the most common cause of ocular morbidity (38.05%), followed by allergic conjunctivitis (21.38%), and oculosporidiosis (rhinosporidiosis) (7.70%). Among the congenital anomalies, congenital cataract topped the list.

CONCLUSIONS
The most common cause of ocular morbidity were refractive errors and allergic conjunctivitis. Among the other causes, most of the diseases were either avoidable or preventable. So, proper health education in the community is a must to prevent the ocular morbidities in children.

KEYWORDS
Ocular Morbidity, Paediatric, Refractive Error

BACKGROUND

Ocular morbidity is defined as the spectrum of eye disease which include both visually impairing and non-visually impairing conditions experienced by a population. Study of ocular morbidity in paediatric population is important because some conditions like refractive error, congenital cataract and retinoblastoma are treatable while Vitamin A deficiency is preventable. Delay in diagnosis may result in irreversible visual loss and in case of retinoblastoma, potential death. It also affects the ability to learn, adjustment in the society and development of the personality of a child.1

Visual disability are one of the most common disabilities to affect children. Blindness in children attributes for one-third of the economic cost of blindness even though it accounts for less than 4% of the overall magnitude.2 It is the second largest cause of blind-person years, following cataract. There are 1.4 million blind children globally and the numbers are increasing every day. 73% of them live in low-income countries.3 About 7 million suffer from low vision, and 10 million children have a correctable refractive error causing visual handicap.4

India has an estimated 320,000 blind children, which is much higher than any other country in the world.5 Estimated National Prevalence of Childhood Blindness or Low Vision in our country is 0.80/1000.6 Around 30% of the paediatric blind population lose their eyesight before the age of 20 years.7

Data on ocular morbidity is important to know the magnitude of problem and determine the social, biological or environmental risk factors involved. It can also help in planning and establishment of targeted screening and awareness programmes to decrease the modifiable risk factors. So, this study and early diagnosis and treatment of ocular diseases in paediatric population is important to prevent the child from being handicapped as well as reducing the economic burden on the society.

            The aim of this study is to determine the ocular morbidity among children less than 15 years of age in southern Odisha.

METHODS

This is a retrospective study conducted in the Departments of Ophthalmology, and Paediatrics, of MKCG MCH, Odisha. All paediatric patients 0-15 years of age attending the Ophthalmology OPD (Referred / Self reporting) during the period August 2017 to July 2018 were included in the study.

 

 

Exclusion Criteria

  • Incomplete data.
  • Uncooperative child.
  • Children whose parents did not give consent for Direct/Indirect ophthalmoscopy.

 

 

Data Collection and Analysis

Data was collected from the records in the case files of children who attended the eye OPD during the study period. Information was collected about the demographic details (especially age, gender), duration of illness and type of ocular disease. The data was tabulated in MS Office Excel sheet and analysed.

RESULTS

 

Sl. No.

Disease

Total No.

Male

Female

 

 

636

346 (54.40%)

290 (45.59%)

1.

Refractive Error

242 (38.05%)

131

111

2.

Allergic Conjunctivitis

136(21.38%)

76

60

3.

Rhinosporidiosis

49 (7.70%)

31

18

4.

VKC

48 (7.54%)

29

19

5.

Trauma

31 (4.87%)

19

12

6.

Conjunctivitis/Sclera/Cornea

24 (3.77%)

9

15

7.

ROP

23 (3.61%)

11

12

8.

Bitot’s Spot

22 (3.45%)

08

14

9.

Congenital Cataract

17 (2.67%)

09

08

10.

Squint

12 (1.88%)

05

07

11.

Orbital Cellulitis

10 (1.57%)

06

04

12.

Iris Coloboma

07 (1.10%)

04

03

13.

Anophthalmos

06 (0.94%)

02

04

14.

Retinoblastoma

05 (0.78%)

04

01

15.

Corneal Opacity

03 (0.47%)

01

02

16.

Trachoma

01(0.15%)

01

0

Table 1

 

Sl. No.

Age Group

Frequency

1.

0 – 4 Years

124 (19.51%)

2.

5 – 9 Years

242 (38.03%)

3.

10 – 14 Years

270 (42.46%)

Table 2

 

Sl. No.

Duration of Illness

 

1.

Less than 1 month

247(38.84%)

2.

1-3 months

243 (38.24%)

3.

3-6 months

138 (21.70%)

4.

More than 6 months

8 (1.22%)

Table 3

 

A total of 636 paediatric patients attended our OPD out of which 54.40% (346) were males and 45.59% (290) were females. 19.51% (124) were within 0-4 years of age, 38.03% (242) were 5-9 years old and 42.46% (270) were 10-14 years old which was maximum. Duration of illness was less than 1 month in 38.84% (247) patients, 1-3 months in 38.24% (243) patients, 3-6 months in 21.70%(138) patients and more than 6 months in 1.22% (08) patients.

Refractive error was the most common ocular morbidity accounting for 38.05% (242) cases and males and females were affected in equal proportion. Allergic conjunctivitis (21.38%) was the second most common condition. This was followed by Rhinosporidiosis and VKC constituting 7.70% and 7.54% of the cases respectively. Blunt trauma with or without hyphema accounted for 4.87% of the cases, which was mostly due to cricket ball followed by bamboo stick injury. Conjunctivitis and other infective conditions accounted for 3.77% with females being affected more than males. Vitamin A deficiency disorder was found to be 3.45%, which was quite high and once again females were affected more in comparison to males. Among congenital anomalies, congenital cataract was a significant cause of ocular morbidity followed by iris coloboma.

DISCUSSION

Ocular morbidity in children affects the ability to learn, adjustment in society, and development of personality.1 Hence, early identification and prompt treatment is needed to avoid any effect on development, quality of life and education of the child. The causes of ocular morbidity differ across countries and various regions in the same country due to difference in geographic, environmental and socio economic background.

In our study, majority of the children who attended OPD for consultation (42.46%) were in the age group 10 to 14 years. This was similar to the finding of Onakpoya et al.2 There was a rise in ocular morbidity with age which correlated with the findings of Kumar et al.3 This could be because elder children are able to express their problems more clearly, hence the reporting is higher. Younger children are unable to or fearful of expressing themselves so the disease can go unnoticed and unreported. Other causes include greater cumulative effect of long standing diseases and greater exposure to infectious agents in older children. However, the study by Chandana Chakraborti et al found higher frequency of consultation in the age group 6-10 years (38.87%).4 This does not match with our study.

In our study proportion of males (54.40%) was higher in comparison to females (45.59%) which is similar to study done by Sethi S et al5 where 60.6% were male and 39.1% were female. This may be due to gender bias in seeking health care in our society. However, there was great variability and no established pattern in male to female ratio with respect to specific eye diseases.

Figure 1

In this study, refractive error was the most common cause of ocular morbidity (38.05%). This result was comparable with Gupta et al,8 who also found refractive error (22%) was the most common disorder. Desai et al6 also reported a similar prevalence of 20.8%. But the Kariapatti paediatric eye evaluation project7 and study by Kumar et al3 showed a lower prevalence than present study, which was 0.55% and 5.4%, respectively. This may be due to the lifestyle changes, reading habits and nutritional status in urban paediatric population as compared to rural population in the other studies mentioned above.

Allergic conjunctivitis contributed 21.38% in the present study. High prevalence (3-17.5%) of allergic conjunctivitis has been reported in some other studies.2,9,10 Poor hygiene, polluted and dusty urban environment may lead to chronic allergic conjunctivitis. It may not cause blindness, but it is an important cause of discomfort, resulting in absenteeism from school and frequent hospital visits in children. The third most common cause of ocular morbidity was Rhinosporidiosis at 7.70%. This is higher than studies by Subramyam et al11 and Anand et al,12 which showed an incidence of only 0.1%. The incidence in our study is higher because of the habit of bathing in ponds in this area.

The incidence of VKC was 7.54%. Male to Female ratio was seen to be 1.52:1. This tendency has also been confirmed in various other studies with male to female ratios ranging from 4:1 to 2:1 (Neumann et al13 and Khan et al14).

Ocular trauma contributed to 4.87% of ocular morbidity in the present study. The most common causes being blunt trauma by ball, penetrating injury while playing with a stick and fingernail injury. Biswas J, et al15 found ocular trauma was responsible for 12.74% of childhood ocular morbidity. Globally also the frequency of ocular trauma in children is high the reasons being, careless activities, unsupervised play and use of dangerous objects for playing.16 This can be avoided if the parents take proper precautions and safety measures.

Infective conjunctivitis accounted for 3.77% of the cases which is similar to studies conducted by Kumar et al3 and Desai et al5 in urban areas. But studies in rural areas like the studies by Gupta et al8 and Singh et al7 show prevalence as 0.8 and 0.9% respectively which does not correlate with our study. This could be due to the unhygienic and overcrowded surroundings and slum dwelling practices in urban areas like ours. Vitamin A deficiency disorder i.e. Bitot’s spot was seen among 3.45% of children. Similar finding was observed in study by Singh et al,17 Vitamin A deficiency in the form of conjunctival xerosis and Bitot’s spots was seen in 2.09% children. Gupta et al (1.8%), Kumar et al (4.1%) and Desai et al (5.39%) also reported Vitamin A deficiency in children.3,8,6 But Prajapati et al reported a higher prevalence rate of 3o%.18 This variability may be due to lower socio economic and nutritional status of that population.

Lens (congenital cataract) constitute 2.87% of ocular morbidity. It is similar to study by Gupta et al.19 They require immediate action in the early years of life to prevent blindness. In present study prevalence of ocular motility disorders (squint) is 1.88%, which is similar to prevalence of other studies.19 Corneal opacity was seen in 0.47% cases. Most were seen to be undernourished. It correlates with the finding of 0.2% in a study by Shakya et al.20 Trachoma was seen in only 1 case (0.15%) as trachoma is no longer a significant cause for blindness in our country.

CONCLUSIONS

This study suggests that refractive errors, allergic conjunctivitis, rhinosporidiosis, VKC, infections of eye and adnexa and ocular trauma are important causes of childhood ocular morbidity. They are either treatable or preventable.

Visual impairment because of refractive errors is an important community health problem as it disturbs school performance and damages behavioural and social development of children. So, there is a requirement for school eye screening programs which should include refraction testing and provision of low cost spectacles for the children. Health education activities in schools should be further enhanced where teachers, students, and parents shall be educated about eye care and hygiene in order to curtail childhood eye infections and injuries and ensure early treatment seeking for eye disorders. Teachers can additionally be taught about common eye problems and how to identify them and report to the respective parent/guardian. Referral systems also should be strengthened so that, early detection and intervention will halt the disease progression and also prevent visual disability. Low vision in a child can affect the daily life at school and home and have a negative impact on their future. Hence, by taking such measures, a large number of childhood blindness and visual handicap can be avoided and the socio-economic well-being of the society can be upgraded.

 

REFERENCES

  1. Pratap VB, Lal HB. Pattern of paediatric ocular problems in North India. Indian J Ophthalmol 1989;37(4):171-172.
  2. Onakpoya OH, Adeoye AO. Childhood eye diseases in southwestern Nigeria: a tertiary hospital study. Clinics (Sao Paulo) 2009;64(10):947-952.
  3. Kumar R, Dabas P, Mehra M, et al. Ocular morbidity amongst primary school children in Delhi. Health and Population Perspectives Issues 2007;30(3):222?229.
  4. Chakraborti C, Mondal M, Choudhury KP, et al. Clinical profile of paediatric ocular morbidity in a tertiary eye care centre in West Bengal. 2011:1-4.
  5. Sethi S, Sethi MJ, Iqbal R, et al. Pattern of common eye diseases in children attending outpatient eye department, Khyber Teaching hospital, Peshawar. J Med Sci 2008;16(2):99-101.
  6. Desai S, Desai R, Desai NC, et al. School eye health appraisal. Indian J Ophthalmol 1989;37(4):173?175.
  7. Nirmalan PK, Vijayalakshmi P, Sheeladevi S, et al. The Kariapatti pediatric eye evaluation project: Baseline ophthalmic data of children aged 15 years or younger in Southern India. Am J Ophthalmol 2003;136(4):703?709.
  8. Gupta M, Gupta BP, Chauhan A, et al. Ocular morbidity prevalence among school children in Shimla, Himachal, North India. Indian J Ophthalmol 2009;57(2):133?138.
  9. Pratab VB, Lal HB. Pattern of paediatric ocular problem in North India. Indian J Ophthalmol 1989;37(4):171-172.
  10. Khurana AK, Sikka KL, Parmar IP, et al. Ocular morbidity among school children in Rohtak city. Indian J Public Health 1984;28(4):217-220.
  11. Kanski JJ, Bowling B. Clinical ophthalmology: a systematic approach: expert consult. 7th Saunders 2011: p. 97.
  12. Kanski JJ, Bowling B. Clinical ophthalmology: a systematic approach: expert consult. 7th Saunders 2011: p. 98.
  13. Neumann E, Gutmann MJ, Blumenkrantz N, et al. A review of 400 cases of vernal conjunctivitis. Am J Ophthalmol 1959;47(2):166-172.
  14. Khan MD, Kundi N, Saeed N, et al. Incidence of keratoconus in spring catarrh. Br J Ophthalmol 1988;72(1):41-43.
  15. Biswas J, Saha I, Das D, et al. Ocular morbidity among children at a tertiary eye care hospital in Kolkata, West Bengal. Indian J Public Health 2012;56(4):293-296.
  16. Rapoport I, Romem M, Kinek M, et al. Eye injuries in children in Israel. A nationwide collaborative study. Arch Ophthalmol 1990;108(3):376-379.
  17. Singh V, Malik KPS, Malik VK, et al. Prevalence of ocular morbidity in school going children in West Uttar Pradesh. Indian J Ophthalmol 2017;65(6):500-508.
  18. Prajapati P, Oza J, Prajapati J, et al. Prevalence of ocular morbidity among school adolescents of Gandhinagar district, Gujarat. Online J Health Allied Sci 2010;9(4):5.
  19. Gupta PN, Gupta V. Ocular morbidities in pediatric outpatient population at a tertiary care ophthalmic centre: a descriptive study. Int J Contemp Pediatr 2018;5(4):1195-1198.
  20. Shakya SR, Bhandary S, Pokharel PK. Nutritional status and morbidity pattern among governmental primary school children in Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2004;2(4):307-314.