E. Epée

[Epidemiological, clinical and therapeutic features of pediatric ocular injuries in an eye emergency unit in Île-de-France].

INTRODUCTION Ocular and orbital trauma is a leading cause of acquired monocular blindness in childhood. These injuries differ from those in adults in some aspects of the management and prognosis, notably the risk of amblyopia. The goal of this study was to analyze the epidemiological, clinical and therapeutic features of ocular trauma in children who consulted in an eye emergency department in Île-de-France. PATIENTS AND METHODS This was a descriptive, prospective and longitudinal study. Over a period of 6 months, we included children aged 15 years old or less, who consulted during calls for ocular trauma. Each child received an ophthalmologic examination as complete as his or her condition and cooperation permitted. Mechanical injuries of the eyeball and chemical ocular burns were distributed respectively according to the Birmingham Eye Trauma Terminology and Duas classification. The visual prognosis was defined as the best corrected visual acuity of the affected eye, measured at the conclusion of treatment. RESULTS Among 586 children who consulted during the study period, 265 suffered from ocular trauma (45.22%). The male:female ratio was 1.6:1. The main places of occurrence of the injuries were home (64.15%) and school (18.11%). Injuries from finger nail scratch were the most frequent (12.45%). One hundred and fifty-seven patients consulted within 6 hours (59.19%). The cornea was the predominant site of the injury (44.40%). Mechanical injuries of the eyeball accounted for 75% of cases. The incidence of ocular chemical burns was 6.41%. Eyelid and orbital injuries were observed in 22.26% and 2.26% of cases respectively. Surgical treatment was required in 6.79% of cases. The incidence of hospitalization was 3.02% with a mean length of stay of 3 days. Four children developed sequelae, including 2 corneal scars and 2 cataracts. No case of blindness was recorded. DISCUSSION The high frequency of traumatic ocular and orbital pathology in our study may be due to its sudden and accidental onset, leading parents to seek emergency care. Most injuries occurred at home and at school, which reflects the presence in these places of potential hazards, often unrealized or neglected. The low frequency of open-globe injury may be related to the ubiquitous recruitment. Indeed, in studies including only severe trauma, this rate may reach 73.4%. This clinical presentation is associated with a poor prognosis because of the risk of infection and sequelae causing decreased visual acuity and amblyopia. Few children were hospitalized. This could be explained by the predominance of mild to moderate trauma. CONCLUSION Ocular trauma accounts for nearly half of pediatric conditions encountered in the eye emergency unit. Adequate emergency care improves the visual prognosis.

La limboconjonctivite endémique des tropiques au nord Cameroun

INTRODUCTION A retrospective study was conducted in the ophthalmology unit of the Garoua regional hospital on children examined from January 2001 to December 2007. We aimed to determine the epidemiological aspects of tropical endemic limboconjunctivitis in northern Cameroon. Included were all the files of patients aged 0-15 years seen with a positive diagnosis of tropical endemic limboconjunctivitis. The data analyzed were obtained through inspection, interview, and a comprehensive ocular exam done for every case, assessing far visual acuity, slit lamp biomicroscopy, and funduscopy when possible. The variables analyzed were age, sex, signs and symptoms, residential area, associated pathologies, and the month and the year of the diagnosis. The data were analyzed with Epi-Info, version 6.04d (French) and the results compared with the Chi(2) test with a 95% confidence interval. RESULTS A total of 6453 children were included: 2036 had a positive diagnosis of tropical endemic limboconjunctivitis, with a frequency of 31.55%. The mean age was 6.5 years. The 1- to 4-year-old age group had the highest number of patients, with a frequency of 33.25%. There were 1120 males (55%). Itching was the most frequent complaint encountered in 60.90% of the patients. Ocular involvement was always bilateral. Tropical endemic limboconjunctivitis is an allergic conjunctivitis present throughout the year with two peaks in March and July. DISCUSSION Tropical endemic limboconjunctivitis can be considered an allergic conjunctivitis affecting boys more frequently than girls in warm and dry environments. It is frequent in children less than 5 years old and regresses with age. CONCLUSION Tropical endemic limboconjunctivitis is a tropical disease with an intertropical aspect.

Les traumatismes oculaires en milieu urbain camerounais : à propos de 332 cas évalués selon l’Ocular Trauma Score☆

PURPOSE To determine the epidemiologic and clinical characteristics of ocular trauma after evaluation with the ocular trauma score at the Army Teaching Hospital in Yaoundé, Cameroon. PATIENTS AND METHODS A descriptive and retrospective monocentric hospital study was carried out from January 2008 to December 2010. Our sample included all patients with ocular trauma. Each traumatized eye was evaluated using the ocular trauma score after measurement of visual acuity. The most severe diagnoses observed were classified according to the Birmingham Eye Trauma Terminology system. RESULTS The frequency out of 364 eyes was 3.56%. There were 204 men (61.44%) with a male/female ratio of 1.59. The mean age was 32.95 years with predominance of 21-30 years. The most affected groups were laborers and craftsmen (28.61%), followed closely by students (23.80%), then armed forces personnel (19.58%). Fights were noted as the most common cause in 31.02% of cases. Punches predominated in 21.39% of cases. In 37.34% of cases, patients were seen within 72 hours of the trauma. Three hundred (90.36%) traumas were unilateral vs. 32 (9.64%) bilateral. The mean visual acuity at the first consultation was 0.3 logMAR. Grading after evaluation was as follows, 13 eyes were grade 1, 19 grade 2, 25 grade 3, 54 grade 4 and 253 grade 5. Fragile and exposed anatomical structures were the most commonly injured. Seventeen eyes exhibited elevated IOP (22 to 45) vs. 7 which were hypotonous. Two hundred and one (55.22%) oculo-palpebral contusions were noted, followed by 110 (30.22%) lacerations. Visual loss was reported in 16.20% and blindness in 8.79% of cases. CONCLUSION In the emergent setting, a good, timely clinical evaluation of each case according to the ocular trauma score may lead to effective management.

A familial study of Hallermann–Streiff–François syndrome

Hallermann–Streiff–François syndrome is a rare sporadic genetic pathology characterized by a phenotype consisting of growth retardation, ocular abnormalities, and a “bird-like head”. We hereby report a case of this syndrome found in three generations of the same family – father, daughter, and grand-daughter – who presented with a short stature and facial dysmorphic features, nystagmus, cataract, and bilateral microphthalmia. The discussion is based on the clinical and genetic aspects, and the challenges in management of this oculo-mandibulo-facial syndrome. The association of congenital cataract, facial dysmorphic features, and microphthalmia, should guide the diagnosis of dysmorphic syndromes such as Hallermann–Streiff–François syndrome.

Complications oculaires, à l’exclusion de la rétinopathie diabétique, chez le jeune diabétique de type 1, au Cameroun

Resume Nous avons recherche les pathologies oculaires presentes chez les jeunes patients diabetiques de type 1, hors la retinopathie diabetique, lors d’une etude prospective transversale, menee du 1er janvier au 31 aout 2011 au Centre de prevention et de prise en charge de la retinopathie diabetique de Yaounde (Cameroun). Ont ete retenus tous les patients diabetiques, d’âge ≤ 21 ans, adresses pour realisation d’une angiographie a la fluoresceine dans le cadre de la surveillance retinienne d’un diabete de type 1. Ils beneficiaient ainsi d’un examen ophtalmologique complet et d’une mesure de leur equilibre glycemique. En 8 mois, 41 patients, soit 81 yeux, ont ete examines. Leur âge moyen etait de 15,8 ans, le sex-ratio F/H de 1,4, la duree moyenne du diabete de 2,9 ans, le taux d’HbA1c moyen de 8,6%. Quinze patients (36,8%) presentaient une pathologie oculaire. L’orgelet, la cataracte et les ametropies etaient les pathologies ophtalmologiques les plus frequentes. Un seul cas de retinopathie diabetique proliferante a ete retrouve. Non pathognomonique de l’enfant diabetique en Afrique, les pathologies oculo-palpebrales infectieuses, ici entretenues par le desequilibre glycemique, sont multiples et variees. La gravite est fonction de la duree et, surtout, de l’equilibre glycemique, difficile a maintenir par l’enfant. La prevention de ces pathologies passerait donc par une sensibilisation accrue a la systematisation du dosage trimestriel de l’HbA1c des enfants diabetiques par les soignants, une implication des deux parents, et une bonne hygiene individuelle et environnementale des soignes, afin de preserver leur avenir visuel.