|Year : 2015 | Volume
| Issue : 2 | Page : 101-104
Pattern of red eye in a Tertiary Eye Clinic in Nigeria
Kehinde Fasasi Monsudi1, Ifeanyi Richard Azonobi2, Abdulkabir Ayansiji Ayanniyi3
1 Department of Ophthalmology, Federal Medical Centre, Birnin Kebbi, Nigeria
2 Department of Ophthalmology, Niger Delta University Teaching Hospital, Okolobiri, Nigeria
3 Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
|Date of Web Publication||21-Nov-2015|
Kehinde Fasasi Monsudi
Department of Ophthalmology, Federal Medical Centre, PMB 1126, Birnin Kebbi, Kebbi State
Source of Support: None, Conflict of Interest: None
Introduction: Red eye is one of the most common reasons why patients present at the eye clinic. It may be due to a nonvision-threatening ocular condition or vision-threatening one. It may also be a symptom of a life-threatening condition, and improper diagnosis and appropriate management may result in ocular morbidity or mortality. Materials and Methods: A retrospective study was carried out on patients who presented to the eye clinic of the Federal Medical Centre, Birnin Kebbi with complaints and features of the red eye. Patients who presented with red eyes from January 1, 2011 to December 31, 2013 were reviewed. The information retrieved from the patients' records ranged from sociodemographic to causes of red eye. The data were analyzed using the Statistical Package for the Social Sciences version 18. Results: Totally, 2623 patients presented on account of red eye during the 3 years study period. There were 1425 (54.3%) males and 1198 (45.7%) females. The majority of the patients were children age group 0-15 years (39.6%) followed by age group 16-31 years (32.8%). The major causes of red eye in our study were due to ocular allergy 1288 (49.1%), microbial conjunctivitis 293 (11.2%), and ocular trauma 286 (10.9%). Conclusion: Ocular allergy accounts for almost half of cases of red eye seen in this population and majority of cases of red eye were found in children. Priority attention should, therefore, be given to ocular allergy to mitigate school absenteeism that may result from red eye.
Keywords: Blindness, conjunctivitis, knowledge, ocular allergy, red eye
|How to cite this article:|
Monsudi KF, Azonobi IR, Ayanniyi AA. Pattern of red eye in a Tertiary Eye Clinic in Nigeria. Afr J Med Health Sci 2015;14:101-4
|How to cite this URL:|
Monsudi KF, Azonobi IR, Ayanniyi AA. Pattern of red eye in a Tertiary Eye Clinic in Nigeria. Afr J Med Health Sci [serial online] 2015 [cited 2021 Mar 8];14:101-4. Available from: http://www.ajmhs.org/text.asp?2015/14/2/101/170170
| Introduction|| |
Red eye is a frequent cause of presentation to eye clinics and general out-patient clinics. , It is a cardinal sign of ocular inflammation caused by dilatation/engorgement of ocular blood vessels. Red eye represents a broad spectrum of disease entities which ranges from some self-limiting conditions, e.g., ocular allergy, inflamed pterygium, and episcleritis to potentially sight and even life-threatening conditions such as orbital cellulitis, uveal tumor, and endophthalmitis. ,, Numerous conditions may be associated with red eye including conjunctivitis (microbial or allergic), keratitis, episcleritis, scleritis, trauma, canaliculitis, dacryocystitis, and dry eye syndrome.  However, most cases of red eye seen in general ophthalmic practice are likely to be conjunctivitis or a superficial cornea injury.  Less commonly, red eye can be caused by angle closure glaucoma, orbital inflammations, panophthalmitis, and rarely acne rosacea. 
The prevalence and causes of red eye differ from one location to another.  Even in the same population, its prevalence and causes differ among various ages and professional groups.  Knowledge of the causes of red eye in a particular location is of immense help to the general and ophthalmic practitioners as it may help in the prioritization of treatment and allocation of resources.
This study was undertaken to determine the pattern and causes of red eye among patients attending the eye clinic in Federal Medical Centre, Birnin Kebbi, Nigeria to create awareness among health care professionals.
| Materials and Methods|| |
This was a retrospective 3-year study conducted from January 1, 2011 to December 31, 2013. It involved all the patients who presented to the emergency unit or directly to Eye Clinic of Federal Medical Centre, Birnin Kebbi, Kebbi State on account of red eye. The medical records of the patients were retrieved through the medical record unit using the new patient's hospital's log book in the accident and emergency unit and the eye clinic of the hospital. The information extracted from the patients' records includes social demographics data like age, sex, occupation, and tribe. Others were laterality and causes of red eye. Record files with incomplete information were excluded. For this study, underage is defined as any child under 5 years of age. Our hospital is the only tertiary hospital in the state with a 400 bedded capacity catering for the population of about 3.2 million persons from the state and others from surrounding states (Zamfara, Sokoto, and Niger) and nearby countries (Niger and Benin Republics). The data were double-entered and analyzed by Statistical Package for the Social Sciences (SPSS version 18.0 Software Statistical Package (2006 SPSS, Chicago, Illinois, USA). The analysis was done using simple frequency proportions and Chi-square test for significance. P < 0.05 were considered statistically significant.
The ethical clearance for the study was obtained from the Ethics and Research Committee of Federal Medical Centre, Birnin Kebbi.
| Results|| |
Totally, 4550 patients presented to the eye clinic during the study period, out of which 2623 (57.6%) presented because of red eye. There were 1425 (54.3%) males and 1198 (45.7%) females with M:F of 1:1.2 and with a mean age of 23.1 ± 5.86 years. The majority of the patients were children within the age group 0-15 years (39.6%) followed by the age group 16-31 years (32.8%) [Table 1].
The occupational distribution of patients is shown in [Table 2] with the preschool children and students being most affected.
The most common causes of red eye were ocular allergy (49.1%), microbial conjunctivitis (11.2%) and ocular trauma (10.9%) [Table 3]. The red eye involved both eyes in 1581 (60.3%) of the patients, and 2629 (10%) of the patients were admitted for treatments. There was a significant relationship between occupation and causes of red eye (P < 0.0001) and between causes of red eye and gender (P < 0.0001).
| Discussion|| |
Ocular allergy was responsible for the majority of causes of red eye in this study (49.1%). This is similar to 40% documented in a previous study in Kano, Northern Nigeria,  and Lagos  (21.3%) Western Nigeria. However, our result differs from those of researchers in Ibadan  and Oshogbo  both in Western Nigeria where conjunctivitis and ocular trauma were the most common causes of red eye responsible for 32.9% and 41.0%, respectively. The preponderance of ocular allergy in our study may be due to dusty environment. However, further studies may be needed to establish any relationship.
Microbial conjunctivitis (13.5%) was the second most common cause of red eye in this study similar to the findings (17%) by Lawan in Kano.  However, in Zaira, Northern Nigeria,  it was the most common cause of red eye-associated diseases found in the study. Although the frequency of occurrence of infective conjunctivitis differs from place to place, in general, it is a common cause of ophthalmic consultation. 
Ocular trauma is a common cause of red eye. In this study, it is the third most common cause of red eye (10.9%). In Oshogbo,  ocular trauma was the most common cause of red eye (41.0%). In this study, majority of cases of ocular trauma occurred in males (68.4%) similar to the findings of Chiapella et al.  and that of Khatry et al. in Nepal.  Ocular trauma is said to be influenced by occupation.  This may explain why ocular trauma, as found in this study, was more common in males compared to females as a result of their involvement in more hazardous occupations.
In this study, keratitis (microbial and non-microbial) was a cause of red eye in 7% of cases seen over the period. In Kano,  microbial keratitis was responsible for 17% of cases of red eyes while nonmicrobial keratitis was responsible for 11% of cases. The difference in this study may be due to overcrowding currently in Kano, which puts pressure on social amenities like pipe borne water, waste disposal, etc., which results in the spread of eye infection.  Although keratitis was a relatively uncommon cause of red eye in our center, cases of keratitis should be given utmost attention in view of its potential for visual loss. 
Pterygium and pingueculum sometimes get inflamed and causes redness of the eyes.  In this study, inflamed pterygium and pingueculum were responsible for 6.3% and 1.2% cases of red eye, respectively. In Kano,  inflamed pterygium was a cause of red eye in 11% of cases. Pterygium and pingueculum occur more commonly in dusty hot climates.  These fibrovascular growths may affect the patient's quality of life and consequent visual loss if neglected.  Early identification and prompt treatment will improve the quality of life and reduce economic loss.
Not uncommonly, uveitis is one of the causes of eye diseases seen in most eye clinics. , It may present with redness of the eyes. Uveitis was responsible for 5.3% of cases of red eye in this study. Uveitis presenting with redness of the eyes could be misdiagnosed with microbial keratitis among nonprofessionals due to some symptoms which are similar. Juxtaposing the treatment of one for the other would result in treatment failure, complications, and blindness. This could occur if steroid which is beneficial in the treatment of uveitis is utilized in some forms of keratitis causing harm and worsening the disease process. Therefore, any case of red eye with recordable diminished acuity should be critically evaluated.
Episcleritis and scleritis are recurrent causes of red eye. It is a rare cause of presentation to eye clinic in Nigeria.  Episcleritis/scleritis were responsible for 1.8% of red eyes in this study. Episcleritis and scleritis are known to exhibit some racial variation which may explain its low incidence as a cause of redness in this study.  Episcleritis and scleritis are the second most common ocular presentation of rheumatoid arthritis.  Although the incidence of rheumatoid arthritis and other connective tissue diseases is not known in this population, its incidence is believed to be low among Africans.  This may explain the low incidence of the red eye due to episcleritis and scleritis in this study.
Ocular foreign body is also a common cause of red eye especially among technical factory workers compared to non-technical workers. , In this study, the ocular foreign body was responsible for 1.7% of red eyes. Birnin Kebbi, the area of this study, is an agrarian and warm dusty environment. Most of these cases of foreign body may be related to farming and other outdoor activities. Use of protective eye goggles outdoors and during work may reduce the incidence of the ocular foreign body in this locality.
Endophthalmitis is a vision-threatening ocular infection caused by exogenous and endogenous bacterial and fungal organisms.  It is responsible for 1.2% of red eye cases in this study. Although, endophthalmitis can occur after ocular surgery, most cases are post traumatic with a reported  incidence of between 0% and 16.5%. The cases of endophthalmitis found in this study were not related to ocular surgery. In view of its profound effect on vision and ocular health, great attention should be paid to every case of red eye especially with associated visual loss in order to ensure prompt diagnosis and aggressive treatment as its overall prognosis may depend on this.
One percent of cases of red eye in this study were due to orbital cellulitis. Orbital cellulitis has a great potential for visual loss and may be life-threatening.  Orbital cellulitis may be confused with preseptal cellulitis especially in the early stage. Hence, careful examination, appropriate clinical and radiological workup is essential to ensure a correct diagnosis is made, and appropriate treatment instituted.
Chemical eye injury, ocular tumor, angle closure glaucoma, and thyroid eye disease were altogether responsible for 1% of red eye in this study. They can constitute a major threat to vision if are misdiagnosed. Meticulous eye examination and appropriate clinical care should, therefore, be offered to these patients.
| Conclusion|| |
Ocular allergy accounts for almost half of cases of red eye seen in this population and majority of the cases of red eye were found in children. Priority attention should, therefore, be given to ocular allergy to mitigate school absenteeism that may result from red eye.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]