Non-trachomatous corneal opacities in the Gambia--aetiology and visual burden.
OBJECTIVE
National blindness surveys conducted in the Gambia in 1986 and 1996 showed an increase in blindness and visual impairment from non-trachomatous opacity. This study aimed to investigate the aetiology of these opacities and to assess the resulting visual burden.


METHODS
A population-based, randomised blindness survey was conducted in the Gambia in 1996. Patients with visual impairment or blindness were examined by an ophthalmologist with a slit lamp. Causes of corneal opacity were determined as accurately as possible by clinical history and examination.


RESULTS
A total of 154 patients with non trachomatous corneal opacity were examined of whom 39 had bilateral opacities and 115, unilateral. Causes included corneal infection, measles/vitamin A deficiency, harmful traditional practices and trauma (unilateral scarring). Overall, corneal pathology alone was responsible for bilateral visual impairment or blindness in 19 (12%) patients and unilateral visual impairment or blindness in 88 (57%) patients. Those patients with bilateral visual impairment or blindness (mean age 59, SD) were older (P= 0.003) than others (mean age 44, SD = 20). The use of harmful traditional eye practices was associated with bilateral corneal blindness or visual impairment (RR = 2.63, 95% CI 1.11-6.21, P = 0.04). Although none of the corneal scars reported here were attributed to trachoma, in patients over the age of 45, the prevalence of trachomatous conjunctival scarring in this group was 38.8% compared to 19.4% of the whole nationwide sample.


CONCLUSIONS
Strategies for the prevention (including the quest for cheaper anti-microbial drugs and co-operation with traditional healers) and surgical treatment of these corneal opacities are discussed.
Bowman
R J C
RJ
International Centre for Eye Health London, UK. richardbowman@iceh.freeserve.co.uk
Faal
H
H
Dolin
P
P
Johnson
G J
GJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D065306:Corneal Injuries; D003318:Corneal Opacity / Q000453:epidemiology / Q000209:etiology*; D015817:Eye Infections / Q000150:complications; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014141:Trachoma / Q000150:complications; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*