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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2021  |  Volume : 18  |  Issue : 4  |  Page : 198-202

Eye-related complaints presenting to the accident and emergency department in a Nigerian tertiary hospital


Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Submission05-Apr-2021
Date of Acceptance29-Sep-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. Dumebi Hedwig Kayoma
Department of Ophthalmology, University of Benin Teaching Hospital, Benin City
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_13_21

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  Abstract 


Background: In resource-limited countries, it is important that only genuine ophthalmic emergencies should be seen in the Accident and Emergency department to reduce the pressure on the limited human and material resources. The aim of the study is to determine the pattern of eye-related emergencies who presented to the Accident and Emergency department in a Nigerian Tertiary Hospital. Methods: This was a retrospective chart review of all consecutive ophthalmic patients who presented at the general Accident and Emergency department of the University of Benin Teaching Hospital between July 2018 and December 2020. Patients who discharged themselves against medical advice were not included in the study. Results: A total of 363 presented with ophthalmic complaints, and their mean age was 32.6 ± 20.2 years. Most of the cases presented as emergencies (61.4%) with more than half (32.8%) requiring ocular surgery. Eyelid laceration was the leading cause of presentation (12.4%). Emergency cases were more likely to present during the weekend (71.5%). Males were 5.1% less likely to present as emergencies. Conclusion: Most of the cases were emergencies with eyelid laceration and penetrating eye injuries being the leading cause. Although the number of nonemergencies was less, the need for the inclusion of primary eye care in the existing primary healthcare centers will further reduce the number of non-emergency cases seen.

Keywords: Accident and emergency, eye-related complaints, Nigeria, ocular emergencies


How to cite this article:
Kayoma DH, Ukponmwan CU, Ese-Onakewhor JN. Eye-related complaints presenting to the accident and emergency department in a Nigerian tertiary hospital. J Clin Sci 2021;18:198-202

How to cite this URL:
Kayoma DH, Ukponmwan CU, Ese-Onakewhor JN. Eye-related complaints presenting to the accident and emergency department in a Nigerian tertiary hospital. J Clin Sci [serial online] 2021 [cited 2022 May 28];18:198-202. Available from: https://www.jcsjournal.org/text.asp?2021/18/4/198/332067




  Introduction Top


The emergency departments in tertiary centers are usually faced by both urgent and nonurgent ophthalmic cases, and ocular complaints constitute about 1%–6% of the overall emergency department visits.[1],[2],[3]

Ophthalmic complaint may be a pointer to immediate visual threats, which if left unaddressed, can lead to significant visual impairment or blindness.[4] As a result, patients often visit the Accident and Emergency Department (A and E) to seek care and allay possible fears. While the A and E can provide immediate care for these ocular complaints, an excessive number of nonemergent eye-related visits may limit the resources available for real ophthalmic emergencies and other medical issues in these settings. In a report from the United States of America, approximately half of all ocular emergency department visits were not related to emergent conditions.[1] Furthermore, in the United Kingdom, studies have shown that 50%–70% of visit to the A and E were nonurgent.[5],[6] This is of importance in resource-limited country like Nigeria to optimize both human and non-human healthcare resources. Hence, this study aims to retrospectively determine the pattern of eye-related complaints presenting to the University of Benin Teaching Hospital, Benin-City. This will allow for the formulation of strategies to effectively reduce the magnitude of visual loss from ophthalmic conditions injury as well as assist policymakers in appropriate allocation of resources.


  Methods Top


This was a retrospective review performed among subjects that presented with ocular complaints to the Accident and Emergency department of the University of Benin Teaching Hospital between July 2018 and December 2020. Patients who discharged themselves against medical advice were excluded from the study. Ethical approval for this study was obtained from the Ethics and Research Committee of the University of Benin Teaching Hospital with protocol number ADM/E 22/A/VOL. VII/14831013. A comprehensive chart review of medical records during the years under review was performed. Information regarding demographics, day of the week of presentation (weekdays was taken as Monday to Friday, while weekend was defined as Friday after work hours to Sunday), diagnoses and treatment outcomes which were categorized as follow-up in A and E, discharged from A and E, admitted into the ophthalmic ward or had ocular surgery was obtained. Patients who discharged themselves against medical advice were excluded from the study. The data were entered, cleaned, and statistical analysis was done using the IBM Statistical Package for Social Sciences Statistics for Windows, Version 21.0 Armonk, NY: IBM Corp. Frequencies, mean, and median were generated to observe patterns of variable distribution among respondents. Test for association was carried out using Pearson's Chi-square and Fischer's exact test. Multivariate analyses were carried out to determine predictors of ophthalmic presentation outcomes. The analyses were considered statistically significant when the P < 0.05.


  Results Top


A total of 363 patients presented to the Accident and Emergency room during the study. These comprised of patients who presented primarily with ophthalmic complaints and those who had associated ophthalmic complaints. Approximately a quarter of the patients (24%) were aged between 21 and 30 years. Patients aged 81–90 years 2 (0.6%) made up the least proportion of those presenting within the period under study. The mean age of patients seen was 32.6 ± 20.2 years. Of the patients who presented at the A and E, 240 (66.1%) were males while 123 (33.9%) were females, with 233 (64.2%) presenting during weekdays and 130 (35.8%) presenting during a weekend.

There were 223 (61.4%) who presented as an ocular emergency with slightly less than one-third of all the patients (emergencies and nonemergencies) requiring ocular surgery. A total of 93 (25.6%) patients were admitted to the ophthalmic ward, as shown in [Table 1].
Table 1: Sociodemographic characteristics of respondents and outcome of presentation (n=363)

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[Table 2] shows that the greater proportion of emergency cases presented were trauma related, as seen in 145 (65.0%) of the cases. The nonemergencies seen were majorly bacteria conjunctivitis 27 (7.4%) and subconjunctival hemorrhage 25 (6.9%).
Table 2: Distribution of diagnoses (n=363)

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In [Table 3], all patients 2 (100%) who presented between the ages of 81–90 were emergencies. However, it shows a relatively decreasing trend in the proportion of patients who presented as emergencies, with increasing age. This association was found to be statistically significant (P = 0.018). Males 165 (68.8%) were more likely to present as emergencies compared to females 58 (47.2%). This was also statistically significant with a P < 0.001.
Table 3: Sociodemographics and mode of presentation

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Emergency cases were significantly more likely to present during a weekend 93 (71.5%), as against during a weekday where 130 (55.8%) of presentations were emergencies (P = 0.003). [Table 4] shows that the variables in the logistic regression model accounted for between 8.2% and 11.2% of the variations observed in the outcome variable (Mode of Presentation). A year increase in age increased the likelihood of patients presenting as an emergency by an odds ratio of 1.013. This was statistically significant (P = 0.018).
Table 4: Logistic regression model for the determinants of mode of presentation

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Males were 5.1% less likely to present as emergencies compared to females. This association was statistically significant (P < 0.001). Patients who presented during weekdays were 2.116 times more likely to be emergencies compared to weekend presentations. This relationship was statistically significant (P = 0.002).


  Discussion Top


Anxiety levels like those seen in patients with systemic conditions can be replicated by eye conditions. This was found to apply to both emergencies and nonemergencies as the patients themselves find it difficult to identify which conditions are serious by their symptoms and therefore need to seek urgent specialist advice.[7],[8]

The hospital's general A and E operates a 24 h walk-in policy and a total of 363 ophthalmic patients were seen within the study period. Approximately one-quarter of the patients were between the ages of 21–30 years. This age group comprises of undergraduates and young graduates who engage in a more outdoor activities and they are also the early-career workers in non-skilled, semi-skilled, and the skilled workforce. Ocular trauma (44.9%) was the leading cause of presentation, this was similar to a study done in a Korean hospital.[9] Males were 61.1% which is not unusual as they have greater risk-taking behavior at an early age and frequent social activity.[9],[10]

Patients who required ocular surgeries made up of approximately one-third of the total number of presentation (32.8%). Eye injuries frequently require surgical interventions to restore the anatomical and physiological function of the eye when possible. In Pakistan[11] and Singapore,[12] open globe injury accounted for a substantial proportion of the presentation in the emergency room. This was quite different in the study by Galindo-Ferreiro et al.[13] were 85.5% of their patients were discharged home same day because most of the patients seen presented with ocular surface diseases.

In the present study, over 60% of patients who presented in the general A and E were real ophthalmic emergencies. This finding is similar to the observations of Kang et al.[14] where 74.7% of cases were found to be true ophthalmic emergency conditions. This is the case in our center because most of the cases were trauma-related, and primary health care centers are not equipped to manage ophthalmic conditions. Although studies done in the United Kingdom and Dublin[5],[6],[15] showed the opposite results, this is likely since these studies were done in dedicated ophthalmic emergency departments.

Ocular injuries were the leading cause of the emergency cases with eyelid laceration 12.4%, penetrating injury 9.9%, and globe rupture 7.4%. Channa et al.[1] in their study found that 36.3% of all ophthalmic visits to the emergency department were ocular injuries while bacterial conjunctivitis (7.4%) was the most common nonemergency condition in the United States. A study done in Central Spain[12] also had conjunctivitis (14.8%) as the most common clinical disorder presenting to the emergency department.

The emergency cases were mainly from the age of <10–60 years. This wide age range comprises of the workforce, young school leavers, and preschool and school children. Work-related injuries, physical activities, contact sports, fights, and unsupervised plays among children may be some of the reasons for this trend. This association was statistically significant.

Majority (71.5%) of the ocular emergencies presented during the weekend. This is most likely because most people are usually not at work during the weekend and so attend to their personal needs such as social, religious, and healthcare. Furthermore, the ophthalmology clinic operates a walk-in policy during weekdays, and so emergency cases are attended to in the clinic. The association was statistically significant.

The logistic regression model for the determinants of mode presentation showed that a year increase in age increased the chances of patients presenting as an emergency. This can be attributed to the fact that, with increasing age, the patient is more educated, knowledgeable, financially independent, and can take decisions. Males (5.1%) were less likely to present as emergencies compared to females, although overall more males presented to the general A and E. This is so because males are usually the decision-makers in their homes and have the finances to seek health care when they decide to. The females, on the other hand, may seek for permission in our environment before visiting the hospital.

The apparent change in trend between the findings on bivariate analysis and multivariate analysis for this study is likely due to the elimination of confounding factors in a logistic regression model, leading to a truer representation of the relationship between the dependent and independent variables.


  Conclusion Top


This study shows that majority of the patients who presented at the A and E department of the University of Benin Teaching Hospital were ocular emergencies, with eye injury being the leading cause. The fact that more than two-third of the patients required surgical intervention and/or were admitted to the ophthalmic ward showed that the cases were truly emergent. There is a need for a dedicated ophthalmic suite in the A and E as this will give a better picture of primary ocular emergencies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of eye-related emergency department visits. JAMA Ophthalmol 2016;134:312-9.  Back to cited text no. 1
    
2.
Stagg BC, Shah MM, Talwar N, Padovani-Claudio DA, Woodward MA, Stein JD. Factors affecting visits to the emergency department for urgent and non-urgent ocular conditions. Ophthalmology 2017;124:720-9.  Back to cited text no. 2
    
3.
Nash EA, Margo CE. Patterns of emergency department visits for disorders of the eye and ocular adnexa. Arch Ophthalmol 1998;116:1222-6.  Back to cited text no. 3
    
4.
Alabbasi OM, Al-Barry M, Albasri RF, Khashim HF, Aloufi MM, Abdulaal MF, et al. Patterns of ophthalmic emergencies presenting to a referral hospital in Medina city, Saudi Arabia. Saudi J Ophthalmol 2017;31:243-6.  Back to cited text no. 4
    
5.
Fenton S, Jackson E, Fenton M. An audit of the ophthalmic division of the accident and emergency department of the royal victoria eye and ear hospital, Dublin. Ir Med J 2001;94:265-6.  Back to cited text no. 5
    
6.
Hau S, Ioannidis A, Masaoutis P, Verma S. Patterns of ophthalmological complaints presenting to a dedicated ophthalmic accident and emergency department: Inappropriate use and patients' perspective. Emerg Med J 2008;25:740-4.  Back to cited text no. 6
    
7.
Clarke A, Rumsey N, Collin JR, Wyn-Williams M. Psychosocial distress associated with disfiguring eye conditions. Eye (Lond) 2003;17:35-40.  Back to cited text no. 7
    
8.
Williams RA, Brody BL, Thomas RG, Kaplan RM, Brown SI. The psychosocial impact of macular degeneration. Arch Ophthalmol 1998;116:514-20.  Back to cited text no. 8
    
9.
Oum BS, Lee JS, Han YS. Clinical features of ocular trauma in emergency department. Korean J Ophthalmol 2004;18:70-6.  Back to cited text no. 9
    
10.
Jafari AK, Bozorgui S, Shahverdi N, Ameri A, Akbari MR, Salmasian H. Different causes of referral to ophthalmology emergency room. J Emerg Trauma Shock 2012;5:16-22.  Back to cited text no. 10
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11.
Baig R, Ahmad K, Zafar S, Khan NU, Ashfaq A. Frequency of ocular emergencies in a tertiary care setting in Karachi, Pakistan – It is time to reduce unnecessary visits. J Pak Med Assoc 2018;68:1493-5.  Back to cited text no. 11
    
12.
Voon LW, See J, Wong TY. The epidemiology of ocular trauma in Singapore: Perspective from the emergency service of a large tertiary hospital. Eye (Lond) 2001;15:75-81.  Back to cited text no. 12
    
13.
Galindo-Ferreiro A, Sanchez-Tocino H, Varela-Conde Y, Diez-Montero C, Belani-Raju M, Garcia - Sanz R et al. Ocular emergencies presenting to an emergency department in Central Spain from 2013 to 2018. Eur J Ophthalmol 2021;31:748-53.  Back to cited text no. 13
    
14.
Kang EY, Tai WC, Lin JY, Huang CJ, Yeh PH, Wu WC, et al. Eye-related emergency department visits with ophthalmology consultation in Taiwan: Visual acuity as an indicator of ocular emergency. Sci Rep 2020;10:982.  Back to cited text no. 14
    
15.
Smith HB, Daniel CS, Verma S. Eye casualty services in London. Eye (Lond) 2013;27:320-8.  Back to cited text no. 15
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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