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Year : 2015 | Volume : 3 | Issue : 1 | Page : 39 - 41  


Original Articles
A Clinical Study of Etiology of Corneal Opacities

Srihari Atti 1, Srinivas Prasad Killani 2, Venkataratnam Peram 2, Sujatha N 3

1Associate professor, 2Assistant Professor, 3Post Graduate. Dept. of Ophthalmology, Osmania Medical College, Sarojini Devi eye Hospital, Hyderabad-500028, Telangana, India.

Abstract:
Background:
Corneal opacities are the common causes of corneal blindness. So, this study is to know the etiology of the corneal opacities.

Objective: This study was to evaluate the etiology of corneal opacities, a common cause of corneal blindness.

Methods: This was a hospital based observational study of100 Patients of corneal opacities, who attended the outpatient department of Cornea, Sarojini Devi Eye Hospital, Osmania Medical College, Hyderabadover a period of 2yrs from August 2012 to August 2014. The patients were evaluated with a detailed history and comprehensive ophthalmic examination by slit lamp, Goldman applanation / Non Contact Tonometer, Indirect Ophthalmoscopy and B scan mainly to know the etiology of the corneal opacities. The details of age and sex, laterality, literacy, socioeconomic status, occupation and complications were collected. The data was evaluated by simple statistical methods.

Results: This study data analysis of 100 patients of corneal opacities showed that the causes were Trauma in 37 patients (37%), Infections in 33 patients (33%), congenital and developmental in 15 patients (15%) and degenerations and dystrophies in 15 patients (15%). The Age wise distribution was 27 patients (27%) in 0-20yrs, 39 patients (39%) in 20-40yrs, 29 patients (29%) in 40-60yrs and 5 patients (5%) above 60yrs. Laterality showed involvement of right eye in 43 patients (43%), both eyes in 35 patients (35%) and left eye in 22 patients (22%). 67 patients (67%) were males and 33 patients (33%) were females. 67 patients (67%) were from the Rural areas and 33 patients were from urban. 53 patients were  Illiterate and 47 patients (47%) were literate. 53 patients (53%) were in  Agricultural occupation. and 19 patients (19%) had complications like adherent leucoma, Complicated cataract, Secondary Glaucoma and Bullous keratopathy.

Conclusions: The most frequent causes of corneal opacities were, trauma (37%) and infections (33%). Nearly 70% of all the causes of corneal opacities were avoidable. The prevalence of corneal opacities was significantly higher with illiteracy, rural agricultural background, decreasing socioeconomic status and with increasing age. 

Key words: Corneal Opacities, Corneal Blindness, Keratitis

 

Corresponding Author: Dr, Srihari Atti, Dept. of Cornea, Sarojini Devi Eye Hospital, Humayun Nagar, Hyderabad-500028

Email ID: srihariatti@gmail.com 

 

 

Introduction:

Blindness is a major problem which causes physical, social and economical dependence of the blind person on their family and society. According to WHO, an estimated 180 million people worldwide are visually disabled, of whom nearly 45 million are blind(four out of five of them living in the developing countries). [1, 2, and 3] About 80% of blindness is avoidable (treatable or potentially preventable). [1, 2, and 3] In recent years the epidemiology of blindness has changed, shifting away from traditional infectious causes to cataract. Indeed, so much emphasis has been placed on managing the backlog of cataract surgery in many developing countries, that theprogrammes dealing with other causes of blindness have been neglected. [4]

Corneal blindness differs from other causes of blindness especially from Cataract, because it is preventable and curable to a large extent. Corneal blindness due to corneal opacity is a common cause of ocular morbidity in developing countries. The term corneal opacity is used particularly for the loss of transparency of the cornea due to scarring, which can occur in many conditions. There are an estimated 3-4 million persons blind due to corneal opacity. [1, 4] With the declining incidence of Trachoma, Leprosy, Xerophthalmia etc., Ocular trauma and corneal ulceration are significant causes of corneal blindness that are often underreported but may be responsible for 1.3 million new cases of corneal blindness every year. [1, 4] Because of the difficulty of treating corneal blindness once it has occurred, prevention measures are the most cost-effective means of decreasing the global burden of corneal blindness.

The importance of corneal disease as a major cause of blindness in the world today remains second only to cataract, but its epidemiology is complicated and encompasses a wide variety of infectious and inflammatory eye diseases that cause corneal opacities. In addition, the prevalence of corneal blindness varies from country to country and even from one population to another, depending on many factors, such as availability, general standards of eye careand the use of traditional eye medicines. [4] Common causes of corneal opacities are corneal trauma, microbial keratitis, post-surgical, congenital and developmental, degenerations and dystrophies. Most of the causes of corneal opacities are avoidable (treatable or potentially preventable). So, this study is to evaluate the causes of the corneal opacities, thereby to know the magnitude of corneal blindness due to corneal opacities.

Materials and Methods:

This was a hospital based prospective study. The study group included100 Patients of corneal opacities, who attended the Outpatient department of Cornea, Sarojini Devi Eye Hospital, Osmania Medical College, Hyderabad over a period of 2yrs from August 2012 to August 2014.The inclusion criteria were the patients with a complaint of diminished vision with the corneal opacities. The patients of corneal opacities with associated Pterygium, Retinal and Scleral diseases were excluded. The study was approved by the institute ethical committee. The informed consent was taken from all the patients of the study group.

Methodology: A detailed clinical history was obtained with a complete ophthalmic examination for all the patients. Data of patient’s age, sex, occupation, socioeconomic status, literacy, laterality and place of residency (urban/rural) with the presenting complaint were recorded. History of associated ocular or systemic diseases and any prior investigations and treatment were noted. The best corrected visual acuity (VA) by age appropriate charts (converted to Snellen’s equivalent), anterior segment evaluation by slit lamp, and posterior segment examination by indirect ophthalmoscopy and IOP measurement by Goldman Applanation Tonometer / Non Contact Tonometer were done. Ultrasonogaphy (B scan) was done to rule out posterior segment pathology. Patients were screened for diabetes, hypertension and other systemic diseases and were excluded. Patients with Pterygium were also excluded. Patients who developed any complications were noted. The data was collected in terms of causes, age and sex distribution, laterality, literacy, socioeconomic status and urban/ruralstatus. The data was evaluated by simple statistical methods.

 

Results:

A total of 100 patients with the corneal opacities were included in the study.

 

Table 1: Distribution of study subjects as per the etiology of corneal opacity

S.no.

Causes (etiology)

No. of patients

Percentage

1

Post traumatic corneal scars 

37

37

2

Post infectious corneal opacities

33

33

3

Congenital and developmental corneal opacities

15

15

4

Corneal degenerations & dystrophies

15

15

           

Table 2: Epidemiological data of study subjects

S.no.

Data

No.of Patients

Percentage

 

1

Age group Distribution

0 – 20

21- 40

41 – 60

Above 60 yrs

 

27

39

29

5

 

27

39

29

5

 

2

Sex distribution

Males

Females

 

67

33

 

67

33

 

3

Laterality of the eye

Right

Left

Both

 

43

22

35

 

42

22

35

 

4

Literacy rate

Illiterates

literates

 

53

47

 

53

47

 

5

Occupation status

Agriculture

Others

 

53

47

 

53

47

 

6

Rural / Urban status

Rural

Urban

 

67

33

 

67

33

 

Table 3: Distribution of study subjects as per complications     

S.no.

Complications

No. of patients

Percentage

1

Uncomplicated

81

81

2

Complicated

19

19

 

Table 1of Etiology shows the trauma in 37 patients (37%), infections in 33 patients (33%), congenital and developmental in 15 patients (15%), and degenerations and dystrophies in 15 (15%) patients.

Table 2 of Epidemiological data shows as follows. Age distribution shows 27 patients (27%) in 0-20yrs, 39 patients (39%) in 20-40yrs, 29 patients (29%) in 40-60yrs and only 5 patients (5%) above 60 yrs. Sex distribution shows that 67 patients (67%) were males and 33 patients (33%) were females. Laterality of the eye shows the involvement of right eye (RE) in 43 patients (43%), left eye (LE) in 22 patients (22%) and both eyes (BE) in 35 patients (35%). Literacy shows that 53 patients (53%) were illiterates and 47 patients (47%) were literates.Occupation status shows that 53 patients (53%) were with the agriculture background and 47 patients (47%) were others. Urban/Rural status shows that 67 patients (67%) were from rural areas and 33 patients (33%) were from urban.

Table 3 of Complications shows that 81 patients (81%) had no complications and 19 patients (19%) had complications like adherent leucoma, complicated cataract, secondary glaucoma and bullous keratopathy especially in severe trauma and severe infections.

Discussion:

The fact that there are 180 million people in the world today severely visually disabled is a tragic, pathetic situation in both social and economic terms. [1] Blindness and visual impairment have far-reaching implications for society, the more so when it is realized that 80% of visual disability is avoidable. [1, 2, and 3]

Our study data analysis of corneal opacities shows that the causes were mainly Trauma (37%), infections (33%), congenital and developmental (15%), and degenerations and dystrophies (15%). Age-wise distribution shows that 70% of the cases were between 20 – 60yrs, especially 39% in 20-40 yrs. which indicates that there is significant burden of severe visual impairment in productive age group. 67% were males and 33% were females, this difference could be due to more outdoor activities of males as compared to females. 67% cases were from rural areas compared to 33% of urban, which shows lack of availability of good health services including preventable eye care services in rural areas. Laterality shows involvement of right eye in 45%, both eyes in 35% and left eye in 22%. Illiterate were (53%) with an occupation of Agriculture (53%). Complications like Adherent Leucoma, complicated cataract, secondary glaucoma and bullous keratopathy, were seen only in 19% patients.

The study of Dandonaet al, [5] shows that the most frequent causes of corneal opacities, included keratitis during childhood (36.7%), trauma (28.6%), and keratitis during adulthood (17.7%). The study of Wang et al, [6] shows that the leading cause was keratitis in childhood (40.0%), followed by ocular trauma (33.3%) and keratitis in adulthood (20.0%). Core study of Noopur Gupta et al, [7] shows that the Common causes of corneal opacity were pterygium (34.5%), ocular trauma (22.3%) and infectious keratitis (14.9%). Our study data also shows that the commonest causes of corneal opacities were Trauma (37%) and infections (33) and in our study pterygium cases were excluded.

The study of Dandonaet al, [5] shows that the prevalence of corneal blindness was significantly higher with decreasing socioeconomic status and with increasing age. The study of Wang et al, [6] shows that the age and illiteracy were found to be associated with an increased prevalence of corneal blindness. Our study also shows that the prevalence of corneal opacities was significantly higher with increasing age, illiteracy, decreasing socioeconomic status in the rural population with an agricultural background.

The epidemiology of corneal opacities is diverse and highly dependent on the ocular diseases that are endemic in each geographical area. Traditionally, the diseases responsible for an increase in the prevalence of corneal opacities have included trachoma, onchocerciasis, leprosy, ophthalmia neonatorum, and xerophthalmia. These diseases still remain important causes, but the recent success of public health programmes in controlling these, has generated a new interest in other causes of corneal opacities including ocular trauma, corneal ulceration, and complications from the use of traditional eye medicines. Whatever the underlying cause, an eye that is blind from corneal opacities usually remain blind throughout the individual’s life unless surgical intervention is successful.

 

Conclusions:

The most frequent causes of corneal opacities resulting in corneal blindness were trauma (37%), and infections (33%). Nearly 70% of all the causes of corneal opacities were avoidable. The prevalence of corneal opacities was significantly higher with increasing age, illiteracy, decreasing socioeconomic status in the rural population with an agricultural background.

There is a need to mobilize public health resources in the countries worldwide, both in industrialized and developing, to decrease the global burden of visual disability through the initiation of Eye health promotion strategies to raise awareness about the causes and prevention of corneal blindness.

References:

  1. Park. Epidemiology of Chronic Non-Communicable Diseases and conditions- Blindness. In: K. Park, editor. Park’s Textbook of Preventive and Social Medicine, 21st ed. Jabalpur(MP): M/s Banarsidas Bhanot; 2011.p.370-72.
  2. Sihota R, Tandon R. The causes of and Prevention of Blindness. In: Sihota R, Tandon R, editorS. Parsons’ Diseases of the Eye, 20th New Delhi: Elsevier, A Division of Reed Elsevier India private Limited;2007.p.523-24,529
  3. Khurana AK, Khurana AK, Khurana B. Community Ophthalmology. In: Khurana AK, editor. Comprehensive Ophthalmology, 5th New Delhi: New Age International (P) Ltd;2012.p.474-78, and 482-84.
  4. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a Global perspective. Bulletin of the World Health organization 2001;79(3):214-21.
  5. Dandona R, Dandona L. Corneal blindness in a Southern Indian population- need for health Promotion strategies. Br J Ophthalmol. 2003;Feb.87(2):133-41.
  6. Wang HZhang Y, Li Z, Wang TLiu P. Prevalence and causes of corneal blindness. Experiment Ophthalmol.2014 Apr;42(3):249-53.
  7. Gupta N,Vashist P, Tandon R, Gupta SK, Dwivedi S, Mani Prevalence of corneal diseases in the rural Indian population: the Corneal Opacity Rural Epidemiological (CORE) study. Br J Ophthalmol 2015;99(2):147-52.

 

Acknowledgements: Authors  acknowledge  the  immense  help  received  from  the  scholars  whose  articles  are  cited  and    included  in  references  of  this  manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.  

Source of Support: Nil. Conflict of Interest: None. 

 

Cite this article as: Atti S, Killani SP, Peram V, Sujatha N.  A Clinical Study of Etiology of Corneal Opacities. MRIMS J Health Sciences 2015;3(1):39-41. 

 

 

 

 

 

 

 

 

 

 

 





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