Prevalence and factors associated with hyphaema in mulago hospital.
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INTRODUCTION/ BACKGROUND: Hyphaema is the presence of red blood cells in the anterior chamber of the eye. Hypahema is most often encountered in children. The available reports in the United States of America indicate a prevalence of 70% or greater in the paediatric population. The visual impairment that could result from this therefore causes a big burden to the more productive younger years of life hence a potentially serious adverse socio-economic impact on the society. The literature on the topic of hyphaema from Africa in general is sparse. In Uganda, one study in mulago hospital, kampala was described during 1977-1980 and showed that hyphaema constituted 10.6% of total admissions to the eye ward. It was also noted that the age group 21-30 years were the most affected. There is no published study on the prevalence and factors associated with hyphaema in Uganda since then. OBJECTIVES: To establish the prevalence and factors associated with hyphaema in mulago hospital. STUDY DESIGN: It was a cross sectional study STUDY SETTING: Ophthalmology department, mulago hospital METHODS: Patients attending the eye clinics and the emergency ward in mulago hospital were screened for hyphaema and those who fulfilled the inclusion criteria were recruited by consecutive enrolment till the sample size was obtained. The study variables included, age, sex, cause of spontaneous hyphaema, type of trauma, time interval between injury and presentation, intraocular pressure, grade of hyphaema, visual acuity at admission and at 6 weeks of follow up. The patient treatment was based on the recommendation in Duane’s clinical ophthalmology. This included bed rest, sedation of children and anxious adult patients with diazepam tablets, steroid (Dexamethasone) eye drops, 1% atropine eye drops and for pressures above 22mm Hg, acetazolamide, 20mg/kg/day, administered in 4 devided dozes and 0.5% timolol eye drops 12 hourly. Surgical washout was done in case of, corneal blood staining, sickle cell trait or sickle cell disease with intraocular pressures (IOPs) of greater than 24 mm Hg for more than 24 hours and total hypahema present for 6 days with IOPs of 25mm Hg or more. STATISTICAL ANALYSIS: The data obtained were recorded on a pre-coded questionnaire, analyzed using SPSS 15.0 and EPIDATA 3.0. RESULTS: Of the 17, 179 patients examined and treated in the eye department, mulago hospital during the study period, 37 had hyphaema giving a prevalence of 0.22%. Hyphaema occurred more often in males than in females (F:M= 1:2.1) and trauma was the main cause of hyphaema (89%). The single most common cause of traumatic hyphaema in children was injury by sticks while at play. The majority of cases of hyphaema occurred in individuals less than 30 years of age (89%). The factors affecting the visual outcome included the duration of hyphaema and amount of blood in the anterior chamber (grade of hyphaema). RECOMMENDATIONS: 1) There is need to prevent eye injuries and hyphaema where there is s possibility of exerting control like in children while at play and in adults at work by use of protective gears. 2) There is need to study the effect of early surgical intervention on the outcome of hyphaema. Early surgical washout of hyphaema will reduce the duration of hyphaema and associated complications. 3) All patients with hyphaema should have ultrasound scan done to rule out other intraocular injuries.