Basedowian Orbitopathy Without Thyreotoxicosis : A Case Report from Sikasso Hospital

Basedowian orbitopathy is an autoimmune disease representing the most frequent extra-thyroidal manifestation. Its pathophysiology is imperfectly elucidated and is the result of cross-reactivity between thyroid antigens and orbital tissue. It is most frequently seen in the context of hyperthyroidism (basedow’s disease or Graves’ disease), sometimes hypothyroidism (Hashimoto’s thyroiditis), or euthyroidism. Diagnosis is often straightforward, but management remains difficult. The introduction of simple medical treatment exposes the patient to the risk of recurrence. In Sikasso, there have been few studies of Graves’ disease. The aim of this study was to describe the clinical, therapeutic and evolutionary features of Graves’ disease in Sikasso Hospital. The patient was a 35-year-old woman with no previous history of Graves’ disease and no history of alcohol or tobacco intoxication, consulting for bilateral exophthalmos with moderate pain for 1 year. Endocrine tests were normal (euthyroidism), as was orbital-cerebral MRI, which revealed stage II exophthalmos with no sellar or supra-saltar abnormalities. The main complication was exposure to keratitis. Our patient was treated with corticosteroids. The evolution was favorable under treatment, with no recurrence after one year’s follow-up. Graves’ disease is the most common cause of hyperthyroidism, but this should not obscure the diagnosis of euthyroidism, as demonstrated in this case report. Exophthalmos remains the main ophthalmological clinical manifestation.

Basedowian Orbitopathy Without Thyreotoxicosis : A Case Report from Sikasso Hospital

Basedowian orbitopathy is an autoimmune disease representing the most frequent extra-thyroidal manifestation. Its pathophysiology is imperfectly elucidated and is the result of cross-reactivity between thyroid antigens and orbital tissue. It is most frequently seen in the context of hyperthyroidism (basedow’s disease or Graves’ disease), sometimes hypothyroidism (Hashimoto’s thyroiditis), or euthyroidism. Diagnosis is often straightforward, but management remains difficult. The introduction of simple medical treatment exposes the patient to the risk of recurrence. In Sikasso, there have been few studies of Graves’ disease. The aim of this study was to describe the clinical, therapeutic and evolutionary features of Graves’ disease in Sikasso Hospital. The patient was a 35-year-old woman with no previous history of Graves’ disease and no history of alcohol or tobacco intoxication, consulting for bilateral exophthalmos with moderate pain for 1 year. Endocrine tests were normal (euthyroidism), as was orbital-cerebral MRI, which revealed stage II exophthalmos with no sellar or supra-saltar abnormalities. The main complication was exposure to keratitis. Our patient was treated with corticosteroids. The evolution was favorable under treatment, with no recurrence after one year’s follow-up. Graves’ disease is the most common cause of hyperthyroidism, but this should not obscure the diagnosis of euthyroidism, as demonstrated in this case report. Exophthalmos remains the main ophthalmological clinical manifestation.

Meningioma of the Optical Nerves in a Case at the Hospitalier Center of Saint Denis in Ile de France

Summary: Optic nerve tumors are rare tumors, representing 3% - 5% of intracranial tumors developing mainly along the optic nerve and/or the chiasm. Optic nerve meningiomas are histologically benign tumors whose severity is linked to diagnostic and especially therapeutic difficulties. The Optic nerve meningioma is the second leading cause of optic nerve tumor after glioma. Observation: We report the case of a 49-year-old woman from South Asia, who consults an ophthalmology department for progressive visual loss in her right eye for about a year with her glasses and would like to renew her optical correction. Having no particular medical history apart from left unilateral blindness is known for approximately 15 years. Magnetic Resonance Imaging (IRM) cerebral found a tissue mass with a clear outline and polylobules on the left temporo-peduncular. Through this case, we describe the circumstances of discovery of the disease, the clinical characteristics, as well as our diagnostic approach. Conclusion: In the majority of cases, these are benign tumours, the circumstances of which are discovered in multiple ways. A mostly unilateral and non-improvable loss of visual acuity must attract our attention. Renewing glasses may be the reason for discovering the disease. Today Magnetic Resonance Imaging (IRM) remains an important and capital examination for the diagnosis and monitoring of this pathology.

Corneal Blindness Caused by Accidental Ocular Use of Chlorhexidine (Hexz) Gel in Two Newborn Born in the Health District of Kati in Mali

Introduction: Corneal opacities in children are relatively common. In children, it is urgent because of the risk of irreversible amblyopia. The causes of these blindnesses vary considerably according to the regions of the world. Chlorhexidine digluconate is a broad-spectrum antiseptic directed against gram-positive and gram-negative bacteria. It has been used as an antiseptic for more than 50 years, both in humans and in animals. However, despite these benefits, it can cause serious damage if applied to the eyes. Incidents of eye damage with 7.1% chlorhexidine have been reported to WHO across Africa. Observation: We report and write two cases of bilateral corneal blindness caused by accidental ocular use of chlorhexidine (HEXZ) GEL 7.1% in two newborns in the health district of Kati in MALI. The ophthalmological examination had revealed corneal opacity, conjunctival hyperaemia and limbic ischemia greater than 50% in 1 eye out of 4, corresponding to stage IV of the ROPPER HALL classification;2 eyes out of 4 were at stage III and 1 eye out of 4 was at stage I of the same classification. Conclusion: It is essential to ensure correct use of chlorhexidine digluconate gel 7%. It is an antiseptic which should not be used on the ocular and auditory mucous membranes, at the risk of most often permanent burns.

Bilateral Central Serous Chorioretinopathy (CRSC) in Pregnancy Complicated with Retroplacental Hematoma: About a Case

Introduction: Central serous chorioretinopathy (CSCR) is associated with serous sensorineural retinal detachment in the macular region. The condition that affects the male gender more than their female counterpart results from focal leakage disturbance of retinal pigment epithelial cells and choroidal abnormalities. The corticosteroid is highlighted as one of the major factors that promote the occurrence of CSCR. Stress and pregnancy, especially in the third trimester, have also been reported by some authors. Central serous chorioretinopathy associated with pregnancy complicated by retroplacental hematoma is a rare event. Observation: We report the case of a pregnant woman at approximately 34 weeks of amenorrhea who presented a sudden and severe drop in visual acuity on a pregnancy complicated by retroplacental hematoma and delivered by cesarean section. The diagnosis was based on clinical arguments associated with photos of the retina made by the MII Ret Cam device (Made In India, Retinoscope Camera) highlighting the lifting of the macular region. Ophthalmological monitoring without medical or physical treatment was instituted. At two months of progression without treatment, bilateral visual acuity was 10/10. Conclusion: Central serous chorioretinopathy and pregnancy is not unusual;however, its bilateral and brutal form in a context of pregnancy complicated by retroplacental hematoma is rare. Despite this favorable evolution, monitoring remains necessary in order to prevent recurrences and complications.

Ocular Manifestations in Severe Acute Malnutrition in Children under 60 Months in a Secondary Health Center

Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage including keratomalacia. This work aims to study possible ophthalmological lesions in severely acutely malnourished children from 0 to 60 months. Patients and Method: This study was carried out in a secondary ophthalmology center. It concerned all severely acute malnourished patients admitted for consultation in the pediatric department. Results: A total of 174 eyes of 87 children aged 0 to 60 months were examined. Two-thirds of the patients were aged between 6 and 18 months. Palpebral lesions are rare, however, we observed 12.64% blepharitis and palpebral dermatitis. Ocular involvement due to vitamin A deficiency was 6.9%, including one case of BITOT SPOT, 4 cases of conjunctival xerosis and one case of keratomalacia. Conclusion: Xerophthalmia is an ocular lesion due to a dietary intake deficient in vitamin A that occurs during severe acute malnutrition. Its occurrence is increasingly rare even in developing countries. However, some cases are observed in practice and may be responsible for profound visual impairments.

Ocular Manifestations in Severe Acute Malnutrition in Children under 60 Months in a Secondary Health Center

Introduction: Severe acute malnutrition (SAM) is one of the main public health problems in the world. It is responsible in addition to the general symptoms, vitamin A deficiency which can cause serious eye damage including keratomalacia. This work aims to study possible ophthalmological lesions in severely acutely malnourished children from 0 to 60 months. Patients and Method: This study was carried out in a secondary ophthalmology center. It concerned all severely acute malnourished patients admitted for consultation in the pediatric department. Results: A total of 174 eyes of 87 children aged 0 to 60 months were examined. Two-thirds of the patients were aged between 6 and 18 months. Palpebral lesions are rare, however, we observed 12.64% blepharitis and palpebral dermatitis. Ocular involvement due to vitamin A deficiency was 6.9%, including one case of BITOT SPOT, 4 cases of conjunctival xerosis and one case of keratomalacia. Conclusion: Xerophthalmia is an ocular lesion due to a dietary intake deficient in vitamin A that occurs during severe acute malnutrition. Its occurrence is increasingly rare even in developing countries. However, some cases are observed in practice and may be responsible for profound visual impairments.

Management of Epidermoid Carcinoma of the Conjunctiva in a Melanoderma Subject in a Secondary Ophtalmology Centre: About a Case

We report a case of a unilateral conjunctival neoformation in a 44-year-old female melanoderma subject. It was a conjunctival squamous cell carcinoma (CSC). The risk factor was exposure to sunlight and dust. No HIV or HPV infection was found. The treatment consisted of simple removal of the tumour with a healthy margin of 3 to 4 mm. After a postoperative follow-up of 18 months, there was no recurrence. As CSC is the most common conjunctival malignancy and given the rate of recurrence with the possibility of associated local invasion, early diagnosis with long-term follow-up is necessary.

Staphylococcus xylosus Isolation of Conjunctival Secretions in an 8-Year-Old Child at Sikasso Hospital (Mali): About a Case

Staphylococcus xylosus is a species of bacteria belonging to the genus Staphylococcus. This genus currently includes several species and subspecies. We distinguish between 2 groups: the group of coagulase-positive staphylococci (CoPS) and coagulase-negative staphylococci (CoNS), a larger group that includes more than forty species and subspecies. Among the CoNS, Staphylococcus xylosus occupies a special place because it is frequently isolated from meats, dairy products, and agricultural environments. It is commonly used in fermentation due to its primary role in the flavor and color development of fermented products. It is a commensal bacterium of the skin of small mammals and farm animals, where it constitutes the majority of flora. In this species, there are a large number of strains, including phenotypes and genotypes. Although S. xylosus is actually a recognized non-pathogenic species, a few strains can be potentially dangerous. They can thus be responsible for mastitis and dermatitis in cattle. With the multiplicity of breeding farms, the consumption of livestock products and the increasingly frequent contact of humans with animals a few rare cases of human opportunistic infections have also been reported in the literature. These include pyelonephritis, endocarditis, urinary, lymphatic, and lymph node infections, contamination of orthopedic materials and catheters. Thereby, we report the case of a lingering and chronic infection of the lacrimal tract by Staphylococcus xylosus in an 8-year-old child in the Ophthalmology Department of Sikasso hospital in Mali.

External Dacryocystorhinostomy: 4 Years’ Experience from CHU-IOTA in Mali

Aim: To analyze the clinical characteristics and the surgical outcomes of external dacryocystorhinostomy (DCR) in patients with nasolacrimal duct obstruction (NLDO). Methods: We retrospectively reviewed the clinical record of 62 patients who underwent external DCR for NLDO between November 2015 and November 2019 at CHU-IOTA in Mali. The preoperative clinical findings and the postoperative outcomes after a minimum follow up of 3 months were analyzed. Results: epiphora, discharges and canthal swelling were main symptoms of the 62 patients (68% women, 32% men), with the mean age of 47 years (10 - 76). Among them, 36 had chronic dacryocystitis, 12 had a traumatic NLDO and 8 followed a septal deviation. The majority (77%) were operated on under local anesthesia with sedation. Bicanalicular intubation was performed in 29% of patients. After postoperative follow up of at least 3 months, only 8 patients had persistent watering, thus a subjective functional success of 87%. Conclusion: In the nasolacrimal duct obstruction, most often secondary to chronic dacryocystitis, external dacryocystorhinostomy remains a technique of choice with very good success.

Socio-Economic Impacts of Primary Open-Angle Glaucoma in Rural Environment in Mali

Primary open-angle glaucoma (POAG) is an optic neuropathy that affects the patient’s quality of life. The present study aims to write the socio-economic factors influencing the management of glaucomatous patients in rural areas. This was a retrospective, descriptive cross-sectional study, carried out from October 19 to 31, 2017 in a rural town. The variables studied were age, sex, occupation, level of knowledge about the disease and its treatment, average monthly income, accessibility of eye care service, health insurance membership, degree of severity of the disease. The frequency of POAG was 5.68%. The average age of the patients was 52 years old with extremes ranging from 25 to 73 years old;the female sex was the most represented with 19 cases out of 36 or 52.77%. 66.67% of our patients were at their first ophthalmological consultations. Health insurance coverage was 2.78%. The average monthly income was 10,000 to 25,000 FCFA in 58.33%. More than half of our glaucomatous patients, 63.89%, think they are affected by their disease. 80% of patients are unaware that they have eye disease. Many lost vision in one or both eyes and were unaware of the disease affecting their eyes. Accessibility to health services and their costs seem to be a factor, in addition to illiteracy.

Prevalence of Refractive Errors among School Children Aged 5 to 15 Years Old at CHU-IOTA

Introduction: Undetected refractive errors constitute a health problem among school children who cannot take advantage of educational opportunities. The authors studied the prevalence of refractive errors in school children aged 5 to 15 at CHU-IOTA. Patients and Method: This is a prospective, descriptive cross-sectional study carried out in the ophthalmic-pediatrics department of CHU-IOTA, from October to November 2023. Results: We received 340 school children aged 5 to 15, among whom 111 presented ametropia, i.e. a prevalence of 32.65%. The average age was 11.42 ± 2.75 years and a sex ratio of 0.59. The average visual acuity was 4/10 (range 1/10 and 10/10). We found refractive defects: astigmatism 73.87%, hyperopia 23.87% of cases and myopia 2.25%. The decline in distance visual acuity was the most common functional sign. Ocular abnormalities associated with ametropia were dominated by allergic conjunctivitis (26.13%) and papillary excavation (6.31%) in astigmatics;allergic conjunctivitis (9.01%) and papillary excavation (7.20%) in hyperopic patients;turbid vitreous (0.90%), myopic choroidosis (0.45%) and allergic conjunctivitis (0.45%) in myopes. Conclusion: Refractive errors constitute a reality and a major public health problem among school children.