This research was conducted to study the epidemiological patterns of eye diseases among children below five years of age.
The male participants were a little more than females as the ratio was 1.1:1. Out of 10886 records, the prevalence of children below five years of age out of the total population was 5%. This is a considerable percentage of affected children at this age group. The age group of this study mounted about 45% of the total children affected with eye disorders, thus the under-five group is almost half of the total affected children. These results are coincidentally matching the result of study conducted in Ethiopia in which it revealed a percentage of 50% of ocular morbidity affecting the older children (6-15 years) .
The study revealed that, there are different patterns of eye diseases affecting children under-five years of age; they vary from simple to blinding diseases. The predominant eye problem affecting those children was eye infections amounting to almost 19% of the total affected participants. This group of eye diseases includes bacterial, viral and fungal eye infections. Different typesof allergies were the second type of eye problems affecting the participants of this study and mounted about 17% of the total. Myopia, hyperopia and astigmatism were the third commonest type of eye disorders affecting children of under- five years of age.
Diseases of the orbit comprising lids, tear canals and eye globe represented a substantial amount among under-five children, it amounted a little more than 10%. The commonest form of this group of disorders is naso-orbital canal obstruction that might lead to serious complications if left untreated. Infection remains the major concern in such circumstance which may lead to cellulites, abscesses and brain involvement if left untreated. The other form of this group of eye diseases is lids swellings, whether infectious based or inflammatory in nature in addition to tumors. Almost the same pattern of eye diseases in this study was reported in a study conducted in rural Egyptians pre-school children. Their study found the highest percentage of ocular morbidity was refractive errors, unlike in this study where it was the third in order. Otherwise their study was matching the finding of this research .
More than 9% of the children under-five years of age were affected with squint disorders and 2.8% were affected with neurologically related eye disorders.
Cerebral visual impairment (due to damage to the visual pathways in the brain) is the leading cause of severe visual impairment and blindness in children in high-income countries. It is also an emerging cause in low-income countries, where a relatively high proportion is attributable to perinatal factors and so potentially avoidable through better perinatal care. Cerebral visual impairment may be missed because it usually affects children who also have other disabilities such as cerebral palsy or learning difficulties. A community-based study of cerebral palsy in Bangladesh showed that a third of children had reduced visual acuity and over half had visual perception problems which adversely affected their quality of life .
The study divulged that other serious eye problems that may cause some form of blindness; including corneal diseases, cataract retinal, glaucoma and retinal diseases were more than 15%. Among these blindness leading disorders, corneal diseases were on top representing 6.6%. Diseases affecting the cornea are considered serious as it is one of the most sensitive and exposed parts of the eye, it highly prone to trauma and infections which in some cases might lead to legal blindness. Therefore, cornea diseases are of concern to all ophthalmologists especially when occurred to this young group of patients. Following cornea diseases, cataract counted 6% of the total affected children of this study. Cataract, the commonest eye disease of all ages is as well has it’s percentage among the young ages. Although cataract is a leading cause of blindness when affects both eyes, or one eye in case the other one affected with other blinding diseases, but the good thing is that it can be treated with relatively simple procedure and the outcome is usually satisfying. Studies discussed that congenital cataract and Retinopathy of Prematurity (ROP) affect visual functions in very early ages and they can be prevented or treated. Modalities to prevent, diagnose and manage these conditions are available. Visual prognosis after cataract surgery in young children has improved considerably. But, congenital and infantile cataracts are still responsible for 10% of global childhood blindness and the leading cause of blindness in many countries of Africa [12, 13].
Glaucoma affected 2.3% of the under-five children in this study. In term of numbers, more than 250 children at this young age were at risk to serious vision loss. Glaucoma in children is a rare disease with variable incidence across countries and ethnic groups. The incidence of primary congenital glaucoma (PCG) in western countries, such as Ireland, Britain, and the USA, lies within 1 per 10–20,000 live births [14-18]. However, the incidence of glaucoma is higher in the Middle East, including Saudi Arabia, where consanguineous marriages are more prevalent. The estimated incidence of PCG in Saudi Arabia is 1 per 2500 live births [19, 20]. According to the congenital glaucoma registry at King Khaled Eye Specialist Hospital, the Southern region of Saudi Arabia has the highest prevalence rate of glaucoma (27.8%), followed by the Western province (23.6%) and the Central region (22.2%). However, the lowest prevalence was recorded in the Eastern province (11.1%) and the Northern Province (9%).
Although it might sound small amount, but it worth mentioning that 0.23% of the under- five children in this study were affected with eye malignant tumors with the predominant type of retinoblastoma. The eye tumors are very risky due to the link and narrow distance between the eye globes and brain that is already connected with the eye through the optic nerve and the retina making a good chance secondary involvement. Fabian and et al stated that retinoblastoma is the most common eye cancer of childhood. However, it is a relatively rare disease, occurring in approximately one out of every 16,000–18,000 live births in the global population. Its incidence is similar across populations, and does not vary according to gender, ethnicity or socio-economic status. Worldwide, approximately 8,000 children develop retinoblastoma each year, with the vast majority presenting with the disease before the age of 5 years .
The patterns of eye diseases according to child gender as yielded in this study showed some variations. The majority of eye diseases affected males more than females, including cataract, glaucoma, orbital diseases, infections, allergies, tumors and neurogenic eye disorders. Diseases that affected females more than males were retinal diseases, refractive errors and squint disorders. Although the males in this study were more than females but still from percentage point of view we will find that males were more affected with eye disease than females after considering the proportion of both genders. Males were more affected than females with ocular disorder in other study conducted by Demissie and et al as well .