Ulcerative Keratitis: incidence, seasonal distribution and determinants in a tertiary eyecare facility south east Nigeria

Background : Ulcerative keratitis is a potentially blinding eye disease found in eyes with predisposing risk factors. Objectives : To determine the incidence, distribution, causative organisms and risk factors for ulcerative keratitis in patients presenting at the University of Nigeria Teaching Hospital (UNTH)- a tertiary referral eye care facility, Enugu, Nigeria. Study Design: This was a hospital based cross-sectional study of 61 new patients with ulcerative keratitis who presented at the UNTH from October 2011-September 2012. Participants’ socio-demographics and predisposing risk factors were documented. Corneal scrapings were collected for microbial diagnosis. Results: A total of 11,056 new patients presented during the study period giving an incidence rate of 0.6%. Of the 61 participants, 44(72.1%) were males, 17(27.9%) were females with an age range of 6 – 75 years and a median age of 54 years. Of the 40(65.6%) culture positive corneal scrapings, 21(52.5%) were purely bacterial, 17(42.5%) were purely fungal while 2(5%) were mixed infection, caused by both bacterial (Staphylococcus aureus) and fungal (Aspergillus fumigatus) organisms in both cases. Commonest predisposing risk factor was non- surgical trauma 43(70.5%) followed by use of harmful Traditional Eye Medicine (TEM) 27(44.3%). The seasonal distribution of corneal ulcer was highest in month June 11(18.0%). Complications from the ulcers included central leucoma 19 (31.2%) and panophthalmitis 6 (9.9%). Conclusion : The incidence rate of ulcerative keratitis is 0.6% occurring highest in the month of June with more bacterial than fungal isolates. Many participants were exposed to non- surgical trauma and use of TEM. Eye health education (emphasizing the deleterious effects of TEMs) and protection (especially for artisans) if instituted can reduce the visual morbidity associated with corneal ulcers.