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Hong Kong Med J 2005;11:85-9

As a persistent global health problem, childhood blindness is caused by different factors in developing and developed countries. Collection of epidemiological data is often helpful for allocating resources of prevention and treatment of eye diseases. These data, however, are not readily available even in developed countries.

Focusing on the only school for the visually impaired in Hong Kong, doctors from the Chinese University of Hong Kong reported on the causes of blindness in these children in the April 2005 issue of the Hong Kong Medical Journal.

Eighty-two blind students at the Ebenezer School and Home for the Visually Impaired were recruited between December 1998 and August 1999. The study involved collection of demographic data, questionnaire assessment of their medical and ocular history, evaluation of visual acuity, and classification of visual loss according to the World Health Organization criteria. Others included slit-lamp examination and dilated binocular indirect ophthalmoscopy.

The study revealed that major past medical illnesses were reported in 50% with prematurity and diseases of the central nervous system found in 27% and 11% of students, respectively. The most common anatomical site for visual impairment was the retina (48%), followed by diseases of the optic nerve (15%), and diseases of the anterior segment and the lens (15%). Because a certain proportion of these cases were due to preventable and treatable causes, the authors concluded that early diagnosis and treatment of such conditions, as well as genetic studies for hereditary eye disease, are useful measures that may help to reduce the incidence of local childhood blindness.

Hong Kong Med J 2005;11:110-2

Published in the April 2005 issue of Hong Kong Medical Journal, doctors from the Queen Mary Hospital reported on the first case of unilateral epistaxis due to leech infestation in a 55-year-old Chinese woman.

The patient presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction, a brownish mass was discovered in her left nostril. Followed by two failed attempts of removal, she was admitted to the Otorhinolaryngology Department. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal.

According to the patient's history, nasal leech infestation was associated with face washing in a local leech-inhabited freshwater stream. This is a rare clinical case because unilateral epistaxis is commonly due to foreign bodies or benign or malignant neoplasm. Aquatic leeches normally enter the orifices and feed on mucosal surfaces of the upper aerodigestive tract and lower genitourinary tract. Endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain, and endoscopic assessment is generally required for diagnosis.

The doctors concluded that it might be difficult to directly remove a live leech because of its powerful attachment to the mucosa and its slimy and mobile body. It can be paralysed using cocaine or other local anaesthetic and if asphyxiation occurs, an emergency direct laryngoscopy and removal under general anaesthetia is then required.