The past two decades have seen a noticeable uptick in
autoimmune conditions among Nigerians. Diseases like rheumatoid arthritis,
lupus, and multiple sclerosis where the immune system attacks the body's healthy tissues have become increasingly common. This pattern extends to
ophthalmic autoimmunity - autoimmune disorders affecting the eyes - which
threaten vision and eye health for
many Nigerians if left unchecked.
Understanding the autoimmune diseases that can rob people of
their sight is key to improving screening, diagnosis and treatment. Three
conditions stand at the forefront of this issue facing eye hospitals across
Nigeria.
Uveitis
Inflammation of the middle eye layer called the uvea, which
contains blood vessels and nerves essential for vision. Up to 4,200 new cases
occur annually in Nigeria, predominantly affecting working-age adults. Uveitis
has varied origins - infectious, traumatic, and autoimmune - but autoimmunity
likely explains over 30% of cases. Damage to eye tissues leads to complications
like cataracts, glaucoma and retinal injury. Early detection and controlling
inflammation are key to preserving sight.
Thyroid Eye Disease
While thyroid disorders have genetic components, thyroid eye
disease (TED) is an autoimmune condition attacking muscles and fatty tissue
around the eyes. Prevalence is unknown in Nigeria but estimated at 375,000
cases based on population and global incidence. TED often occurs alongside
hyperthyroidism where the immune system produces antibodies against thyroid
hormones but also targets tissues around the eyes. Resulting inflammation and
tissue expansion leads to bulging eyes, swollen eyelids, double vision, and
potential vision loss from compressed nerves.
Sjögren's Syndrome
An autoimmune disorder affecting moisture-producing glands
in the eyes and mouth. Prevalence in international data suggests up to 650,000
cases in Nigeria. Sjögren's causes immune cells to attack and destroy the
lacrimal (tear) and salivary glands, resulting in severely dry eyes and dry
mouth. When left untreated for years, the corneal damage from chronic dryness
can cause permanent vision impairment.
Barriers to Diagnosis and Treatment
Several obstacles have hindered progress in tackling
autoimmune eye disease in Nigeria:
1. Lack of ophthalmic training and awareness about
autoimmunity's role in conditions like uveitis, delaying accurate diagnosis and
management.
2. Limited diagnostic testing available to analyze
antibodies and biomarkers to confirm autoimmune disorders, leading to missed or
incorrect diagnoses.
3. Scarcity and unavailability of newer biologic drugs for
autoimmune diseases which can control inflammation and prevent tissue damage
before it causes permanent vision deficits.
4. Poor coordination between specialties, as autoimmunity
requires collaborative management between ophthalmologists, rheumatologists,
endocrinologists and immunologists which is currently lacking.
5. Insufficient health policy focus on autoimmune conditions
compared to infectious diseases, trauma, and age-related eye disorders.
Turning the Tide
Reversing the trajectory of vision loss from autoimmune eye
disease necessitates multi-pronged strategies:
• Enhanced ophthalmology training programs centered on the latest advancements in autoimmune diseases.
• Investments in diagnostic technology and testing
capacity for detecting ophthalmic autoantibodies.
• Improved patient education on symptoms and early warning
signs indicating the need for an eye evaluation.
• Updated clinical guidance for referring at-risk patients
to rheumatology.
• Widened access to biologics and immunosuppressants for
treating autoimmune activity.
• Specialist centers of excellence concentrating
multi-disciplinary expertise in one location.
By recognizing autoimmune mechanisms as a rising contributor
to preventable blindness, Nigeria can begin developing comprehensive solutions
tailored to this emerging health threat. Collaborative efforts bridging medical
education, research, access to treatment and patient empowerment will help save
the vision of thousands of Nigerians in the years ahead.
