The Emerging Threat of Autoimmunity to Eye Health in Nigeria

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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.

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