Ocular complications among Noma survivors: A cross-sectional study

Noma (cancrum oris) is a swiftly advancing gangrenous condition that predominantly impacts malnourished children in low-resource environments. Survivors often endure extensive facial disfigurement, which may involve the periorbital and orbital regions, leading to considerable ocular morbidity. Despite this, the range and distributon of ocular sequelae in Noma survivors remain inadequately documented in the literature. This study was conducted to ascertain the pattern and frequency of ocular complications among Noma survivors.

To describe the pattern and distribution of ocular manifestations among Noma survivors attending a Noma referral center in North-western Nigeria.

A cross-sectional study was conducted at Noma Children's Hospital, Sokoto, Nigeria, over a period of 2 years and 5 months (January 2022 - June 2025). Noma survivors in stages IV and V with clinical or symptomatic ocular involvement were consecutively recruited. Sociodemographic data, disease staging, laterality, and detailed ocular examination findings were recorded, such as destroyed eyeball (pthisis bulbi), telecanthus, ectropion, orbital dystopia, staphyloma, lower eyelid defect, corneal scar, ptosis, diplopia, cataract, and pseudoesotropion. Data were analysed using IBM SPSS version 25; descriptive statistics, Chi-square tests, and 95% confidence intervals (CIs) were computed, with statistical significance set at p < 0.05.

A total of 62 participants were enrolled, comprising 35 (56.5%) males and 27 (43.5%) females, with ages ranging from 5 to 58 years (median age: 12 years). Forty-four participants (71.0%) had stage V disease, while 18 participants (29.0%) had stage IV disease. Orbital dystopia was identified as the most common finding (79.0%; 95% CI: 68.9-89.1%), followed by lower eyelid defects (67.7%; 95% CI: 56.0-79.4%), ectropion (51.6%; 95% CI: 39.2-64.0%), and ocular dysmotility (27.4%; 95% CI: 16.3-38.5%). Pseudoesotropion was the least frequent finding, observed in 8.1% of cases. Statistically significant associations were observed between dystopia and sex (χ² = 4.413, p = 0.036) and between ectropion and sex (χ² = 4.340, p = 0.030).

Ocular sequelae are frequently observed and exhibit a variety among Noma survivors, with orbital dystopia and lower eyelid defect representing the most common findings. These findings emphasise the importance of early ophthalmological evaluation and multidisciplinary reconstructive intervention in the management of Noma survivors.