It has been estimated that some 1.4 million children around the world are blind and about three quarters of them live in Asia or Africa. Much of this blindness could be prevented or treated and a report from Nigeria (IR Ezegwui and colleagues. Br J Ophthalmol 2003;87:20–23) well illustrates this point.

In southeastern Nigeria there are three schools for blind pupils. Of 162 pupils, 142 were examined and two were excluded from the study because they were not blind. The rest were either blind (136 pupils) or had severe visual impairment (4). Six functionally blind pupils had significant vision when supplied with appropriate lenses. The most common cause of blindness was cataract (33, 24%). Thirty pupils (21%) had disease of the whole globe, of whom 17 had phthisis bulbi (a soft and shrunken eye usually following infection or trauma). The other 13 had anophthalmos, microphthalmos, or disorganised globe. Corneal scarring was the cause of visual loss in 30 pupils (21%) and was attributed to measles in 26. The contribution of vitamin A deficiency was not assessed. Glaucoma or buphthalmos were the cause in 13 (9%). Ten cases (7%) were thought to have been the result of using traditional eye medications. For 54 pupils (39%) their blindness had resulted from factors active in childhood, 21 (15%) were considered hereditary, 11 (8%) from intrauterine causes, and for 54 (39%) the timing of the insult was unknown. In all, 91 pupils (65%) were blind from causes considered preventable (such as measles) or treatable (such as cataract).

Much childhood blindness in developing countries can be avoided. The causes of blindness vary between and within countries and local data are important in determining approaches to prevention and treatment.