Orbit (Amsterdam, Netherlands) · 2026
Challenges to oculoplastic surgical care in resource-limited areas: a systematic review of needs in sub-Saharan Africa.
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Kryshtalskyj Michael T, Holland Simon P, Morgenstern Kenneth E, Punja Karim G, Black Evan H, Burkat Cat N
Аннотация
PURPOSE: To characterize challenges to delivering oculoplastic surgical care in sub-Saharan Africa (SSA) and to identify priority areas for sustainable capacity building.
METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Scopus were searched for peer-reviewed articles describing challenges in oculoplastic care in SSA. Risk of bias was assessed.
RESULTS: Of 231 identified articles, 35 studies met inclusion criteria, representing 8,103 patients across 15 SSA countries. Most studies were medium case series (n = 26), with additional national surveys (n = 4), qualitative studies (n = 2), and reviews offering original insights (n = 3). Oculoplastic care was chiefly delivered by general ophthalmologists (46%), with only 14% of studies authored by oculoplastic surgeons. Workforce shortages were pronounced, with limited opportunities and systematic barriers to pursuing quality fellowship training. Infrastructure deficits included lack of orbital implants (34% of studies), limited neuroimaging, and insufficient operating room resources. Over half of studies (54%) described advanced disease at presentation, attributed to cost, travel, tenuous referral systems, and primary care challenges. Sociocultural factors, including fear of disfigurement, stigma, religious beliefs, gender inequities, and reliance on traditional medicine, also delayed care. Orbital trauma, cicatricial eyelid complications, contracted sockets, and advanced malignancies, were common presentations in a predominantly young population; over 50% of patients were younger than 39 years.
CONCLUSIONS: Oculoplastic surgical care in SSA is constrained by critical workforce shortages, limited training pathways, infrastructure deficits, and sociocultural barriers to timely care. Sustainable global partnerships should prioritize context-specific education, infrastructure investment, task-sharing models, and community-level engagement to improve access and outcomes.
METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Scopus were searched for peer-reviewed articles describing challenges in oculoplastic care in SSA. Risk of bias was assessed.
RESULTS: Of 231 identified articles, 35 studies met inclusion criteria, representing 8,103 patients across 15 SSA countries. Most studies were medium case series (n = 26), with additional national surveys (n = 4), qualitative studies (n = 2), and reviews offering original insights (n = 3). Oculoplastic care was chiefly delivered by general ophthalmologists (46%), with only 14% of studies authored by oculoplastic surgeons. Workforce shortages were pronounced, with limited opportunities and systematic barriers to pursuing quality fellowship training. Infrastructure deficits included lack of orbital implants (34% of studies), limited neuroimaging, and insufficient operating room resources. Over half of studies (54%) described advanced disease at presentation, attributed to cost, travel, tenuous referral systems, and primary care challenges. Sociocultural factors, including fear of disfigurement, stigma, religious beliefs, gender inequities, and reliance on traditional medicine, also delayed care. Orbital trauma, cicatricial eyelid complications, contracted sockets, and advanced malignancies, were common presentations in a predominantly young population; over 50% of patients were younger than 39 years.
CONCLUSIONS: Oculoplastic surgical care in SSA is constrained by critical workforce shortages, limited training pathways, infrastructure deficits, and sociocultural barriers to timely care. Sustainable global partnerships should prioritize context-specific education, infrastructure investment, task-sharing models, and community-level engagement to improve access and outcomes.