ABSTRACT
Ocular involvement in leprosy is estimated to be 70-75%, about 10-50% of leprosy patients suffer from severe ocular symptoms, and blindness occurs in about 5% of patients. The disease leads to many ophthalmologic symptoms and signs in the range of the eyeball itself, as well as of the bulb adnexa, ie, eyebrows, eyelids with eyelashes, and lacrimal drainage system. Especially dangerous are complications of lagophthalmos and corneal hypoanesthesia, neurotrophic or infectious keratitis, and iridocyclitis and cataract formation, which may lead to significant decrease of visual acuity or even blindness. Multidrug treatment rapidly interrupts transmission of Mycobacterium leprae by infectious patients, but even after being completed, it does not guarantee the withholding of ocular complications.
Subject(s)
Eye Diseases/epidemiology , Eye Diseases/etiology , Eye Infections, Bacterial/microbiology , Leprosy/complications , Mycobacterium leprae/isolation & purification , Blindness/epidemiology , Blindness/etiology , Corneal Diseases/etiology , Corneal Diseases/physiopathology , Eye Diseases/microbiology , Eye Infections, Bacterial/epidemiology , Eyelid Diseases/etiology , Eyelid Diseases/physiopathology , Female , Humans , Incidence , Keratitis/etiology , Keratitis/physiopathology , Leprosy/diagnosis , Male , Prognosis , Risk AssessmentABSTRACT
Ocular involvement in leprosy is estimated to be 70-75%, about 10-50% of leprosy patients suffer from severe ocular symptoms, and blindness occurs in about 5% of patients. The disease leads to many ophthalmologic symptoms and signs in the range of the eyeball itself, as well as of the bulb adnexa, ie, eyebrows, eyelids with eyelashes, and lacrimal drainage system. Especially dangerous are complications of lagophthalmos and corneal hypoanesthesia, neurotrophic or infectious keratitis, and iridocyclitis and cataract formation, which may lead to significant decrease of visual acuity or even blindness. Multidrug treatment rapidly interrupts transmission of Mycobacterium leprae by infectious patients, but even after being completed, it does not guarantee the withholding of ocular complications.
Subject(s)
Humans , Male , Female , Prognosis , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/epidemiology , Blindness/etiology , Blindness/epidemiology , Incidence , Risk Assessment , Corneal Diseases/etiology , Corneal Diseases/physiopathology , Eye Diseases/etiology , Eye Diseases/microbiology , Eye Diseases/epidemiology , Eyelid Diseases/etiology , Eyelid Diseases/physiopathology , Keratitis/etiology , Keratitis/physiopathology , Leprosy/complications , Leprosy/diagnosis , Mycobacterium leprae/isolation & purificationABSTRACT
AIMS: In a quantitative prospective study the corneal sensation in patients with leprosy was compared with age matched controls. METHODS: The patients with leprosy were classified as paucibacillary and multibacillary and were divided in three groups: (1) patients without clinically detectable eye pathology; (2) patients with lagophthalmos, (3) patients with signs of iridocyclitis. The corneal sensitivity was assessed with the Cochet and Bonnet aesthesiometer. RESULTS: There was a significant decrease in corneal sensitivity in multibacillary patients without clinically detectable eye pathology and in patients with lagophthalmos or iritis when compared with controls. A significant correlation between the loss of power of the orbicularis oculi muscle and the degree of corneal sensation loss could not be established. No significant decrease in corneal sensitivity was found in paucibacillary patients without eye pathology compared with the control group. CONCLUSION: The results of this study showed that loss of corneal sensation can occur while there is no clinically detectable eye pathology, at least in multibacillary patients. Regular checkups of the corneal sensation should, therefore, be part of the routine control of leprosy patients. Health education on eye care and early warning signs should be encouraged.
Subject(s)
Corneal Diseases/physiopathology , Eye Infections, Bacterial/physiopathology , Leprosy/physiopathology , Sensation Disorders/physiopathology , Adult , Aged , Humans , Middle Aged , Oculomotor Muscles/physiopathology , Prospective StudiesABSTRACT
Corneal involvement in leprosy is known to be influenced by factors such as lagophthalmos, ectropion, and corneal anesthesia. In the present study conducted on 400 eyes of leprosy patients, observations were made on tear film abnormalities, and their relation to the above-mentioned factors was analyzed. The abnormality of tear film breakup time (BKUT) was found to be clinically more significant (47.2%) than a Schirmer's test alone (24.5%), and this finding was of greater significance in the lepromatous form of leprosy. An abnormal BKUT reflects a decreased mucin secretion by the conjunctival goblet cells. Tear film abnormalities in association with lagophthalmos, corneal anesthesia, concomitant ocular diseases, and environmental factors such as high relative humidity have been identified as factors contributing to corneal involvement in leprosy in India. It is not surprising that with so many mechanisms of corneal involvement the clinical manifestations are diverse, and all forms of pathological changes may contribute to corneal morbidity.
Subject(s)
Corneal Diseases/etiology , Leprosy/complications , Cornea/physiopathology , Corneal Diseases/physiopathology , Corneal Opacity/etiology , Female , Humans , Keratitis/etiology , Male , Tears/metabolismABSTRACT
The patient was affected by a lepromatous leprosy and had a unilateral oedema of the posterior layers of the cornea with a conjonctival hyperhemia. The authors review the various aspects of corneal changes in leprosy: -- paralytic and non specific changes in trigeminal paralysis; -- direct and specific changes: opacification of corneal nerves, a vascular keratitis, corneal leproma, disorders of the vascularisation either by pannus or by interstitial vascularisation. The epidemiological problems are briefly considered.