Recent advances in ocular leprosy.

Proper MDT soon after detection of leprosy and anti-reaction measures with newer steroids, regular supervision and monitoring of those released from treatment (RFT) reduce the incidence of ocular leprosy to a remarkable extent. Today, most eye complications are because of normal ageing process or of other phenomena in normal healthy population. Cataract and lagophthalmos are the main causes of blindness. However, in India, though the rate of cataract surgical coverage is up to the mark, the same for lagophthalmos is lagging far behind. Integration of management of ocular leprosy into community eye health care service is the talk of the day along with other health care facilities delivered to people affected with leprosy (PAL). Routine eye examinations are necessary for all PB and MB patients, as well as for the RFT persons in order to detect and treat eyes that are at high risk. All eye surgeries can be performed when needed, irrespective of deformities and bacteriological status, by latest microsurgical techniques with good outcome, and better rehabilitation measures. Reorientation training in ocular leprosy is the immediate special need for ophthalmologists, paramedical ophthalmic assistants and eye health care managers working in general hospitals in those areas that were previously "leprosy endemic zones".

[Ocular impairment in leprosy].

Leprosy causes several ocular disorders, and it also causes aftereffect with high frequency in various ways. Primary impairment is the ocular disturbance caused with direct invasion of nerve and ocular tissue by Mycobacterium leprae. Secondary impairment is the complication of nerve paralysis and residual inflammation due to primary disorder. Main work at Japanese national leprosariums has been the control of primary and secondary impairment in recent years. Clinical ophthalmic study in the leprosarium revealed a increase of age-related ocular disease in addition to aftereffect of leprosy. Severe sequelae due to sensory and functional disturbance will require suitable applications of advanced clinical technologies.

Study of ocular changes in leprosy patients.

In this study, 997 leprosy patients were examined, 528 of them with lepromatous leprosy (53%), 199 with borderline leprosy (20%), 167 with tuberculoid leprosy (16%) and 103 (10.3%) with indeterminate leprosy. Changes in the ocular bulb were noted in 314 patients (31.5%) specially in those with lepromatous leprosy. These alterations were greater with increasing age of the patient and length of disease. Severe ocular lesions were rare, probably due to previous systemic treatment. The "pearls" in the fundus of the eye resulting from leprosy were also studied.

Strategies for improvement of management of ocular complications in leprosy.

Responsibility for eye care of leprosy-affected persons should be shared between leprosy and eye care staff. Leprosy and PHC staff should be responsible for: treatment of reversal reactions in the face, and of recent lagophthalmos, with prednisolone, conservative treatment of mild lagophthalmos, referral of patients with severe lagophthalmos and/or exposure keratitis, unless there is sufficient expertise within the programme, recognition of the acute red eye and treatment of acute conjunctivitis, referral of all other conditions of acute red eye, unless there is sufficient expertise within the programme, recognition of severe visual impairment and referral as needed, recognition of the need for reading glasses in patients aged over 40 years, in rehabilitation services, encouraging medical colleges, Control of Blindness Societies, and staff of general eye care facilities, to actively take part in the treatment of eye complications in patients affected by leprosy, and encouraging charitable organizations to provide special eye care programmes for patients affected by leprosy, in particular for those who are disabled and are living in leprosy settlements. Eye care services (a visiting ophthalmologist or paramedical ophthalmic assistant to the specialized leprosy centres for consultation is an appropriate alternative and may sometimes be even more feasible) should take the responsibility for: eyelid surgery in patients with large lid gaps (> 6 mm), or, signs of exposure keratitis, and treatment and follow-up of acute iritis, corneal ulcers, foreign bodies, and other causes of 'the acute red eye', in cooperation with the leprosy service or PHC staff. The eye care services should offer 'positive discrimination' in the treatment of cataract-blind leprosy patients, realizing the great difficulties that these patients have in avoiding injuries or taking care of injuries once they have occurred, especially in the case of limbs that have lost protective sensation.

Prevention of blindness in leprosy: an overview of the relevant clinical and programme-planning issues.

Visual disability continues to be a significant problem in leprosy patients due to cataract, chronic iridocyclitis, and corneal disease. Clinical and epidemiological aspects of these problems are described and the current status of eye care in leprosy programmes is discussed.

Considerations in the integration of eye care into leprosy care services.

Little attention has been directed to the development, management and evaluation of eye care programmes for leprosy patients. This paper examines when an eye care programme for leprosy patients is needed, methods for integrating eye care into leprosy control programmes and lists of available ocular leprosy teaching materials.

Mal de Hansen / Hansen's disease

O mal de hansen é ainda uma das doenças milenares com grande incidência em nosso país. Os dados recentes obtidos revelam 18 doentes para cada 100 mil habitantes, com uma prevalência de 1.8 para cada mil habitantes. A hanseníase é uma entidade altamente incapacitante pelas mutilaçöes que determina, nas mäos, braços, pés, pernas além das alteraçöes oculares graves decorrentes da falta de tratamento profilático. É sobre as diversas alteraçöes oculares que o autor discute nesse artigo

Proposta para avaliaçäo e cuidados oculares na hanseniase / Proposal for eye assessment and care in leprosy

As autoras apresentam uma proposta simples para avaliaçäo e cuidados oculares no paciente portador de hanseníae, para os serviços que näo dispöem de médico oftalmologista. A avaliaçäo compreende a entrevista e o exame da parte anterior do olho, anexos, pressäo intra-ocular e acuidade visual. No tratamento, säo descritos os cuidados para os comprometimentos mais comuns

Ocular leprosy: a case report and discussion of the pathology.

Although leprosy is considered rare in Australia outside the Northern Aboriginal population, its presence within Indian and Southeast Asian migrant groups must be considered. A case of ocular leprosy is presented in which the definitive diagnosis was delayed because lid changes had been diagnosed as senile ectropion. The pathology of ocular leprosy is discussed, together with relevant therapeutic considerations.

[Eye diseases and ophthalmological care in a developing country (author's transl)]. / Augenkrankheiten und ophthalmologische Versorgung in einem Entwicklungsland. Bericht über ein Eye-Camp in Andhra Pradesh/Indien.

Five million blind people in India suffer from cataract, which is a curable condition. Untreated cataract accounts for more than half of the cases of blindness in that country. Twenty percent of all cases of blindness are caused by infections, while malnutrition accounts for 27% in children. In India, ophthalmological care has been provided for many years now in eye-camps. In cataract surgery, the expression method is customary. Trachomas at all stages, infectious eye diseases, traumatic lesions, vitamin A deficiency and leprosy are also diagnosed and treated in large numbers of cases. By way of an example the authors, assistants at the First Eye Clinic of Vienna University, describe an eye-camp in Andhra Pradesh where they worked. Work of this kind can be recommended to others.