Catastrophic ocular complications in leprosy: a case report.

Leprosy is a chronic, granulomatous infectious disease commonly affecting the skin, nerves, mucosa and eyes. The stigma associated with the disease frequently leads to delay in presentation to health professionals. Treated patients, though considered cured presumptively, many continue to live with physical disabilities and deformities. Intact visual acuity prevents humans from trauma and any reduction in visual acuity, especially in leprosy, increases the risk of getting injured by many folds. Here, we present a case of leprosy with complete loss of vision due to bilateral anterior staphyloma secondary to keratitis and his physical deformities preventing him to take care of his eyes. This paper aims to emphasize on the importance of a baseline ophthalmology consultation in all newly diagnosed leprosy patients and repeat examination at onset of any new symptoms of the eye.

COVID-19 and the Unfinished Agenda of VISION 2020.

PURPOSE: To critically evaluate the potential impact of the coronavirus disease (COVID-19) pandemic on global ophthalmology and VISION 2020. DESIGN: Perspective supplemented with epidemiologic insights from available online databases. METHODS: We extracted data from the Global Vision Database (2017) and Global Burden of Disease Study (2017) to highlight temporal trends in global blindness since 1990, and provide a narrative overview of how COVID-19 may derail progress toward the goals of VISION 2020. RESULTS: Over 2 decades of VISION 2020 advocacy and program implementation have culminated in a universal reduction of combined age-standardized prevalence of moderate-to-severe vision impairment (MSVI) across all world regions since 1990. Between 1990 and 2017, low-income countries observed large reductions in the age-standardized prevalence per 100,000 persons of vitamin A deficiency (25,155 to 19,187), undercorrected refractive disorders (2,286 to 2,040), cataract (1,846 to 1,690), onchocerciasis (5,577 to 2,871), trachoma (506 to 159), and leprosy (36 to 26). Despite these reductions, crude projections suggest that more than 700 million persons will experience MSVI or blindness by 2050, principally owing to our growing and ageing global population. CONCLUSIONS: Despite the many resounding successes of VISION 2020, the burden of global blindness and vision impairment is set to reach historic levels in the coming years. The impact of COVID-19, while yet to be fully determined, now threatens the hard-fought gains of global ophthalmology. The postpandemic years will require renewed effort and focus on vision advocacy and expanding eye care services worldwide.

Gerhard Henrik Armauer Hansen (1841-1912)--100 years anniversary tribute.

2012 marks the 100th year of death of Gerhard Henrik Armauer Hansen (1841-1912), who discovered Mycobacterium leprae, but also gave the first systematic scientific work on the leprosy of the eye. The article reviews his life and scientific achievements with special regard to eye and ophthalmology.

Nordisk ophthalmologisk tidsskrift 1889-1892: the Nordic Journal of Ophthalmology - a forerunner of Acta Ophthalmologica.

In the second half of the nineteenth century several ophthalmological journals appeared (Germany, England, France, United States). In the northern countries (Denmark, Finland, Norway, Sweden) an initiative lead to 'Nordisk ophthalmologisk Tidsskrift' published in the scandinavian languages in the years 1889-92. The 'driving force' behind the journal was the first professor in Ophthalmology in Copenhagen, Dr. Edmund Hansen Grut. The purpose with this presentation is to give the background for the rise and fall of the journal which was an attempt to promote Nordic Ophthalmology. The authors turned out, however, to be mainly those involved as editors. The journal never gained broad acceptance and it simply stopped in 1892, without any closing remarks. In spite of its short life the journal should be remembered for the very first publication on the arcuate scotoma, the Bjerrum scotoma from 1889. Although shortlived the initiative was not in vain, as can be read in the preface to the very first volume of Acta ophthalmologica.

75th Anniversary of the Stiles-Crawford Effect(s): a celebratory special symposium, October 23, 2008; Rochester, New York.

There are rather few articles which, so-to-speak, serve to change the landscape in a scientific field. One of those was the discovery of the "directional sensitivity of the retina" by Walter Stanley Stiles and Brian Hewson Crawford (first reported in 1933). Subsequently, their findings were subdivided by Hansen into two logical components, "the Stiles-Crawford Effects of the First and Second Kinds, (SCE- 1 and SCE-2)." The former (SCE-1) dealt with aspects of their research which addressed alterations in perceived brightness of a visual stimulus; the second (SCE-2) was associated with the perceived hue and saturation of these visual stimuli. These discoveries arose out of a failed attempt by W.S. Stiles and B.H. Crawford to measure properly the areas of the entrance pupils of their experimental subjects as part of a research program which addressed problems of glare, e.g., disability glare, in illuminating engineering. Their research was conducted at the National Physical Laboratory (NPL), which is located in Teddington, Middlesex, England. These two fine scientists properly deduced the reason for the failure of their experimental design, and they effectively described and defined a new feature of the visual system which was largely ascribed to the retina. In time, it was realized that this phenomenon was associated in large measure with the waveguide/fiber-optics properties of photoreceptors, and that this was a feature shared by virtually all vertebrate species. This paper is divided into two parts. In the first part, Enoch describes, as best he can, the culture and working conditions at NPL during 1959/60 when he served as a post-doctoral fellow with W.S. Stiles. And in the second part of this paper, the authors describe the findings of W.S. Stiles and B.H. Crawford at the time of their discovery. Today, we celebrate the 75th Anniversary of that research. The organizing committee for this program (alphabetically) is David Atchison, Jay M. Enoch, Vasudevan Lakshminarayanan, and Pieter Walraven. Our group of speakers today will follow with discussions of aspects of subsequent work which has evolved from the initial discoveries made by the late W.S. Stiles and B.H. Crawford.

Eponymous doctors associated with Edinburgh, part 3--Abraham Colles, Sir William Ferguson, John S Haldane, Argyll Robertson, Thomas Young.

In the first papers in this series, it was shown that eponyms were often bestowed on physicians and surgeons who were already famous, had made many discoveries never honoured with eponyms, and were often the leading doctors of their day. Only occasionally was the eponym suggested by a friend or colleague; more usually it was a doctor abroad who wanted to show respect to a great man but the choice of the particular syndrome or discovery was a random one. Eponyms may have had their uses. They were usually much shorter than a detailed description of a medical syndrome or anatomical feature and may sometimes have been used as euphemisms in much the same way as, until recently, bedside teachers protected the patients by speaking of 'mitotic lesions' or 'neoplasms', 'Hansen's Disease' or 'acid-fast bacilli'. The conferring and use of eponyms appears to be lessening but, as shown in this final paper, they are still used and possibly useful, and can tell us things of interest about the recipient and the proposer.

Initial diagnosis of leprosy in patients treated by an ophthalmologist and confirmation by conventional analysis and polymerase chain reaction.

PURPOSE: To report the initial diagnosis of leprosy in patients seeking treatment from an ophthalmologist in a tertiary eye care center, its confirmation by histopathologic and polymerase chain reaction analysis, and review of literature. DESIGN: Noncomparative retrospective case series. PARTICIPANTS: Patients with no known history of leprosy who were selected based on either a clinical suspicion or a histopathologic diagnosis and were found to have ocular or periocular lesions suggestive of leprosy. METHODS: Review of clinical records of patients with no known history of leprosy seen by an ophthalmologist at a tertiary eye care referral center. MAIN OUTCOME MEASURES: Patient demographics, presenting symptoms and signs, diagnostic studies, complications, and treatment. RESULTS: Among the 6 patients (5 women and 1 man; average age, 55 years), only 2 were found to have leprosy from clinical examination alone. Histopathologic characteristics or demonstration of acid-fast bacilli, suggestive of leprosy, were found in 5 patients. Definite confirmation of leprosy was made by polymerase chain reaction performed on formalin-fixed, paraffin-embedded tissues of 4 patients having suspected leprosy based on clinicohistopathologic examination results. CONCLUSIONS: The diagnosis of leprosy relies on the clinical symptom complex, epidemiologic factors, and demonstration of acid-fast bacilli in the tissue sample. Considering that the global leprosy population is 12 million, a patient with leprosy may be found anywhere. The ophthalmologist may be the first one to encounter such patient, in which case suspicion and detection of ocular findings may lead to early treatment of the infection. Polymerase chain reaction may be a new tool in the definite diagnosis of leprosy when suspicion of the diseases is raised by clinicohistopathologic studies.

The ophthalmic trials of G. H. A. Hansen.

G. H. A. Hansen (1841-1912) is widely known as the discoverer of the infectious cause of leprosy. It is less well known that his career was threatened by an episode involving experimentation on the eye. As a staff physician at the leprosy hospitals of Bergen, Norway, early in his career, Hansen learned about ocular involvement in leprosy and co-authored Leprous Diseases and the Eye. In 1873 he observed bacilli in leprous nodules, but proof of an infectious origin was difficult to obtain because the agent could not be cultured and no one had demonstrated direct transmission. Hansen tried several unsuccessful experiments, and in 1879 he passed a cataract knife that had incised an active leprous nodule into a woman's conjunctiva. No nodule developed, but the woman complained of pain and said she was never asked for permission. Hansen was brought to trial where eminent physicians testified on his behalf-but Hansen himself readily admitted that no permission had been sought for fear the woman would say no. He was convicted, and relieved of his post as staff physician, but he was allowed to retain an appointment as Chief Medical Officer of Health for Leprosy, in which capacity he worked for the rest of his life.

[Space perception: the history and its significance for art]. / Rumperceptionen, dens historie og betydning for kunsten.

Some aspects of the opthalmologic history of Denmark are briefly mentioned. Lens extraction in 1667 in Copenhagen, Edmund Hansen Gruts stereoophtalmoscopy in 1857, Ludvig Panums area in 1858 (single vision) space perception and outside this area double vision), squint treatment, Marius Tschernings periscopic spectacle lenses, Henning Rønnes stereoortograph and keiroscope and Gerhard Rønnes stereoscope. Space perception depends mostly on binocular function (convergens), but in fact some space perception occurs in vision due to perspective, accommodation, parallaxe, blurring, colours and shadows. The Danisk Poet, Hans Christian Andersen, has in his novels mentioned latent squint. The German poet Rainer Maria Rilke was much interested in perspective in connection with the development of impressionism, especially Paul Cézanne. Rilke in his later period developed the view that concentration on perspective removed those essential aspects from the world, in which he found God or a fourth dimension, as exemplified in the presence of ghosts.

Estudo da variação da pressão intra-ocular postural e do tempo do ciclo pupilar na hanseníase / ?

Com o objetivo de estudar a variação da pressão intra-ocular postural e o tempo do ciclo pupilar em hansenianos de controle ambulatorial de um hospital universitário, foram selecionados voluntários sadios e pacientes paucibacilares e multibacilares. As medidas da pressão intra-ocular, realizadas com a tonometria de aplanação, demonstraram que as pressões intra-oculares médias na posição sentada, não apresentaram diferenças estatisticamente significativas entre os grupos estudados. As medidas realizadas na posição sentada e em decúbito dorsal imediato demonstraram que houve tendência à maior variação da pressão intra-ocular postural no grupo multibacilar, não havendo, entretando, significância estatística no achado; as medidas realizadas cinco minutos após a permanência na posição de decúbito dorsal demonstraram aumento siginificativo da pressão intra-ocular no grupo multibacilar. As medidas do tempo do ciclo pupilar, realizadas clinicamante na lâmpada de fenda, apresentaram-se mais prolongadas no grupo multibacilar, seguidas pelo paucibacilar e pelo controle, havendo diferenças estatíticamente significativas entre este e o multibacilar. Os achados podem sugerir comprometimento do sistema nervoso autônomo ocular, mas não foi observada correlação entre a variação da pressão intra-ocular postural e o tempo do ciclo pupilar na hanseníase.

[Research at the African Institute of Tropical Ophthalmology]. / Recherche à l'IOTA.

Research is one of the four main activities of AITO. It is vital for the determination of health care priorities, and for the design, implementation, and evaluation of programs and projects in OCCCMED countries. Most of the research is surgical and focused on the diseases which cause blindness. Cataracts are the principal cause of blindness and have been the focus of many studies aimed at making surgery more accessible in terms of both geographical availability and cost. Trachoma is a major public health priority in the countries of the Sahel and a survey of its prevalence is underway in several countries. This study should lead to the development of preventive and curative treatments aimed at controlling blindness caused by trachoma by the year, 2020. Vitamin A deficiency, the cause of xerophthalmia and high mortality rates in infants, has been surveyed in several countries. A survey of glaucoma, another major cause of blindness which is often not recognized or treated, will be carried out in Bamako. Other studies focus on leprosy, malaria and the effects of visual disability on the quality of everyday life. It will be a major challenge over the next five years to develop the capacity within local populations to identify, design and implement research programs in community health aspects of ophthalmology that will take into account the needs and constraints of sub-Saharan Africa.

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.

Enfermedad de Hansen Tuberculoide en región orbitaria / Hansen's disease tuberculoid in orbit region

La incidencia de complicaciones oculares en la Enfermedad de Hansen es mayor en la forma lepromatosa, dada por la mayor presencia del bacilo en las estructuras oculares y sus anexos, por los fenómenos reaccionales tipo 1 y 2, y por daño neurológico del V y VII par craneal. Se observan complicaciones en la córnea, conjuntiva, párpados, iris, pestañas, cejas, cuerpo ciliar, glandula lagrimal y conducto lacrimonasal, con deterioro progresivo hasta la ceguera. Se presenta más precozmente en pacientes con lepra tuberculoide y tardíamente en la forma lepromatosa. Presentamos el caso de una paciente femenina de 78 años de edad con manifestaciones clínicas única de Enfermedad de Hansen Tuberculoide en región periorbitaria izquierda, de un año de evolución