Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

Unsolved matters in leprosy: a descriptive review and call for further research.

Leprosy, a chronic mycobacterial infection caused by Mycobacterium leprae, is an infectious disease that has ravaged human societies throughout millennia. This ancestral pathogen causes disfiguring cutaneous lesions, peripheral nerve injury, ostearticular deformity, limb loss and dysfunction, blindness and stigma. Despite ongoing efforts in interrupting leprosy transmission, large numbers of new cases are persistently identified in many endemic areas. Moreover, at the time of diagnosis, most newly identified cases have considerable neurologic disability. Many challenges remain in our understanding of the epidemiology of leprosy including: (a) the precise mode and route of transmission; (b) the socioeconomic, environmental, and behavioral factors that promote its transmission; and

Prevençao da cegueira em hanseníase

1- As manifestaçoes oculares da hanseníase podem ser causa de cegueira em aproximadamente 250.000 indivíduos no mundo. Portanto, é claro que a hanseníase ocular se constitue em importante fonte de cegueira evitável. Há necessidades claras de açoes coordenadas para prevenir a perda visual nos pacientes com hanseníase. 2- A detecçao precoce e tratamento da hanseníase é de grande importancia para previnir futuras complicaçoes e incapacidades devidas à doença, incluindo a perda visual. Programas nacionais de controle da hanseníase e prevençao de cegueira devem, portanto, ter uma atuaçao ativa na identificaçao e tratamento destes pacientes com risco de cegueira. 3- Há uma forte necessidade de alertar os profissionais que trabalham com oftalmologia para hanseníase ocular e suas consequências. Com este objetivo os treinamentos nas escolas médicas em nível de graduaçao e pós graduaçao necessitam ser enfatizados. 4- Recomenda-se que todas as reunioes nacionais e internacionais de hanseníase devem dar particular atençao para a hanseníase ocular. 5- Profissionais de saúde que atuam com a hanseníase e assistentes oftalmológicos devem ter um papel chave na detecçao e conduçao da morbidade ocular

[Eye involvement in leprosy. A study in Togo, West Africa]. / Augenbeteiligung bei Lepra. Eine Studie in Togo/Westafrika.

It is well known that ocular changes occur in leprosy, but data on their frequency differ very considerably (0.8-100%). Two groups of lepers in Togo were examined: first, 206 lepers who had had the disease for approximately 10 years and a second group (101) patients who had been suffering from it for approximately 24 years and had severe mutilations. It became apparent that sooner or later all lepers suffer from ocular complications. The following symptoms were found: loss of the eyebrows in 40.8% (42.6%), loss of the eyelashes in 29.6% (34.6%), lagophthalmos caused by involvement of the 7th cranial nerve in 21.4% (31.7%), corneal changes in 34.5% (49.5%), uveitis in 5.8% (19.8%), atrophy of the optic nerve in 12.6% (11.9%) and cataract in 21.8% (12.8%). The duration of the disease, the type of leprosy and the time when treatment was started are obviously the main factors associated with ocular changes in leprosy.

Leprosy in a trachomatous population.

In an Egyptian leprosy hospital, 17% of 133 patients had a visual acuity of less than 3/60. Corneal opacity, phthisis bulbi, and cataract accounted for 85% of blindness. Leprosy and trachoma together produce blinding corneal opacity by exposure, leprous keratitis, and trichiasis and entropion. Inturned lids, a late result of conjunctival scarring due to childhood trachoma, were less frequent in patients with lepromatous leprosy than in patients with tuberculoid leprosy; because conjunctival scarring from trachoma depends on cell-mediated immunity, patients with lepromatous leprosy may not have had severe trachomatous scarring develop due to their lifelong abnormality in cellular immunity. In patients with leprosy, even when complicated by trachoma, simple measures to prevent or restore vision include medical treatment of leprosy, surgical correction of lid deformities, sector iridectomy for constricted pupils or central corneal opacities, and cataract extraction.