Histopathological study of ocular erythema nodosum leprosum and post-therapeutic scleral perforation: a case report.

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae , clinically present either as tuberculoid, borderline or lepromatous type. Erythema nodosum leprosum (ENL) is an acute humoral response in the chronic course of lepromatous leprosy. Although very severe ENL reactions are known in systemic leprosy, such severity is rare in ocular tissues. A leprosy uveitis patient suffered from a severe form of post-therapeutic ENL reaction which resulted in perforation of the globe at the site of preexisting subconjunctival leproma. Painful blind eye was enucleated. Histopathological study revealed infiltration of numerous polymorphs and macrophages packed with acid-fast bacilli in the conjunctiva, cornea, ciliary body, ora serrata and sclera. A profuse influx of neutrophils on a background of macrophages packed with M. leprae confirmed the ocular ENL reaction. This case is reported to alert the ophthalmologists to a rare ocular complication of ENL.

Lepra Ocular, conceptos actuales / An update in ocular Leproxy

Se cree que la lepra es la enfermedad sistemática con mayor incidencia de repercusión ocular, La afectación ocular se produce sobre todo en las formas lepromatosas. Las manifestaciones oculares son proteiformes y se relacionan con la invasión por el bacilo de las estructuras del segmento anterior y/o anejos, reacción inflamatoria y/o afectación neural de las estructuras oculares. La manifestación extraocular más frecuente es la madarosis de las cejas. La córnea es la parte más afectada del globo presentando una forma de queratitis patognomónica de localización temporal superior. En el iris aparecen también lesiones características como atrofia peripupilar aspecto atigrado y miosis insalvable por denervación. Es además característica la uveítis aguada y crónica. Las lesiones esclerales, son infrecuentes, aunque muy espectaculares. En el fondo de ojo solo se han descrito lesiones de forma esporádica

Leprosy the systemic disease with higher incidence of ocular findings. Eye disease is shown especially in lepromatous disease. Ocular complications are assorted and related to anterior segment and/or extraocular structures invasion by Mcobacterium leprae, inflammatory reaction, and nervous damage of the ocular structures. Superciliary madarosis is the most common extraocular finding. Cornea is the main affected structure of eye. There is a characteristic keratitis located in the superior temporal quadrant. The iris shows typical lesions like peripupilary atrophy, the pupil can be miotic and not responsive to mydriatics because of denervation. The scleral lesions are rare but amazing. Posterior segment lesions have been sporadically described

Expression of protein gene product 9.5 in lepromatous eyes showing ciliary body nerve damage and a "dying back" phenomenon in the posterior ciliary nerves.

BACKGROUND/AIM: Peripheral nerve destruction is the hallmark of leprosy. Ocular complications form a substantial part of the clinical manifestations but histopathology of nerve destruction within ocular structures has not been shown satisfactorily. The role of protein gene product (PGP) 9.5 in identifying nerve destruction in the ciliary body and posterior ciliary nerves of lepromatous eyes is shown. METHODS: Serial sections from two lepromatous eyes and two non-lepromatous eyes were stained with PGP 9.5. Histopathological comparison was done on the expression of the PGP 9.5 stain in nerves within the ciliary body, posterior ciliary nerves adjacent to the optic nerve, and nerves tracking through the sclera. RESULTS: In non-lepromatous eyes, PGP 9.5 was expressed in nerves within the ciliary body, the nerves within the sclera, and posterior ciliary nerves adjacent to the optic nerve. In lepromatous eyes no PGP 9.5 was expressed, signifying nerve destruction. CONCLUSIONS: Nerve destruction in lepromatous eyes has been confirmed histopathologically by the absence of or patchy staining with PGP 9.5. Nerve destruction in the ciliary body can extend to the posterior ciliary nerves by an ascending axonopathy. This "dying back" phenomenon is akin to the "glove and stocking" anaesthesia found in lepromatous leprosy.

Recurrent scleritis in lepromatous leprosy.

BACKGROUND: Recurrent immune-mediated scleritis after adequate treatment of leprosy is not well documented in the literature. We describe an Australian resident with unilateral intra-ocular lepromatous leprosy who had persistent non-infectious scleritis. METHODS: A man of Anglo-Indian ancestry initially presented with lepromatous leprosy and unilateral ocular involvement. The affected eye had an interstitial keratitis and a granulomatous anterior uveitis that responded to antileprotics and anti-inflammatory agents. Despite systemic cure with triple antileprotic therapy, he developed recurrent scleritis that required multiple scleral patch grafts for scleral thinning and, subsequently, an enucleation. Histology failed to demonstrate persistent infection, rather a chronic non-granulomatous scleritis, which was probably immune mediated. RESULTS/CONCLUSIONS: This case demonstrates an ocular complication of leprosy that is infrequently reported. Patients with ocular involvement by leprosy are at risk of developing recurrent scleritis despite systemic cure with antileprotics.

Impregnaçäo sui generis conjuntivo-escleral por clofazimina em um paciente portador de hanseníase / Impregnation sui generis of the conjunctiva and sclera by clofazimine in a carrier Hansen's disease

Os autores apresentam o caso de um paciente de 40 anos de idade, portador de hanseníase forma virchoniana que recebeu, por via oral, durante 9 anos, clofazimina, numa dose total de 324 gramas. Apresentou intensa pigmentaçäo na conjuntiva e esclera por este medicamento. A biomicroscopia observavam-se com facilidade cristais policromáticos na conjuntiva e esclera de ombos os olhos. O estudo destes cristais também foi possível à microscopia óptica de fragmento da conjuntiva a fresco. O caso é discutido com os achados na literatura e os autores chamam a atençäo para os diagnóticos diferenciais

Ocular leprosy in nine-banded armadillos following intrastromal inoculation.

Leprosy shows a higher percentage of ocular involvement than any other systemic infection. In humans, the cornea is the first ocular tissue affected. Our previous studies in armadillos with naturally acquired and experimental disseminated leprosy showed that 44% had corneal infection. Mycobacterium leprae is found in armadillo burrows in Louisiana, U.S.A., and ocular abrasions may be the portal of entry for these organisms in wild armadillos. To test the cornea as a route of infection, we injected eight armadillos intrastromally with 2 x 10(6) M. leprae in 1 microliters. Two and 4 months later, the armadillos were sacrificed and their eyes processed for light- and electron-microscopy. After 2 months, M. leprae were found in histiocytes mainly in the corneal limbus, sclera and bulbar conjunctiva. At 4 months, however, there was a visible corneal leproma in one animal. Microscopically, it was found to be a histiocytic granuloma with heavy M. leprae invasion. In addition, cells were seen in the anterior chamber. Leprosy is endemic in regions where other corneal infections which compromise the epithelial barrier property are prevalent and where leprosy bacilli are found in the environment. The entry of leprosy bacilli into the cornea may produce lesions which spread posteriorly in the eye.

[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.

Lepromatous iridocyclitis diagnosed by anterior chamber paracentesis.

A 34-year-old man with a three-month history of intraocular inflammation after ocular trauma with a fir branch, had an acute unilateral fulminant iridocyclitis. The iris had a thick, gray, cheesy membrane composed of nodular lepromata. The patient denied a history of Hansen's disease, despite the dermatologic and facial features that suggested the diagnosis. Anterior chamber paracentesis and scleral nodule biopsy demonstrated Mycobacterium lepra. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin.

Ocular leprosy in the Canal Zone.

The results of a two year survey of eye problems among the patients at the Palo Seco Hospital in the Canal Zone are presented. Only two patients, one classified as having lepromatous leprosy and the other as having the tuberculoid form of the disease, failed to exhibit ocular complications. The high prevalence of leprotic ocular disease (96%) is most probably due to the advanced age of the patients, the lengthy duration of their illness, and the high percentage of patients afflicted by the lepromatous form of the disease.