Factors influencing corneal involvement in leprosy.

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.

Cataract surgery in the management of the late complications of lepromatous leprosy in South Korea.

Clinical examination of 113 patients in South Korea with lepromatous leprosy and severe visual impairment showed that the main cause of visual loss was the combined effect of corneal and lens opacities associated with small nonreacting pupils and iris atrophy. Cataract surgery with broad iridectomy and inferior sphincterotomy offers these patients with chronic lepromatous complications the best chance of preserving vision. Eighty-one cataract operations were performed under local anaesthesia, and in 90% vision improved; in 60% this improvement was 2 Snellen's lines or more.

Unsuspected ocular leprosy

Ophtalmic findings suggestive of leprosy include loss of eyebrows and eyelashes, beaded corneal nerves, puntacte subepithelial superior limbal corneal opacities, entropion of the upper eyelids, conjunctival hyperemia an the other canthal area, iris pearls and unexplained unilateral or bilateral 7th nerve histories were presented. The average time interval between the initial presenting complaint the establishment of the correct diagnosis was six years. There is no accurate method of determining the real incidence of leprosy in the United States, but it would appear to be higher than suspected. Ophthalmologists should consider leprosy when examining patients with any of the findings just mentioned, particularly if the patient has a sssociated skin or neurologic findings or nasal stuffiness.