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.

Pupil cycle time and early autonomic involvement in ocular leprosy.

Ocular complications of leprosy patients often develop insidiously and with few if any symptoms. This study involves measurement of the pupil cycle time (PCT) to evaluate the autonomic nerve system of the iris to determine the presence of subclinical intraocular involvement. The study included 19 lepromatous (LL), 19 borderline lepromatous (BL), and five borderline tuberculoid (BT) leprosy patients and involved 25 healthy volunteers, 10 patients with pulmonary tuberculosis and eight with Duhring disease. The PCT was measured in these groups. In all leprosy groups included in the study the PCT was higher than in the control groups. Moreover, the PCT of the leprosy patients without any intraocular involvement was higher than in the controls. These results show that in the ophthalmic examination of leprosy patients without any symptoms the fact that autonomic nerve system of the eye is affected by the leprosy can often be determined by measuring the PCT.

Intraocular pressure and iris denervation in Hansen's disease.

We retrospectively analyzed 255 Hansen's disease patients and found low intraocular pressure (less than 7 mm Hg) in 12% of them. We showed a correlation between low intraocular pressure and avascular keratitis and iritis. We also found that patients with low intraocular pressures had abnormally large postural changes in intraocular pressure. We speculate that abnormalities in the autonomic innervation of the anterior segment of the eye may be related to the intraocular pressure abnormalities. Further investigations along this line may increase our understanding not only of the pathophysiology of Hansen's disease but also of the mechanisms regulating homeostasis of intraocular pressure.

Estudo da clínica ocular em hansenianos em hospital de dermatologia sanitária: a prevençäo em nossas mäos / Ocular study of Hansen's disease at a dermatological hospital: the prevention in our hands

Este estudo foi baseado na observaçäo de 363 pacientes portadores de diferentes tipos da Doença de Hansen. Ao examinarmos o paciente, näo tínhamos conhecimento prévio do seu tipo de lepra, de modo que o exame do paciente podia ser realizado sem que houvesse a influência de um diagnóstico precedente. O protocolo consistiu dos seguintes ítens: acuidade visual, funçäo do músculo facial, estudo das sobrancelhas, cílios, aparelho lacrimal, pupila, motilidade ocular, sensibilidade corneana, teste de Schirmer e estudo do segmento anterior do globo ocular com lâmina de fenda. Nosso estudo compreendeu 363 pacientes portadores das seguintes formas: Virchowiana (275), Tuberculóide (57), Indeterminada (29) e Dimorfa (2). A idade variou de 18 a 82 anos. Havia: 229 homens e 134 mulheres; 183 brancos, 157 mulatos e 23 negros

Uveal changes in leprosy.

A total of 424 leprosy patients were screened for uveal involvement. Uveal changes were found in 11.2% of these patients. Uveal involvement was more common in patients with greater duration of the disease and in patients on irregular Dapsone therapy. Of the patients with uveal involvement 82% were lepromatous, 16% were borderline and 2% were of tuberculoid leprosy. Uveal changes in form of active iridocyclitis (21.3%), healed iridocyclitis (58.5%), iris atrophy (10.6%), iris pearls (7.4%), small irregular pupil (46.7%), pupil refractory to dilatation (56.3%) were seen. Posterior segment involvement was rare. Lepromatous and borderline leprosy patients with no clinical evidence of uveal involvement had decreased power of accommodation as compared to normal subjects.

Ocular findings in leprosy in the United States.

We examined 55 clinic patients with biopsy-proven Hansen's disease and catalogued the ocular findings. Forty patients had lepromatous disease and 15 had tuberculoid disease. Visual acuity was 20/40 or better in 52 patients. Examination of pupillary size in all cases and after dilation with cocaine and hydroxyamphetamine in 15 cases showed decreased sympathetic innervation to the iris dilator muscle in seven cases. Ocular inflammation was uncommon: there was one case of active interstitial keratitis, three of episcleritis, and four of iritis. Although 41 patients had ocular problems attributable to Hansen's disease, the severity of the ocular complications was much less than reported in similar studies from other countries. We believe that the differences were the result of effective antimicrobial and anti-inflammatory therapy.

A study of autonomic functions in leprosy.

The two groups of leprosy patients were compared with normal for the evaluation of the functional status of the autonomic nervous system, with the aid of several established procedures. Our findings reveal that in the leprosy patients the adrenergic system is hypo-functional as compared to the cholinergic. Further, in maculoanaesthetic group, there appears to be a physiological Dale's vasomoter reversal when adrenaline was used.

A study of autonomic functions in leprosy

The two groups of leprosy patients were compared with normal for the evaluation of the functional status of the autonomic nervous system, with the aid of several established procedures. Our findings reveal that in the leprosy patients the adrenergic system is hypo-functional as compared to the cholinergic. Further, in maculoanaesthetic group, there appears to be a physiological Dale's vasomoter reversal when adrenaline was used.