Estudo das alterações oculares em pacientes hansenianos provenientes de área hiperendêmica (Município de Sooretama, Espírito Santo) / Ocular manifestations in leprosy patients at the hyperendemic area of the Southeast Brazil

Objetivo: Estimar a freqüência de alterações oftalmológicas em pacientes hansenianos de controle ambulatorial em Município hiperendêmico em Hanseníase no norte do Estado do Espírito Santo (Sooretama). Local: Posto de saúde da prefeitura do Município de Sooretama . Materiais e Métodos: Trinta e nove pacientes hansenianos, provenientes do Programa de Controle de Hanseníase do Município de Sooretama no ano de 2001, foram submetidos a exame oftalmológico de acordo com protocolo pré-estabelecido. Os dados obtidos e os dados referentes a doença foram cruzados e analisados estatisticamente. Resultados: Dos 39 pacientes avaliados, vinte e um casos (53,85 porcento) eram da forma Indeterminada, 13 casos (33,33 porcento) da forma Dimorfa, 4 casos (10,26 porcento) da forma Tuberculóide e 1 caso da forma Virchowiana. A acuidade visual foi melhor que 0,8 em 74,35 porcento dos olhos e em nenhum caso a baixa de acuidade visual foi atribuída diretamente a Hanseníase. A alteração ocular mais freqüentemente encontrada foi a madarose parcial de supercílios com 12 casos (30,77 porcento), seguida pela hiposecreção lacrimal com 7 casos (17,94 porcento) e madarose parcial de cílios com 6 casos (15,38 porcento). A hipoestesia corneana e catarata ocorreram em 5 casos (12,82 porcento). Triquíase, opacidades corneanas e ceratite puntata ocorreram em 3 casos (7,69 porcento). Esclerite foi observada em 2 casos (5,13 porcento). Não foram observados neste estudo: entrópio, ectrópio, eritema nodoso, dacriosistite, madarose total, corneoescleral roll, episclerite, anestesia corneana, espessamento de nervos corneanos, vascularização, úlceras corneanas, precipitados ceráticos, nódulos irianos, sinéquias, esférulas hansenóticas, irite aguda e crônica. Conclusão: A baixa freqüencia das manifestações oftalmológicas graves foi atribuída a alta prevalência da forma Indeterminada da Hanseníase.

Clinical ocular study in leprosy patients at a sanitary dermatological hospital in Brazil.

This study is based upon the observation f 363 leprosy patients having different types of the disease. At the time of the examination, we did not have any previous knowledge about the type of leprosy the patients were having. Thus, the eye examination was done without the knowledge of clinical diagnosis. The ocular examination protocol covered the following: visual activity, facial muscle function, eyebrows, eyelashes, lacrimal system, pupil, eye motility, corneal sensitivity, Schirmir's test and study of the anterior segment of the ocular bulb with a slit-lamp. The study patients included 275 cases of lepromatous leprosy, 57 tuberculoid, 29 indeterminate and two dimorphous cases. The age of the patients ranged between 18 and 82 years, and 229 of them were males. Among those patients, 183 were whites, 23 were black and 157 were mulatto.

Study of ocular changes in leprosy patients.

In this study, 997 leprosy patients were examined, 528 of them with lepromatous leprosy (53%), 199 with borderline leprosy (20%), 167 with tuberculoid leprosy (16%) and 103 (10.3%) with indeterminate leprosy. Changes in the ocular bulb were noted in 314 patients (31.5%) specially in those with lepromatous leprosy. These alterations were greater with increasing age of the patient and length of disease. Severe ocular lesions were rare, probably due to previous systemic treatment. The "pearls" in the fundus of the eye resulting from leprosy were also studied.

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.

Assessment and treatment of the dry eye in leprosy.

During the period of existence of the Ophthalmologic Prevention Centre we have come across a large number of patients with corneal dehydration (dryness cornea, dry eye) due to various causes. We find that majority of the patients had a big improvement in their symptoms and the signs of the dry eye with just a simple prevention technique.

Presence of M. leprae in the conjunctiva, vitreous body and retina of a patient having lepromatous leprosy.

Histopathological study of the ocular globe of a lepromatous leprosy patient revealed the presence of lepra bacilli in the conjunctiva, sclera, episclera, cornea, iris, ciliary body, vitreous body and retina.