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Ophthalmology DepartmentHasanuddin University

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Introduction

Leprosy is a chronic granulomatousdisease caused by the intracellular acid-fast bacillus Mycobacterium leprae,

whose clinical manifestations are largelyconned to the sin, peripheral nervoussystem, upper respiratory tract and eyes!

"t is estimated that #!$-%& of the totalare blind from leprosy related causes andanother % percent are blind from non-leprosy causes!

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leprosy patients can be regarded as aspectrum determined by the cell-mediated

immunity of the individual! 'atients are either paucibacillary (smear

negative) or multibacillary (smear positive)! *enerally in paucibacillary cases, damage

to the eye is caused indirectly by M!lepraeeither secondary to motor or sensory nervedamage!

"n multibacillary cases, eye is damaged dueto inltration by M!leprae!

+or simplicity, ocular lesions can beclassied in to two groups!#! potentially sight threatening lesions !

%! academic lesions!

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Potentially sight threateninglesions

Lagophthalmos (whole spectrum)

Corneal hypoaesthesia (whole

spectrum) Acute iritis and scleritis (MB

leprosy)

Chronic iritis and iris atrophy(MB leprosy)

Cataract (whole spectrum)

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Academic lesions

o visual signicance but contributeto the stigma which these patientsendure!

.uch as loss of eyebrows andeyelashes!

Hair loss is due to hair rootinltration with lepromatousgranuloma!

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Ocular complication

1. Extra ocular

Cilia

Palpebra

Lacrimal gland

2. cular

Anterior segment

Posterior segment

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Extra ocular

Complication Madarosis supercilia

/esult of damage to the cilia root due toleprosy bacilli and generally on the old

type lepromatous 'alpebral atrophy0his situation can aggravate ectropion

Lagophtalmos

1aused by orbicularis oculi muscleparalysis as the e2ect of ! 3""(inltration of leprosy bacilli to thenerve) damage

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Lacrimal secretion disorders

0riggered to various causes4

'alpebral dysfunction Loss of blining re5e6

7ctropion

8cute and chronic Dacryocystitis .econdary organisms and destruction of

the nasal bones resulting in obstructionof the nasolacrimal duct!

Extra ocular

Complication

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Ocular complication

Most of the ocular complications caused by 4 1on9uctiva 1ornea

7pisclera 8nterior sclera "ris 1illiary :ody Lens

1omplications occur depends on4 "mmunological status of patients 0ype of leprosy

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Con!ucti"a

8 mild con9unctival in5ammation

with edema and dilated bloodvessels may be seen!

'terygium, with collections ofmacrophages containing M! leprae,has been reported!

Ocular complication

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Cornea M! leprae can invade the structure only by

direct e6tension from surrounding tissues!

0he ; common lesions are 0hicening and beading of corneal nerves .upercial punctate eratitis (.'

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Episclera and #clera

0his involvement is common in

untreated lepromatous patients! 'resenting with nodules up to $ mm

in diameter at the sclerocorneal9unction!

.cleritis is mostly seen in advanceduntreated lepromatous patients andmay weaen the globe!

Ocular complication

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Ciliary $ody and &ris Lepromatous iridocyclitis is one of the

commonest causes of blindness in leprosy!

8cute iridocyclitis is a commoncomplication of erythema nodosumleprosum (7L) reactions!

Miliary lepromas or iris pearls near the

pupillary margins pathognomonic! Destruction of the tissues of the iris and

ciliary body causes atrophy and shrinageof the globe nown as pthisis bulbi!

Ocular complication

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Lens

1hronic iridocyclitis may be

responsible for the early formation ofcataract!

.teroids, used in the treatment oflepra reactions may hasten theformation of subcapsular cataract!

Ocular complication

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'osterior segment

0he choroid and retina are not

ordinarily involved in leprosy! 0here have been a few anecdotal

reports of e6tensions of lepromatouslesions form the ciliary body to thechoroid which appear as minutenodular lesions!

Ocular complication

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Ocular complication

(image)

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Ocular complication

(image)

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Conclusion

0he eye is involved in all forms ofleprosy, more in lepromatous thantuberculous leprosy!

/epeated and careful e6amination ofthe eye especially of those withlepromatous leprosy and those with

nerve involvement a2ecting the eyecannot be overemphasi?ed!

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