|Year : 1986 | Volume
| Issue : 1 | Page : 15-18
Leprotic paralytic lagophthalmos with ectropion and its surgical correction
Pavan Kumar, RC Saxena, SN Srivastava
Departments of Ophthalmology & Dermatology King George's Medical College, Lucknow, India
Departments of Ophthalmology & Dermatology, King George's Medical College, (Lucknow)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar P, Saxena R C, Srivastava S N. Leprotic paralytic lagophthalmos with ectropion and its surgical correction. Indian J Ophthalmol 1986;34:15-8
|How to cite this URL:|
Kumar P, Saxena R C, Srivastava S N. Leprotic paralytic lagophthalmos with ectropion and its surgical correction. Indian J Ophthalmol [serial online] 1986 [cited 2020 Feb 19];34:15-8. Available from: http://www.ijo.in/text.asp?1986/34/1/15/26351
Leprosy an ancient disease, has a high incidence of ocular involvement. Since mycobacterium leprae has a predilection for peripheral nerves the superficial branches of the trigeminal and facial nerves are involved, resulting in an insensitive cornea and lagophthalmos. Paralytic ectropion of lower lid is due to loss of tone of the orbiculous oculi muscle, resulting in persistent watering. So, a. double threat to the cornea exists wherein foreign bodies and the discomforts of an exposed cornea go unnoticed and the unblinking lid fails in its protective function. Thus blindness results in a patient with arrested or active leprosy, if the motor function of the lids is not restored, since little can be done to restore corneal sensation. This paper presents a clinical study of VII cranial nerve involvement in leprosy, with a brief discussion about the surgical amelioration of lagophthalmos and ectropion in one of the cases with bilateral involvement.
| Material and methods|| |
100 leprotic patients studied and were clinically classified as below
1. Lepiomatous leprosy .. 64 patients
2. Tuberculoid leprosy .. 28 patients
2. Borderline leprosy .. 8 patients
Only 7 patients with tuberculoid leprosy had leprotic paralytic ectropion. These patients of orbicularis-oculi involvement had symptoms of chronic tearing, watering, irritation and diminution of vision to different extents. [Table - 1]. All these patients were having V and VII nerve involvement.
On examination, these patients were of average built and showed bilateral ocular adenxal findings-loss of eye-lashes and eyebrows, skin nodules, paralysis of Orbicularisoculi, anaesthetic patches on the skin, with diffuse infiltration of lids, which were stiff and immobile, lagophthalmos was present.
The cornea showed moderate to severe degrees of exposure Keratopathy, Punctate Keratitis and corneal Scarring, Vascularised corneal opacity was present in one patient.
On investigation, the lacrimal passages were fully functioning even after several years of leprotic ravaging of the surrounding tissues.
All patients with Orbicularis-oculi palsy had been on Tablet Dapsone for two years or more. The progress of the active disease was halted, but the sequale to the Vth and VIlth cranial nerve involvement required surgery under general anaesthesia separately in each eye. Surgical technique for correction of lagophthalmos used was the Gillie'sMusculo fasical sling, utilizing the temporalis muscle in a modified form as first tried by Jhonson in 1962, which consists of using the lower portion of the temporalis tendon and leaving the muscle fibres untouched in their lid, so that the polarity of the muscle transplant is not reversed, unlike that in Gillie's Procedure, thereby the function and movement of the new lid motor is assured.
| Observations|| |
Each operated eye of the patient was clinically examined regarding the following parameters-as shown in [Table - 2]. There was same ability of the transfer to act independently of the rest of the temporalis muscle and reflex activity in the temporalis transfer was present to some extent. Both eyes of one patient were operated, separately and successfully. So success rate was 100%. [Table - 2].
| Discussion|| |
Non-operative conservative treatment has nothing to recommend to the lagophthalmos in leprosy, though medical treatment such as local Priscol injections in the neighbourhood of the facial nerve has been tried.
Various surgical techniques have been employed to correct such deformities and rehabilitate such unfortunate victims. Tarsorraphy of the lateral half of the eyelids had given only partial success. Surgeons have associated the above described technique with that of Kuhnt-Szymanowski's.
In others, in addition to raising the lower lid with strips of fascia lata, a subtotal section of the L.P.S. has been done in an attempt to narrow the opening of the levator through lack of antagonism of the orbicularis.
Our consensus is in favour of the above simple technique, as there was no necessity of repitition or addition of the other sites and thus a commendable improvement was made regarding the patient's countenance and alleviating his discomfort.
Thus this method does not provide an ideal solution, yet it provides for a reasonably efficient working device capable of protecting the eyeball. It ensures gentle pressure of the lower eyelid on surface of the eyeball rectifying the position of the lacrimal ducts and directing the flow of tears almost normally.
| Summary|| |
In 100 cases of leprosy, 7 developed lagophthalmos, Ectropion, watering and exposure Keratitis, from involvement of VIlth and Vth cranial nerves. With the recent effort, and rehabilitation of such patient, we used the method originated by Sir Harold Gillie to restore lid function. A motor mechanism for the paralysed lid was created by using a portion of the temporal is muscle, unconsciously when the jaws moved in chewing or biting or by conscious effort, thus correcting exposure Keratitis and preventing blindness.
| References|| |
Ffytche, T.J. 1981, Brit. J. Ophthalmol. 65: 231-239.
Jhonson, A. H 1965, International J. Leprosy, 33 : 89-94.
Nema, H.V. and Mathur, J.J. 1967, Rev. 38: 159-161.
Saxena, R.C., 1963, J. All Ind. Ophthal. Soc. 11: 13-16.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2]