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ARTICLE
Year : 1966  |  Volume : 14  |  Issue : 5  |  Page : 214-216

Survey of ocular complications in lepromatous leprosy


Govt. Opthalmic Hospital, Madras, India

Date of Web Publication17-Jan-2008

Correspondence Address:
E Balakrishnan
Govt. Opthalmic Hospital, Madras
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Balakrishnan E. Survey of ocular complications in lepromatous leprosy. Indian J Ophthalmol 1966;14:214-6

How to cite this URL:
Balakrishnan E. Survey of ocular complications in lepromatous leprosy. Indian J Ophthalmol [serial online] 1966 [cited 2021 Jul 28];14:214-6. Available from: https://www.ijo.in/text.asp?1966/14/5/214/38657

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Due to the advances in Plastic Sur­gery, rehabilitation of leprosy patients have received enough attention. How­ever, the ocular complications continue to be dreaded. So a survey was con­ducted at the Central Leprosy Teach­ing and Research Institute, Tirumani, Madras (1960-62), to assess the extent of the problem in this region. This Institute has 884 beds where infective lepromatous leprosy patients are ad­mitted and treated till they are none infective.

During the survey, the patients were examined routinely ward by ward and the following questions were kept in mind

a) Whether the ocular complica­tions were prevented by treat­ment with sulphone or its com­pounds;

b) Did the ocular complications in­crease with the age of the pa­tients.

In each patient, the acuity of vision, the duration of leprosy since it was first diagnosed and the duration of treatment at the time of survey were noted. The anterior segments of the eyes were examined with a hand slit lamp and the fundii with an Ophthal­moscope.


  Result of Surgery Top


In all 385 Infective Lepromatous patients were examined, out of which 178 (46%) had Ocular complications.


  Discussion Top


Ocular complications in Leprosy vary in different countries. Holmes (1957) found that in Japan, Korea, Okinawa, Formosa and Hongkong 10% of the leprosy patients had ocular complications. He noted that in India the percentage was larger. In Israel, Landon and Gobboy (1955) suggested that the involvement of the eyes was over 90%. In Havana, Lopes found "Some lesions of the eyes or its ap­pendages in every single case of Lep­rosy".

In this survey 46% had ocular com­plications even during treatment with sulphone or its compounds. Superfi­cial Keratitis seemed to be the com­monest of the complications and in many cases it was found along with other complications of the eye. The Interstitial Keratitis though often des­cribed as a common complication of lepromatous leprosy, was found to be only one per cent. Chronic dacryo­cystitis was rare. Ten cases of leproma iris and two cases of iris pearl were seen. In a subsequent review after six months, it was interesting to note that in six cases lepromas and in one of iris pearl the nodules got spontaneously absorbed. Choroiditis, though said to be rare was found to be in 9 percent and there was one case of retinal pearl. Iridocyclitis constituted 17 per cent and continued to be a dreaded compli­cation leading to blindness. Two types of them were seen:

(1) Granulomatous, insidious in onset, without congestion or pain, with posterior synaechiae and chronic in nature:

(2) non-granulomatous with acute onset, with pain and circum­corneal congestion and keratic precipitates.

There were exacerbations and re­missions. Often the Erythema Nodo­sum Leprae reaction is followed by the second type of iridocyclitis.

During the survey, it was noted that some patients had congested eyes with a feeling of tiresomeness and pain over all the joints on the day of taking sulphone tablets. During the rest of the week, they were free from these symp­toms. It might be due to a minor degree of bacterial or tissue allergy and a higher dose of sulphone might have precipitated a reaction with acute iridocyclitis.

In this survey the following points of interest were noted

(1) The longer the duration of lep­romatous leprosy, the greater was the percentage of ocular complications.

(2) In spite of treatment with sul­phone or its compounds, lepro­tic iridocyclitis continued to be a serious problem. Once set in, it continued for years and the treatment was only symptoma­tic.

(3) Fifty per cent of leproma iris and iris pearls spontaneously regressed within six months.

(4) Ophthalmologists should think of new ways and means of pre­venting and treating leprotic iridocyclitis instead of living in false security when sulphone or its compounds are used for treatment.

I thank Dr. Dharmendra, the Direc­tor of the Central Leprosy Teaching and Research Institute, Tirumani for providing all the facilities to conduct this survey, Dr. Guhanandam, who vo­lunteered to assist me, the Staff Nurse Ramesh, for all the help rendered and I am thankful to Dr. G. Venkatasamy, Professor of Ophthalmology, Medical College, Madurai for the photographs.[4]

 
  References Top

1.
Alan C. Woods "Endogenous Uveitis", The Williams & Wilkins Company, Baltimore.  Back to cited text no. 1
    
2.
R. G. Cochrane "Leprosy in Theory and Practice", John Wright and Sons Ltd.. Bristol.  Back to cited text no. 2
    
3.
W. J. Holmes (1957), Leprosy of the Eye. Leprosy Review No. 3 Vol. XXVIII-Quarterly publication of Bri­tish Leprosy Association.  Back to cited text no. 3
    
4.
Somerset E. J. and Sen N. R. (1956), British Journal of Ophthalmology 4; 167.  Back to cited text no. 4
    


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