|Year : 1966 | Volume
| Issue : 5 | Page : 214-216
Survey of ocular complications in lepromatous leprosy
Govt. Opthalmic Hospital, Madras, India
|Date of Web Publication||17-Jan-2008|
Govt. Opthalmic Hospital, Madras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Balakrishnan E. Survey of ocular complications in lepromatous leprosy. Indian J Ophthalmol 1966;14:214-6
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|| |
In all 385 Infective Lepromatous patients were examined, out of which 178 (46%) had Ocular complications.
| Discussion|| |
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.
| References|| |
Alan C. Woods "Endogenous Uveitis", The Williams & Wilkins Company, Baltimore.
R. G. Cochrane "Leprosy in Theory and Practice", John Wright and Sons Ltd.. Bristol.
W. J. Holmes (1957), Leprosy of the Eye. Leprosy Review No. 3 Vol. XXVIII-Quarterly publication of British Leprosy Association.
Somerset E. J. and Sen N. R. (1956), British Journal of Ophthalmology 4; 167.
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2]