|Year : 1978 | Volume
| Issue : 2 | Page : 21-24
Ocular involvement in leprosy-(A study in mining areas of India)
Deptt. of Ophthalmology, Safdarjang Hospital, New Delhi, India
B P Acharya
Deptt. of Ophthalmology, Safdarjang Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Acharya B P. Ocular involvement in leprosy-(A study in mining areas of India). Indian J Ophthalmol 1978;26:21-4
India has a large number of leprosy patients (about 3.2 million). It has been estimated that one of every five leprosy patients of the world, lives in India. Leprosy is endemic among the coal-miners. At some places like Asansol, Assam and Orissa, the incidence of leprosy is high in the mining regions. Over-crowding, unhygienic living conditions and malnutrition are considered to be principal causes of endemicity of leprosy. This infectious disease is insidious and sometimes exists asymptomatically before causing different deformities. Eye affection following leprosy is very common. Ocular leprosy can ultimately result in blindness to ,,,,,,, Coal miners lead a hazardous and difficult life. Ocular morbidity due to leprosy poses a dangerous problem for them and also for the industry. We do not yet have a clear idea of the gravity of the problem of ocular leprosy among coal miners. It is, therefore, considered worthwhile to report the incidence, clinical pattern etc. amongst coal miners in India.
| Material and Observations|| |
From 1971 to 1975, patients from the different leprosy centres of Asansol and Dhanbad were examined. The Asansol Central Hospital and the Dhanbad Central Hospitals offer specialised treatment for the coal miners of West-Bengal, Assam, Orissa, Andhra Pradesh and Madhya Pradesh.
The Leprosy hospital of Asansol is situated near the Central Hospital, Asansol. The patients attending these places and nearby leprosy centres were examined to see the ocular involvement. Total number of patients examined were 2731 and they were clinically differentiated and grouped e.g. Lepromatous, Borderline and Tuberculoid types. Out of 2731 patients examined there was ocular involvement in 309 patients, of whom 19 were blind. Lepromatous variant commonly involved the ocular tissues and ten percent of them become blind [Table - 1]. Nearly seventy percent of the affected were males and predominantly occurred in the second and the third decades [Table - 2].
| Discussion|| |
Leprosy may affect the eye in many ways, ,,,, which include 1) infection of the skin of the lids, tear passages and lacrimal glands, 2) Secondary to the involvement of facial nerve (zygomaticofacial) and ophthalmic division of the trigeminal nerve, 3) The mycobacterium leprae may invade directly the anterior segment of the eye-causing gradual involvement of conjunctival and corneal tissues etc. 4) By sensitization of the tissue to the presence of mycobacterium leprae either locally or even elsewhere in the body. Reactions in leprosy i.e. lepra reaction and erythema nodosum leprosum (E.N.L) also play an important role in ocular leprosy.
Ocular involvement in leprosy varied from 5 to 100 percent as reported by different workers from various parts of the world [Table - 3]. The marked difference in the incidence is possibly not only due to selection variation in study of the patients but also due to geographical pattern of the general incidence of the disease. The exact incidence variation cannot be compared amongst one another even from reports available in India, owing to wide variation in samples. Similarly comparable reports on the occurrence of ocular leprosy from other mining regions are also lacking. However, it is striking that the degree of prevalence of ocular involvement does not vary significantly from one endemic zone to another.
Males are predominantly affected and often the principal type is the lepromatous variant. The percentage of ocular involvement and blindness may also depend on the size of the sample The samples studied here has a larger number of cases of tuberculoid leprosy. But the incidence of ocular involvement and blindness is higher in the cases of both the lepromatous and the borderline types but not in the tuberculoid variant. Our findings are, therefore, consistent with what has been observed by others.
The percentage incidence [Table - 4] of different ocular manifestations of leprosy are, by and large, similar to that described by others. The incidence of impaired corneal sensitivity is strikingly high, in the present series compared to other [Table - 4]. Shields et al [Table - 4] reported disturbed corneal sensitivity in 36% of total 100 indoor patients. Temporal pallor of the optic disc as observed by the author is 5.2% of the cases is also significant as it was noted by other author also. It, therefore, appears, that wide variation in these clinical signs possibly depend again on size of sample-studied as well as on the selection of centres.
The present study, indicates that, incidence of leprosy in miners is no greater than in general population and environmental factors may not be etiologically or pathogenetically related to occurrence of leprosy in these areas.
| Summary|| |
2731 patients already diagnosed by Leprologist as leprosy patients were seen at the coalmining area from 1971 to 1975 to find out the ocular affection in these cases. Eye involvement in leprosy was found in about 1 . 1.3% of the cases. Ocular findings in these patients were noted as per proforma and compared with the findings of other workers in this field.
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[Table - 1], [Table - 2], [Table - 3], [Table - 4]
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