|Year : 1980 | Volume
| Issue : 1 | Page : 19-21
Blindness due to leprosy
N Radhakrishnan, Sathia Albert
Department of Ophthalmology, Thanjavur Medical College, Thanjavur, India
Department of Ophthalmology Thanjavur Medical College ,Thanjavur, Tamilnadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Radhakrishnan N, Albert S. Blindness due to leprosy. Indian J Ophthalmol 1980;28:19-21
There are approximately 18 million people in the world suffering from leprosy. Three million patients are in our country and Tamil Nadu alone has one million leprosy patients as its share. Leprosy probably has the highest incidence of ocular involvement of any infectious disease affecting man. The incidence of ocular lesions of leprosy varies from approximately 15% of the patients with tuberculoid leprosy to approximately 100% of patients with long standing lepromatous leprosy.
It is aptly and only said that leprosy is a disease horrible to live with and difficult to die from. When the threat of blindness is also added to the patient's natural dread of the disease, the condition is indeed terrifying.
The aim of this paper is to give the details of incidence of blindness in the leprosy patients, various causes of blindness and the role of an ophthalmologist to prevent blindness due to leprosy.
| Methods and material|| |
320 inmates of leprosy beggars rehabilitation home [Table - 1],[Table - 2] Manaiaripatti, Thanjavur district were examined with binocular loupe and torch light for ocular manifestations of leprosy.
Patients with gross loss of vision in one eye or both eyes i.e. less than 3 metres vision with best possible correction were listed and causes of blindness studied in detail. [Table - 3]
Patients with unilateral or bilateral lagophthalmos were examined in detail for the following findings :- cause of lagophthalmos, corneal sensation, corneal damage due to exposure, Bell's phenomenon, paralytic ectropion and visual acuity [Table - 4].
| Discussion|| |
On analysing the results it is found that 14% of the eyes are blind and the major causes of blindness are exposure keratitis due to lagophthalmos 25%, leucoma and various forms of keratitis 25%, iridocyclitis 10%, sclerits with sclerosing keratitis 10%, cataract 10%.
Blindness mentioned here due to cataract is operable and usually prognosis of cataract surgery in leprosy patients is excellent. Wound healing is good and incidence of endophthalmitis is rare.
17 patients had lagophthalmos and out of these 7 patients had bilateral facial palsy. 3 patients are blind both eyes due to exposure keratitis. Apart from VII nerve paralysis, lagophthalmos may result due to the following causes also in leprosy (1). Primary leprous myositis resulting in weakness of orbicularis muscle. (2) due to rigidity of the lids when involved in a reacting tuberculoid path. (3) due to extensive atrophy of the skin and orbicularis muscle. Anyhow in our studies all cases of lagophthalmos were not due to facial nerve paralysis. Degree of damage to cornea due to exposure is highly variable depending upon 1. Degree of orbicularis weakness 2. Corneal sensation. 3. Amount of mucin and meibomian secretion and 4. Blink reflex.
It is surprising to note that six patients even though have lagophthalmos for the past few years their cornea is absolutely normal. No evidence of exposure keratitis is observed. These patients have normal corneal sensation, good Bell's phenomenon, normal lacrimal gland function and also good blink reflex.
This proves that the damage of exposure keratitis essentially due to mechanical defectlagophthalmos can be overcome by the non mechancial physiological factors inherent in the individual patient. Tears, precorneal film and corneal sensitivity are factors which make the insult of lagophthalmos either a tolerable or intolerable burden to the eye.
Prevention of Blindness
As ophthalmologists, we have to screen the Hansen's patients regularly, periodically catching the cases with corneal pathology and iridocyclitis at a very early stage. Treating these condition effectively, along with good control of the systemic disease can go a long way in lowering the incidence of blindness due to Hansen's diseases. Timely tarsorraphy or temporalis sling operation or prescription of protective glasses will help the patients to escape from exposure keratitis and to retain his vision.
Inspite of years of research and enormous number of conferences on leprosy, the disease still remains a major medical problem. Nevertheless blindness from leprosy can be a thing of the past if an early diagnosis and appropriate treatment is undertaken. Further more, recently developed drugs hold an additional promise for improved results. As Wayson has stated "Instead of thinking leprosy as a disease of foul smelling sores and grotesque facial mutilations we shall consider it as a communicable affection of protean manifestations, and do our best for their eye care and prevent the misery of blindness to occur on them."
| Acknowledgement|| |
Our sincere thanks to Dr. G.M. Yahya, Dean & Dr. M. Naimudin chief ophthalmic surgeon Thanjavu medical College for their encouragement to present this paper. We are also thankful to Dr. Rajagopal, medical officer, Leprosy Beggars Rehabilitation Home Manaiaripatti for his help in examining the inmates of the home.
| References|| |
Albert, H., 1973, Amer. J. Ophthalmol. 75:3.
Allen, J.H., 1960 Amer. J. Ophthalmol. 61:987.
Choyce, D.P., 1969, Brit. J. Ophthalmol. 24:217.
Holmes, W.J. 1957, J. Amer. Ophthalmol. SOC., V145.
Wayson, W.E., 1933, Ear, Nose and Throat, Laryngoscope 43:991.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]