|Year : 1982 | Volume
| Issue : 2 | Page : 65-68
Clinical observation on iridocyclitis in leprosy patients
Safdarjang Hospital, New Delhi, India
B P Acharya
Safdarjang Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Acharya B P. Clinical observation on iridocyclitis in leprosy patients. Indian J Ophthalmol 1982;30:65-8
Despite energetic treatment ocular affections in leprosy not uncommonly lead to blindness. Iridocyclitis specially of chronic diffuse type is the principal lesion which results in gradual loss of vision. The frequency with which the iris, ciliary body and the choroid are affected and their mode of affection are not yet fully known.
The present study is a clinical profile of such affection amongst leprosy patients in a hyperendemic coal mine area of Asansol in West Bengal and Dhanbad in Bihar and urban unrelated situation around Delhi. While the patients in the former situations were mostly from coal mining worker's family members and also from the population living in coal mining belt. The hospital patients of Delhi are mostly from adjoining states of Delhi belonging to agricultural and other industrial communities.
| Materials and method|| |
The patients were seen in both the locations by the author in indoor as well as outdoor clinics. Most of the patients came of their own accord for their eye troubles and a fair number of patients were referred from leprosy clinics. Some cases were followed up for investigating purposes in the peripheral clinics particularly in coalmining areas. In the Safdarjang Hospital, the patients were mostly referred cases and also from voluntarily reported cases to the Eye Department. The period of observation in Asansol and Dhanbad areas was from Jan., 1968 to Oct., 1975 and at Safdarjang Hospital, New Delhi were from Jan., 1976 to July, 1981.
| Observations|| |
Out of 7258 cases of Iridocyclitis 715 were due to Leprosy. The profile and prevalence of case of leprosy in uveitis in the hyperendemic areas and local Delhi are is almost the same. [Table - 1] The prevalence of these 715 patients of iridocyclitis following leprosy is high in the age group of 20 to 50 years. It is moderate with in the age group of 50 to 65 years, low in 17 to 20 years and nil below 17 years [Table - 2]. Out of 715 cases 504 were lepromatous, 144, Border line and 67 tuberculoid type of leprosy as shown in the [Table - 3]. Blindness was observed in 91 cases, 18 of which showed acute exacerbation of iridocyclitis of subacute or chronic nature. [Table - 4][Table - 5].
Other complications associated with the cases of Iridocyclitis due to leprosy were as follows :
(a) Lenticular opacities-251 cases (35%). Of these 79 had complete lens opacities.
(b) Secondary Glaucoma : 15 cases (2.1 %).
(c) Low intraocular tension was found in 28 cases (3.8%) with complicated cataract, degenerative changes of the iris with signs of chronic iridocyclitis with no perception of light.
(d) Of acute iridocyclitis were 4 cases and they had high intraocular tension with iris bombe and complete posterior synaechiae and blockage of the pupils by the organised exudate.
(e) Iris pearls were seen in 47 cases, of which 16 had posterior synaechiae. These pearls looked dull yellowish and were of pin-head size.
(f) 6 cases of choroiditis were seen.
(g) Smear from fluid of anterior chamber was made and was stained with Zehle Neelson Stain and acid fast bacilli were found only in one case.
| Discussion|| |
The patients included in this study were already on anti-leprosy treatment for long time. They were all advanced cases of leprosy and the sample was thus a selective one, The disease process was arrested and the patients came to Eye O.P.D. of their own or were referred from various leprosy clinics.
Iridocyclitis following lepromatous type of leprosy was 70.5% in 715 patients. This is in conformity with observations of other worhears.,, The Iris, ciliary body and rarely the choroid were affected in these cases. M. Leprae selectively affected the anterior segment of the eye because of the lower temperature.4+ In this study, 6 cases showed choroidal involvement-patchy inflammatory areas near posterior part of the fundii with vitreous opacities. Fundi examinations in most of the cases were difficult due to inadequate pupillary dilatations posterior synechia and lens opacities.
Iridocyclitis in leprosy appeared not to start with onset of the disease. It is a later development indicated by its higher prevalence in the advanced age group of patients and appeared to be also due to extension of the disease to iris, ciliary body and choroid. Direct involvement of the iris and ciliary body was evidenced in some cases with the formation of iris pearls and presence of acid fast bacilli in the anterior chamber of the eye. But in many cases Iris pearls or presence of acid fast bacilli were not found in the fluid of the anterior chamber by usual methods.
In one case, lepra bacilli were found in the anterior chamber fluid even after 9 years of treatment, although the bacilli were beaded and appeared to be non-viable [Figure - 1]. The skin smear of the patient was negative 3 years earlier. The lepra bacilli can live for longer time in mucous membrane and also in dartos muscle of the scrotum and Iris muscle longer than the skin inspite of the continuous sulphones (D.D.S.) treatment. Presence of lepra bacilli had been demonstrated in the anterior chamber of lepromatous patients and noted in the Iris in postmortem examination But Presence of lepra bacilli in the anterior chamber fluid of the eye even after 9 years of treatment is extremely rare.
Acute Iridocyclitis followed Lepra reaction and Erythema nodosum Leprosum (E.N.L.) and it was common in Lepromatous type and border line cases and rare in tuberculoid type. Tuberculoid type when associated with tuberculosis may give rise to E.N.L. reaction. In this series E.N.L. and lepra reaction were seen only in lepromatous and borderline cases with having history of sulphones treatment for prolonged period (more than 1 year). The clinical picture of the acute Iridocyclitis following the reaction was similar to that of nongranulomatous iridocyclitis seen elsewhere commonly. But in chronic diffuse Iridocyclitis which constituted 547 patients out of 715, showed the picture of granulomatous uveitis and most of these patients had very little symptoms.
Ocular affection in Leprosy ,in coal mining area was about 11%. Blindness following iridocyclitis in leprosy is common and the end result of the disease. Ocular involvement and iridocyclitis had been seen mostly as a sequelae and complications of leprosy. Hence it gives the clinicians sufficient time to prevent its occurrence or its further advancement by the treatment. Failure to detect the eye complications in its initial stage could always lead to visual loss or even blindness.
Eye complications in leprosy are multifarious of which iridocyclitis is the most important and sometimes the forerunner of other complications including blindness. The major victims of Iridocyclitis in Leprosy patients are the Lepromatous and borderline cases. These two clinical types of cases are also basically infectious type of cases. The disease in these forms is bilateral and generalized and the victims are prone to develop deformities besides ocular complications. In India majority of leprosy cases belonged to the non-infectious or tuberculoid type of the disease (75%).13 Hence about 25% cases of leprosy who are considered potentially infectious and also contributing to the occurrence of Iridocyclitis blindness due to leprosy, require special care by which the spread of the disease as well as ocular involvement and subsequent loss of vision can largely be prevented and cured.
| Summary|| |
7258 Patients with Iridocyclitis were seen from 1968 to July, 1981 and recorded from coalfield Hospitals and Safdarjang Hospital, New Delhi. 715 patients with Iridocyclitis following leprosy are discussed in detail. Blindness in 91 patients an account of leprosy was seen. Out of these 715 cases, acute Iridocyclitis was seen in 168 patients and 547 cases were of chronic Iridocyclitis.
| References|| |
Allen, J.H., 1966, Amer. J. Ophthalmol. 61 :987.
De Barros, M.J., 1946, Amer. J. Ophthalmol,29 : 162.
Harley, R.D., 1946, Amer. J. Ophthalmol. 29295.
Swift, T.R. and Bauschard, F.D., 1972, Ind.J, Leprosy, 40 : 142.
Ramu, G and Desikan, K.V., 1979, Leprosy in India 51 : 341.
Hashizume, H. and Shonuma, E., 1968, Int. J.Leprosy, 27 : 61.
Agarwal, L.P. 1960: Docum ophthalmol quoted from Duke Elder 1966 19 : 97, System of Ophthalmology, Vol. IX, Henry Rimpton, London.
Sommerset, E.J. and Dharmendra, 1978, Eye Lesions in Lepros. Ed. By Dharmendra Vol. I, page Volume
Acharya, B.P. 1978, Ind. Jour. Ophthalmol, 26 ;
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]