Year : 1953 | Volume
: 1 | Issue : 2 | Page : 66--67
Leproma of the ciliary body
Mansing Nirankari, MR Chaddah
Department of Ophthalmology, Medical College, Amritsar, India
Department of Ophthalmology, Medical College, Amritsar
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Nirankari M, Chaddah M R. Leproma of the ciliary body.Indian J Ophthalmol 1953;1:66-67
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Nirankari M, Chaddah M R. Leproma of the ciliary body. Indian J Ophthalmol [serial online] 1953 [cited 2022 Jan 25 ];1:66-67
Available from: https://www.ijo.in/text.asp?1953/1/2/66/40802
A young Hindu male, RC., aged 20, shopkeeper by profession. presented himself in the Ophthalmic Department of the V.J. Hospital, Amritsar, on 12th February, 1952 with a nodule at the limbus of the right eve. He complained of redness of the right eye, for the last two months, pain of moderate severity with watering, duration 1 months and diminution of vision since one month. There was a localised nodule in the right eyeball at the limbos, in the upper and outer quadrant.
Two months ago he noticed redness of the right eye for which he consulted a local doctor, without any relief. On the contrary, two weeks later he developed moderately severe throbbing pain in the right eyeball. It varied in severity of its own accord and was referred to the temples. Nothing gave him relief until he noticed a small swelling of the size of a pea at the limbos. With the appearance of the swelling the pain diminished in severity but acuity of vision was decreased. The swelling went on increasing gradually till he went to a mofussil eve hospital where his swelling was partially removed but it recurred within two weeks.
Family and his own previous history were non contributory.
He was admitted as a case of gumma of the ciliary body. On making further inquiries he said that he had noticed an anesthetic patch on the outer part of the upper third of both thighs. This aroused the suspicion of leprosy.
General physical examination revealed slight depression of the bridge of the nose and wide expanding hares. Hair on the outer third of the eyebrows were missing. A patch of anesthesia was detected on the upper third of both the thighs. This area was surrounded by a few small tubercles. Multiple nodules were seen on the scrotum a rare involvement. [Figure 2].
Oil examination of the eye a translucent nodule, yellowish white in colour was seen astride the limbos extending from 9 to 12 o'clock position [Figure 1]. It was roundish, discrete and well defined, about 3 to 4 mm. high, firm, with conjunctiva freely mobile over it except at one spot where it was adherent. Its size was that of a small grape and it was fixed to the surrounding structures. It was tender to touch and was surrounded by the circumcorneal congestion and conjunctival blood vessels were running over it. The regional glands were not enlarged.
Cornea was normal in all aspects but for the part opposite to that involved by the nodule which was infiltrated. A few well defined K.P.'s of different sizes were present ill the lower part and some of there showed brown pigmentation.
Anterior chamber was irregular in depth being shallow opposite the nodule.
Iris was lighter in colour, pattern slightly disturbed bur crypts and regular pattern were easily discernible. "There was no nodule on the iris. Pupil was drawn up towards the limbal nodule and was pear-shape,. A fine film of exudate stretched across the whole papillary area except ill the upper nasal part. It had regular margins and was reacting sluggishly to light. It did not dilate with atropin.
Tension was 25 mm. Hg (Schiotz) right eye and 18 mm. Hg. (Schiotz) left eye.
Slit Lamp examination confirmed what was seen with the corneal loupe. Fundii oculi could not he seen.
(1) Blood for Wasserman Reaction - negative.
(2) E.S.R. 30 tern. first hour - (Westergren).
(3) Mantoux Test + + (old tuberculin 1 in 100).
(4) Nasal Discharge was highly positive for lapra bacilli.
(5) Histo-pathological examination of the nodule showed large number of Lepra Cells (mononuclear cells full of Lepra Bacilli) and Lepra Bacilli.
"These clinched the diagnosis of leproma, while circumcorneal congestion, presence of K.P.'s, shallow anterior chamber, pear-shaped pupil, and marked ciliary tenderness pointed to its origin front ciliary body. Pattern of iris was comparatively less disturbed which further favoured the origin, from the ciliary body.
It is the rarity of leprosy in the plains of the Punjab and furthermore it is the extreme rarity of this ocular manifestation, along with involvement of the scrotal skin which has prompted us to report this case.