OCULAR MANIFE STATIONS
OF L EPR OSY
Devi H Putri, SpM
Leprosy remains one of the world’s major blinding diseases
Leprosy patients develop sight-threatening lesions and blindness
Ocular changes were common in patients with duration of
leprosy for more than 15 years.
Ocular lesions were found more in lepromatous leprosy
followed by borderline leprosy and tuberculoid leprosy.
The ocular lesions of leprosy can be classified into 4 categories:
Lesions following direct invasion of the eye by M. leprae
Inflammatory lesions consequent to sensitization of ocular tissue to M. leprae
antigens and due to formation of intravascular immune complexes
Secondary lesions following granulomatous infiltration of the V and VII
cranial nerves
Secondary lesions following granulomatous infiltration of contiguous
structures – eyebrows, eyelids, lid glands, lacrimal drainage system.
I. Direct Invasion of the eye by M. leprae
Cornea
The 3 common lesions are
Thickening and beading of corneal nerves
Superficial punctate keratitis (SPK)
Interstitial Keratitis
K E R AT I C P R E S I P I TAT
Superficial punctuate keratitis
CORNEAL THICKENING
Beads on a string’ appearance of thickened corneal nerves
UVEA
Insidious chronic anterior uveitis
Posterior synechia, keratic precipitates, iris pearls
CONJUNCTIVA
A mild conjunctival inflammation with edema and dilated blood
vessels .
Pterygium, with collections of macrophages containing M. leprae.
IRIS PEARLS
Iris pearls
ANTERIOR UVEITIS
Lepromatous iridocyclitis
EPISCLERA AND SCLERA
common in untreated lepromatous patients, presenting with nodules up to 5 mm in
diameter at the sclerocorneal junction. Scleritis is mostly seen in advanced untreated
lepromatous patients and may weaken the globe.
POSTERIOR SEGMENT
The choroid and retina are not ordinarily involved in leprosy.
CATARACT
Chronic iridocyclitis
Steroids, formation of subcapsular cataract.
SCLERITIS
Scleritis
CHOROIDITIS
Choroidal involvement
II. Sensitization M.leprae antigens immunecomplexes
Acute uveitis has been considered to be an immune complex
disease within uveal vessels
Hipersensitivity Reaction type III & IV
III. Secondary lesions of the trigeminal and facial nerves
Lepromatous leprosy, involvement of both V and VII cranial nerves
is bilateral but total paralysis is rare.
In tuberculoid types, the involvement of both nerves is usually
unilateral and depends on location of the skin lesion.
N V sensations impairment of the face,conjunctiva and cornea.
N VII the zygomatic branch paralysis of the orbicularis oculi.
IV. Secondary lesions of eyebrows, eyelids, lid glands, lacrimal drainage
system.
The eyebrow, starting from its lateral aspect may lose hair (madarosis),due
to hair root infiltration with lepromatous granuloma, not so common.
Lagophthalmos often causes ectropion and causing epiphora.
Bilateral Chronic dacryocystitis and blefaritis granulomatous infiltration of
the lacrimal and meibomian glands in lepromatous leprosy and lacrimal gland
in tuberculous leprosy is seen.
OCULAR LEPROSY SIGN
Cornea Thickenedcornealnerves
Superficialstromalkeratitis
Lids Madarosis Blepharochalasis Lacrimalsystem Acutedacryocystitis Sclera Episcleritis Scleritis* Nodules Cornealanaesthesia@ Pannus
* potentiallysight-threatening
Nodules Ectropion Lagophthalmos 0 Chronicdacryocystitis Staphyloma* Exposure keratopathy *
Reducedblinking Entropion Interstitialkeratitis Band-
Trichiasis shapedkeratopathy Cornealleproma
Fundus Peripheralchoroidallesions ? Synechiae Secondaryglaucoma
Ciliarybody Lossofaccommodation Hypotonia* Phthisis Iris Acuteiritis:a
Retinalvasculitis ?Papilitis Secondarycataract Seclusio pupillae
Chroniciritis:0 Irispearls Irisatrophy
Miosis Corectopia Polycoria ? Irisleproma Lens ?Catarac
Secondarycataract
GRADING
Grade-I: Insensitivity of cornea is not very severe in itself. Long
standing neglect can render it serious.
Grade-II: Lagophthalmos by itself is not serious but due to the
exposure of cornea is capable of producing exposure keratitis.
LAGOPHTHALMOS
Grade-III: Lesions like Keratitis, Iritis, Scleritis produce visual impairment
Grade IV the disease induces a progressive blurring of vision; Corneal
Perforation, iridocyclitis chronic, secondary glaucoma .
Grade-V: Signifies a burnt out disease in eyes with development of
unilateral or bilateral phthisis bulbi (blind eye).
S E C O N D A RY C ATA R A C T
The four potentially sight threatening lesions (PST lesions) in leprosy
are:
• Lagophthalmos and exposure keratitis
• Corneal hypo/anaesthesia
• Acute and chronic iritis
• Cataract (secondary)
THERAPY
Ocular
leprosy
complicatio
n
medical surgical
THERAPY
Medical Surgical
Lubricant Tarsoraphy, ectropion
Siclopegia Trabekulektomi,cataract extraction
Steroid Keratoplasty
CONCLUSIONS
The eye is involved in all forms of leprosy, more in lepromatous
than tuberculous leprosy.
Repeated and careful examination of the eye especially of those
with lepromatous leprosy and those with nerve affecting , especially
since M. leprae can survive in the iris and ciliary body long after
skin lesions have become negative.
Thank you
