- Volume 70 , Number 2
- Page: 127–9
Study of pattern of ocular changes in different types of leprosy patients
To the Editor:
Involvement of eyes is one of the most serious complications that can occur in leprosy, and, if neglected or left untreated, could eventually cause blindness. In a recent multi-center study between 4% to 7% of the leprosy patients were found to be blind and between 6% and 50% had severe visual impairment (1, 2).
The present study was carried out on a random sample of 100 leprosy patients seeking care for leprosy, not just for eye problems. These patients were seen at the general outpatient department for skin at the Dayanand Medical College and Hospital located at Ludhiana, India.
Each patient was examined carefully. The age, gender, and type of leprosy (Ridley-Jopling classification), duration of the disease, its treatment and the regularity of treatment were noted. Slit-skin smears were done and the disease confirmed histopathologically. The eyes were examined and a slit-lamp examination carried out.
The ages and genders of these 100 leprosy patients are given in Table 1. The mean age was 36 ± 14 years with a range of 5 to 70 years. Over half the patients were in the 16 to 35 year old range. Seventy-three of the patients were male.
The overall eye involvement among these 100 patients, was 53%. Eye involvement was most common among LL patients (90%), followed by BB patients (53%), BL (47%). and BT (28%). We saw no TT patients in this group. Eye involvement was more common among patients who had had the disease for more than five years (90%) than among those who had had the disease for less than five years (38%).
The types of ocular lesions seen in these patients according to disease type are given in Table 2. Madarosis was seen in 24% of these patients, followed by conjunctivitis (16%), corneal opacity (14%), decreased corneal sensation (13%), lagophthalmos (12%), and lesions of the iris and ciliary body (10%). Two patients, one BB and one BL, had choroiditis. Choroiditis was not an incidental finding in our patients but was due to leprosy because none had tuberculosis, diabetes, mellitus, HIV, sarcoidosis, syphilis, etc., which are common causes of choroiditis in India.
Three cases of cataract were of the senile-type and the cataract started in the senile cataract age group in all of these instances.
In general our observations in these 100 leprosy patients do not differ from those of other authors (1, 2, 3, 4, 5, 6, 7, 8). It seems clear that if blindness is to be prevented in leprosy patients, the eyes of all leprosy patients should be examined at regular intervals. Merely referring leprosy patients for eye examinations after eye complications become evident is not sufficient. The aim should be to detect the ocular complications of leprosy before the leprosy patient becomes an eye patient.
- Alka Dogra, M.D., Reader and Head
Department of Dermatology
Dayanand Medical College & Hospital,
Ludhiana
- Anju Aggarwal, M.D. Resident
Department of Dermatology
Dayanand Medical College & Hospital,
Ludhiana
- Gurkirat S. Bajwa, M.D., Reader
Department of Ophthalmology
Dayanand Medical College & Hospital,
Ludhiana
- Shallu Khurana, M.D., Senior Resident
Department of Dermatology
Dayanand Medical College & Hospital,
Ludhiana
REFERENCES
1. Acharya, B. P. Ocular involvement in leprosy (a study of mining area of India). Indian J. Opthal. 2 (1978)21-24.
2. Courtright, P. and Johnson, G. Prevention of blindness in leprosy. Publ. International Centre for Eye Health. 1988.
3. Dethlefs, R. Prevalence of ocular manifestations of leprosy in Port Moresby, Papua New Guinea. Br. J. Opthal. 65 (1981) 223-225.
4. Gnanadoss, A. S. and Rajendra, N. Ocular lesions in Hansens (leprosy). Indian J. Opthal. 34 (1986) 19-23.
5. Malla, O. K., Brandt, F. and Anten, J. G. F. Ocular findings in leprosy patients in an institution in Nepal (Khokana). Br. J. Opthal. 65 (1981) 226-230.
6. Mithal , S., Pratap, V. K., Gupta, Alka and Rajiv. Clinico-histopathological study of eye in leprosy. Ind. J. Opthal. 36 (1988) 135-139.
7. Parsad, V. N., Narain. M., Mukliya, R. D., Bist, H. K. and Khan, M. M. A study of ocular complications in leprosy. Indian J. Lepr. 56 (1984) 241-250.
8. Soshamma, S. and Suryavanshi, N. Eye lesions in leprosy. Lepr. Rev. 60 (1989) 33-38.
Address for correspondence
Dr. Alka Dogra, Reader and Head
Department of Dermatovenereology & Leprosy, Dayanand Medical College & Hospital
Ludhiana - 141001 (Punjab) India
E-mail: samdogra@glide.net.in