Ophthalmology Department

Halu Oleo University

 Leprosy is a chronic granulomatous disease caused by th
e intracellular acid-fast bacillus Mycobacterium leprae, w
hose clinical manifestations are largely confined to the sk
in, peripheral nervous system, upper respiratory tract an
d eyes.
 It is estimated that 1.5-2% of the total are blind from lepr
osy related causes and another 2 percent are blind from n
on-leprosy causes.
 leprosy patients can be regarded as a spectrum de
termined by the cell-mediated immunity of the in
dividual.
 Patients are either paucibacillary (smear negative)
or multibacillary (smear positive).
 Generally in paucibacillary cases, damage to the e
ye is caused indirectly by M.leprae either secondar
y to motor or sensory nerve damage.
 In multibacillary cases, eye is damaged due to infil
tration by M.leprae.
 For simplicity, ocular lesions can be classified in to
two groups.
1. potentially sight threatening lesions .
2. academic lesions.
 Lagophthalmos (whole spectrum)
 Corneal hypoaesthesia (whole spectrum)
 Acute iritis and scleritis (MB leprosy)
 Chronic iritis and iris atrophy (MB leprosy)
 Cataract (whole spectrum)
 No visual significance but contribute to the stigma which
these patients endure.
 Such as loss of eyebrows and eyelashes.
 Hair loss is due to hair root infiltration with lepromatous
granuloma.
1. Extra ocular
 Cilia
 Palpebra
 Lacrimal gland
2. Ocular
 Anterior segment
 Posterior segment
 Madarosis supercilia
Result of damage to the cilia root due to leprosy bacilli an
d generally on the old type lepromatous
 Palpebral atrophy
This situation can aggravate ectropion
 Lagophtalmos
Caused by orbicularis oculi muscle paralysis as the effect
of N. VII (infiltration of leprosy bacilli to the nerve) damag
e
 Lacrimal secretion disorders
Triggered to various causes:
 Palpebral dysfunction
 Loss of blinking reflex
 Ectropion
 Acute and chronic Dacryocystitis
 Secondary organisms and destruction of the nasal bones re
sulting in obstruction of the nasolacrimal duct.
 Most of the ocular complications caused by :
 Conjuctiva
 Cornea
 Episclera
 Anterior sclera
 Iris
 Cilliary Body
 Lens
 Complications occur depends on:
 Immunological status of patients
 Type of leprosy
Conjuctiva
 A mild conjunctival inflammation with edema and dilated
blood vessels may be seen.
 Pterygium, with collections of macrophages containing
M. leprae, has been reported.
Cornea
 M. leprae can invade the structure only by direct exte
nsion from surrounding tissues.
 The 3 common lesions are
 Thickening and beading of corneal nerves
 Superficial punctate keratitis (SPK)
 Interstitial Keratitis
 ‘corneal pearls’  characteristic of lepromatous le
prosy.
 The V nerve involvement results in impairment of co
rneal sensibility predisposing to corneal ulcers.
Episclera and Sclera
 This involvement is common in untreated lepromatous p
atients.
 Presenting with nodules up to 5 mm in diameter at the sc
lerocorneal junction.
 Scleritis is mostly seen in advanced untreated lepromato
us patients and may weaken the globe.
Ciliary body and Iris
 Lepromatous iridocyclitis is one of the commonest c
auses of blindness in leprosy.
 Acute iridocyclitis is a common complication of eryth
ema nodosum leprosum (ENL) reactions.
 Miliary lepromas or iris pearls near the pupillary marg
ins  pathognomonic.
 Destruction of the tissues of the iris and ciliary body c
auses atrophy and shrinkage of the globe known as p
thisis bulbi.
Lens
 Chronic iridocyclitis may be responsible for the early for
mation of cataract.
 Steroids, used in the treatment of lepra reactions may ha
sten the formation of subcapsular cataract.
Posterior segment
 The choroid and retina are not ordinarily involved in lepr
osy.
 There have been a few anecdotal reports of extensions of
lepromatous lesions form the ciliary body to the choroid
which appear as minute nodular lesions.
 The eye is involved in all forms of leprosy, more in leprom
atous than tuberculous leprosy.
 Repeated and careful examination of the eye especially o
f those with lepromatous leprosy and those with nerve in
volvement affecting the eye cannot be overemphasized.