Ophthalmology Department

Hasanuddin University

EYE COMPLICATIONS OF
LEPROSY
Introduction

 Leprosy is a chronic granulomatous disease

caused by the intracellular acid-fast bacillus
Mycobacterium leprae, whose clinical
manifestations are largely confined to the
skin, peripheral nervous system, upper
respiratory tract and eyes.
 It is estimated that 1.5-2% of the total are
blind from leprosy related causes and another
2 percent are blind from non-leprosy causes.
 leprosy patients can be regarded as a spectrum
determined by the cell-mediated immunity of the
individual.
 Patients are either paucibacillary (smear
negative) or multibacillary (smear positive).
 Generally in paucibacillary cases, damage to the
eye is caused indirectly by M.leprae either
secondary to motor or sensory nerve damage.
 In multibacillary cases, eye is damaged due to
infiltration by M.leprae.
 For simplicity, ocular lesions can be classified in
to two groups.
1. potentially sight threatening lesions .
2. academic lesions.
Potentially sight threatening
lesions
 Lagophthalmos (whole spectrum)
 Corneal hypoaesthesia (whole spectrum)
 Acute iritis and scleritis (MB leprosy)
 Chronic iritis and iris atrophy (MB leprosy)
 Cataract (whole spectrum)
Academic lesions

 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.
Ocular complication

1. Extra ocular
 Cilia
 Palpebra
 Lacrimal gland
2. Ocular
 Anterior segment
 Posterior segment
Extra ocular Complication

 Madarosis supercilia
Result of damage to the cilia root due to
leprosy bacilli and 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) damage
Extra ocular Complication

 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 resulting in obstruction of the nasolacrimal
duct.
Ocular complication

 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
Ocular complication

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.
Ocular complication

Cornea
 M. leprae can invade the structure only by direct
extension 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
leprosy.
 The V nerve involvement results in impairment of
corneal sensibility predisposing to corneal ulcers.
Ocular complication

Episclera and Sclera

 This involvement is 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.
Ocular complication

Ciliary body and Iris

 Lepromatous iridocyclitis is one of the
commonest causes of blindness in leprosy.
 Acute iridocyclitis is a common complication of
erythema nodosum leprosum (ENL) reactions.
 Miliary lepromas or iris pearls near the pupillary
margins  pathognomonic.
 Destruction of the tissues of the iris and ciliary
body causes atrophy and shrinkage of the globe
known as pthisis bulbi.
Ocular complication

Lens
 Chronic iridocyclitis may be responsible for
the early formation of cataract.
 Steroids, used in the treatment of lepra
reactions may hasten the formation of
subcapsular cataract.
Ocular complication

Posterior segment
 The choroid and retina are not ordinarily
involved in leprosy.
 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.
Ocular complication (image)
Ocular complication (image)
Conclusion

 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 involvement affecting
the eye cannot be overemphasized.