Original Article JK-PRACTITIONER

Ocular Manifestations of leprosy -- A Clinical Study

Junaid S. Wani M.S., Sabia Rashid M.S, Muzaffar Sherwani M.S, A.R. Nasti M.S

ABSTRACT
Leprosy (Hansen’s Disease; Hanseniasis) is a chronic disease caused by Mycobacterium Leprae.
Today leprosy impairs the physical, social and economic well being of about 15 million people especially in
the third world countries because of under developed health care provisions. There is no systemic disease
which so frequently gives rise to disorders of the eye as leprosy does. Extraocular structures and anterior
segment structures of the eye are generally affected by leprosy. Posterior segment structures, particularly
the choroid may show some pathology, in which lesions have been identified, though rarely.
A total of 100 patients were studied for ocular involvement. Ocular lesions were found in 69
patients, more in lepromatous leprosy followed by borderline leprosy and tuberculoid leprosy. Ocular
changes were common in patients with duration of leprosy for more than 15 years. Madarosis and
lagophthalmos were found to be the major affections. Corneal involvement was seen in 25 patients and
uveal tract involvement in 22 patients. No patient with posterior segment involvement was seen.

JK-Practitioner2005;12(1):14-17

MATERIAL AND METHODS. 1. Distribution of patients

This study was conducted in the according to age.
department of Ophthalmology, Govt Age in No of %age
M e d i c a l C o l l e g e , S r i n a g a r. 1 0 0 years patients
diagnosed cases of leprosy were taken 10-20 03 03
up for study,which comprised of those 21-40 28 28
cases who attended the out patient 41-60 54 54
department, referred for routine eye >61 15 15
checkup.Each patient was subjected to Majority of the patients belonged
detailed history taking followed by a to the age group of 41-60 years.
detailed ocular and general physical 2. Patients showing Ocular
examination as per a set involvement
format.Patients were clinically divided
Total No of Patients %age
into Lepromatous, Borderline and
Patients showing
Tuberculoid types.
Ocular
Examination of adnexae and
Involvement
extraocular structures included the
examination of face,orbits,eye- 100 69 69
Authors’ affiliations :
Junaid S. Wani, Sabia Rashid
brows,eye-lids,palpebral fissure, blink The high incidence of ocular
Prof. A.R. Nasti
reflex,extraocular movements and involvement may be because of late
Deptt. of Ophthomology GMC b e l l ’s p h e n o m e n o n , l a c r i m a l diagnosis and treatment.
Srinagar, sac,evidence of dry eye if any. 3. Distribution of patients
Muzaffar Sherwani Examination of the anterior according to sex.
Directorate of Health Services segment structures was done in detail
Kashmir with the help of a slit-lamp.The Sex No of Patients %age
conjuctiva, cornea, anterior chamber, Male 82 82
Accepted for publication : iris,pupil and lens were examined for Female 18 18
August 2004 different findings. A dilated fundus
examination wherever possible was 4. Distribution of patients with
Correspondence to : done, using both a direct and indirect ocular involvement according to
Junaid S. Wani ophthalmoscope. Recording of visual sex.
Post Box No : 1040, acquity and intraocular pressure was Sex No of Patients %age
GPO, Srinagar also performed. Male 57 82.60
email:drwani@msn.com RESULTS. Female 12 17.39
The study of 100 patients with
leprosy revealed the following results. As far as sex incidence is

Key Words: Lepromatous leprosy, Borderline leprosy, Tuberculoid leprosy,

Vol.12, No. 1, January-March 2005 14
 JK-PRACTITIONER
concerned,this study revealed a sex ratio of 5:1.The high Among the 25 patients with corneal
incidence of males may probably be due to more involvement,superficial keratitis was seen in 7 cases,corneal
exposure.Males usually attend the hospital for treatment opacities in 5 cases,interstitial keratitis in 4 cases,adherent
more voluntarily,thus easily identified. leucoma in 1 case,corneal ulcer 3 cases and 5 cases of pannus
5. Type of Leprosy and Ocular involvement. were seen.All the 25 cases had lepromatous form of leprosy.
Type of Leprosy No of Patients %age Out of 22 cases of uveal involvement,20 cases had
chronic iridocyclitis and 2 cases had acute
with Ocular involvement iridocyclitis.Although it is mentioned that iris pearls are
Lepromatous 52 75.36 pathognomic of leprosy, no such case was seen in this study.
Borderline 10 14.49 Complicated cataracts were encountered in 13 cases.12
Tuberculoid 07 10.14 cases were from lepromatous group and 1 case from
Among the three major types of leprosy.all were borderline group.9 cases had bilateral cataracts while 4 cases
found to have ocular changes with lepromatous type had unilateral cataracts.
being predominant. Although lagophthalmos was commonly
encountered(28.98%), majority of the patients were lucky to
6. Duration of leprosy. have positive Bell’s phenomenon as protective mechanism
Less than 15 years More than 15 years and hence the incidence of exposure keratitis was relatively
No of cases %age No of cases %age low(7.24%).
18 26.08 51 73.91 Incidence of Lagophthalmos according to the type of
The ocular complications were found to be Leprosy
directly proportional to the duration of leprosy.Most of Type of leprosy No of cases %age
the cases with ocular lesions with more than 15 years Lepromatous 13 18.84
duration were in lepromatous group since it takes longer Tuberculoid 04 5.79
time in lepromatous leprosy for ocular changes to Borderline 03 4.34
manifest. g. Other lesions.
7. Ocular lesions. Iris atrophy 04 cases
a. Madarosis in various types of leprosy. Ciliary staphyloma 02 cases
Type of No of cases %age Unilateral facial nerve paralysis 05 cases
Leprosy with Madarosis Incidence of Blindness
Lepromatous 36 52.17 No of blind patients Unilateral Bilateral %age
Borderline 10 14.49 28 09 19 40.57
Tuberculoid 04 5.79 Out of 28 cases of blindness,27 were of lepromatous
The loss of eye-brows(superciliary madarosis) and leprosy and 1 case was of borderline leprosy.
eye lashes(madarosis) was encountered in 72.46% of Causes of Blindness.
patients. Type of involvement No of patients
b. Lid lesions Iridocyclits 19
Lid abnormality No of cases %age Exposure keratitis 03
Ectropion 06 8.69 Corneal opacity 03
Entropion 03 4.34 Interstitial keratitis 03
Trichiasis 09 13.04 Blindness in this study was high,inspite that all the
All the 6 cases of ectropion were seen in lepromatous patients were receiving systemic anti-leprosy treatment.Late
leprosy.Among the 3 cases of entropion,2 cases were seen in diagnosis of ocular changes,inadequate treatment of both
lepromatous and 1 case in tuberculoid leprosy.Trichaisis was ocular and systemic leprosy,patient ignorance alongwith
seen in 9 cases of which 7cases were of lepromatous group poor socio-economic conditions,social stigma and lack of
and 2 cases of borderline group. regular supervision may be the contributing factors.
c. Among the complications of lacrimal system,2 cases DISCUSSION.
of chronic dacryocystitis were observed in lepromatous Eyes are commonly involved in leprosy,the mechanism
leprosy.It may be due to damage of the nasal being infiltration of the tissues and damage to the nerves.The
cartilage,secondarily causing chronic dacryocystitis. involvement varies from 40-80%,as quoted in various
d. Among the conjunctival lesions,chronic studies.The present study showed an incidence of 69%
conjunctivitis was seen in 11 cases.10 cases were in similar to other studies.(Table 1.)
lepromatous group and 1 case was seen in borderline group.2 The ocular involvement was found to be higher in
cases of pterygia observed were of borderline group. lepromatous leprosy(75.36%), followed by borderline
e.Scleritis and episcleritis were observed in 8 cases,out (14.49%) and tuberculoid leprosy (10.14%) in our
of which 5 cases were of lepromatous type and 3 cases of study.Ocular complications appear to be more common
borderline leprosy. among lepromatous patients than tuberculoid as anterior
f. Sight threatening lesions. segment of the eye provides a favourable environment for
Type of involvement No of cases %age the M.Leprae which are more numerous in the lepromatous
Corneal involvement 25 36.23 patients.The incidence of various eye lesions reported by
Uveal involvement 22 31.87 different studies is shown in table 2 and table 3.
Complicated cataract 13 18.84 Our study observed madarosis as the commonest

15 Vol.12, No. 1, January-March 2005


finding (72.46%). The other common eye affections
included lagophthalmos (28.98%), ectropion (8.60%),
scleritis and episcleritis (11.59%),corneal involvement
(36.23%), uveal involvement (31.88%), complicated
cataract (18.84%), which are in accordance with other
studies.
In the present study, cases of blindness were much
higher (40.57%) than reported by Hornblass9 (1974) 08%,
Sheild 10 (1974) 33%, Malla et al 4 (1981) 28%,
Courtright (1984) 29.50%, HerKsin Tsai15 (1985) 31%. This
5
could be because of longer duration of illness and delay in
treatment in our patients.
JK-PRACTITIONER
The ocular involvement in leprosy is directly related to
the duration of the disease.18 In our study the mean duration
of illness was 15 years.Those patients with longer duration
of illness (>15 years), (73.91%) had more severe
involvement, multiple lesions and more mutilations.
As reported in different studies, the anti-leprosy
treatment does not prevent or retard the development of
ocular lesions. However early treatment may arrest the
posterior segment changes.19 In the present study, most of the
patients were on anti-leprosy treatment and we observed that
inspite of all patients undergoing sulfone mono or multidrug
therapy, incidence of blindness was high.It may be due to

Table 1.
Study Ticho&I.Ben.Sira Dutta Dehelfs3 Malla et al4 Courtright et al5 Present Study
(1970) 1972) (1981) (1981) (1984)
Ocular 63% 80% 52% 74% 40% 69%
Involvement

Table 2. Eye Lesions(%)

Study Madarosis Lagophthaimos Ectropion Scleritis& Uveal Cataract
Episcleritis Involvement
1. Allen6 (1966) — — — — 17 22
2. Emru7 (1970) — — — — 28 —
3.Weerekon8(1972) 60 27 — — — —
4.Hornblasss9(1973) — — — — 16 08
5. Sheilds10 (1974) 59 29 13 — — 27
6. Das11 (1980) — — — 03 — —
7. Lamba12 (!983) 70 13 05 — 14 —
8. Courtright5(1984) — 15 — — — 05
9. Rawal13 (1984) — 8.1 — 14 — 30
10. Spaide14 (1985) 58 — 3.60 — 13 1.80
11. HerKsin15(1985) — — — 07 — —
12. Present Study 72.46 28.98 8.60 11.59 31.87 18.84

Table 3. Corneal Lesions (%)

Incidence of various corneal lesions in various studies.
Study Superficial puntate Interstitial Corneal Pannus Corneal Corneal
keratitis keratitis opacities anaesthesia ulcer
6
1. Allen (1960) 19 — 06 05 36 —
2. Emiru7(1970) 12 — — 05 — —
3. Hornblass9(1973) 26 10 50 02 — —
4. Dehelfs3(1981) 20 01 — — 14 —
5. Murat16 (1981) 11.60 — — — — —
6. Lamba12(1983) 02 — — 02 23 —
7. Courtright5(1984) — — — 11 23 —
8. Spaide14(1985) 27 — 18 05 — —
9. HerKsin15(1985) — — — — 24 —
10. Alka Gupta17(1990) 24 07 10 08 63 02
11.Present Study 10.14 5.79 7.24 7.24 17.39 4.34

Vol.12, No. 1, January-March 2005 16


delay in diagnosis, as patients attend the eye clinic at late
stage of ocular involvement.20
Although prompt institution of treatment and
availability of newer and better antileprosy drugs has
JK-PRACTITIONER
markedly improved the outcome of those affected,the
process of ocular involvement continues notwithstanding
regular medical treatment.21

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