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陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 2熏晕燥援 4袁 Dec援18袁圆园园9 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押陨允韵援圆园园园岳员远猿援糟燥皂 窑Investigation窑 Ocularinvolvementinleprosy:afieldstudyof1004 patients

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1 DepartmentofOphthalmology,RangarayaMedicalCollege, cornealanaesthesia;iridocyclitis;;blindness Kakinada,AndhraPradesh,India 2 NationalLeprosyEradicationProgramme,Kakinada,Andhra ReddySC,RajuBD.Ocularinvolvementinleprosy:afieldstudyof Pradesh,India 1004patients. 2009;2(4):367-372 Correspondenceto: SCReddy.DepartmentofOphthalmology, InternationalMedicalUniversityClinicalSchool,JalanRasah, 70300Seremban,NegeriSembilan,Malaysia.screddy98@hotmail. INTRODUCTION com eprosy,causedbyMycobacteriumleprae,affectsskin, Received:2009-07-23Accepted:2007-11-05 L nasalmucosa,peripheralnerves,anteriorsegmentof theeye,andresultsinthedisbilitiesandblindnessifnot Abstract treatedin-time.Basedontheclinicalappearanceofskin ·AIM:Todeterminetheprevalenceofocularinvolvement lesions,involvementofnervesandnumberofleprabacilliin andpatternofocularmorbidityinleprosypatients. skinbipsy,thediseaseisclassifiedasmultibacillaryor · METHODS:Leprosypatientswereexaminedintheir lepromatousleprosy(LL),paucibacillaryortuberculoid respectivetreatmentcentersbytheophthalmologistovera leprosy(TL)andborderlineleprosy(BL).Theeyeis [1] periodofthreeyears.Afterrecordingvisualacuity,anterior affectedinthisdiseaseinfourways :(i)bydirectinvasion segmentwasexaminedwithtorchlightandmagnifyingloupe. ofleprabacilliwhichreachtheciliarybodythroughblood IntraocularpressurewasmeasuredwithSchiotztonometer. streamandthenspreadintootherstructures,(ii)secondary Funduswasexamined,afterdilatingpupilswithtropicamide toinvolvementoffacialnerveandophthalmicdivisionof eyedrops,withdirectophthalmoscope. trigeminalnerve,(iii)intheformofhypersensitivityreaction · RESULTS:Outof1004patientsexamined,530were totheantigenicsubstancesreleasedinthebreakdownof sufferingfromlepromatousleprosy,413fromtuberculoid leprabacilliwhicharepresentinthecirculatingblood;and leprosy,61fromborderlineleprosy.Ocularlesionsrelatedto (iv)secondarytochangesintheskinandsupporttissueof leprosywerenotedin606(60.3%)patients.Cornealchanges thelids,teardrainagesystem.Oneormoreofthefactors (81.1%)werethemostfrequentlyobservedlesionsfollowed mayberesponsibleforeyelesions,especiallywhenthe byeyelidchanges(42.1%).Potentiallysightthreatening diseaseislongstandingandinadvancedstage. lesionssuchaslagophthalmos(17.3%),cornealanaesthesia Thereareover10.7millionleprosypatientsintheworld; (36.1%),andiridocyclitis(14.7%)wereseeninthese anditisanticipatedthatover0.75millionnewcaseswillbe patients.Noneofthepatientsshowedanyfunduschanges detectedeachyear[2].Leprosyisstillconsideredasignificant relatedtoleprosy.,notrelatedtosystemicdisease, healthprobleminmanycountries,andIndiaisoneofthem wasnotedin177(17.6%)leprosypatients.Blindnessrelated withhighprevalenceofregisteredpatients (5per10000 toleprosywasseenin169(16.8%)patients;chronic population)[3]. iridocyclitiswithitscomplicationswasthemostcommon causeofblindnessinthesepatients. Mostoftheworld'sleprosysufferersliveindeveloping countrieswheretheprevalenceofmanyotherdiseasesis ·CONCLUSION:Ocularinvolvementwasseenin60.3%of high,andstigmatizationlimitstheuseofmedicalservices leprosypatients;corneallesionsbeingthemostcommon. resultinginthedelayoftreatmentandhence,morechances Oneormorepotentiallysightthreateninglesionswereseenin two-thirdsofthesepatients.Blindnessrelatedtoleprosywas ofinvolvementofothersystemsbythedisease.The seenin16.8%ofpatients.Earlyreferralofpatientswitheye involvementofeyesresultinginvisualhandicapisagreat problemsandtreatmentofpotentiallysightthreatening disasterforaleprosypatient,especiallyifhe/shehasalready lesionsandcataractwillreducetheprevalenceofblindnessin otherdeformitiesofhandsorfeet.Thepresentstudywas leprosypatients. conductedinEastandwestGodavaridistrictsofAndhra · KEYWORDS:ocularlesions;leprosy;lagophthalmos; Pradeshstate,IndiawiththecollaborationofZonalleprosy 367 Ocularinvolvementinleprosy officer,NationalLeprosyEradicationProgramtodetermine andcataractwerereferredtothenearestgovernment theprevalenceofocularinvolvementandpatternofocular hospitalforfurthermanagement. morbidityinleprosy;andtoprovidenecessarytreatment Thefollowingdefinitionswereusedinthisstudy: (medicalandsurgical)fortheneedypatients. Cornealsensationnormal-whenthereisspontaneous MATERIALSANDMETHODS blinking/patientfeelsthesensationoftouch;corneal Beforestatingthisproject,anaudiovisuallecturewasgiven sensationdiminished(hypoaesthesia)-whenthereisdelayed bytheophthalmologisttoallthemedicalofficers,non blinking/patientfeelslesssensationoftouch;corneal medicalsupervisorsandnonmedicalassistantsworkingin sensationabsent (anaesthesia)-whenthereisnoblinking/ fourgovernmentleprosycontrolunitsandthreeleprosy patientdoesnotfeelsensationoftouch. missionhospitals,EastandWestGodavari districts Chroniciridocyclitis-historyofredness,painanddiminution explainingtheclinicalfeaturesofdifferentocularlesions ofvisionintheeye,smallirregularpupilwithposterior relatedtoleprosyandtheirmanagement.Followingthis, synechiae/irisatrophy. theywereassignedtopickuptheleprosypatientswitheye Complicatedcataract-evidenceofpastiridocyclitiswith problemsfromtheircentersandassemblethemonthe lenticularopacityreducingthevisiontolessthan6/18. scheduleddatesintheirrespectivetreatmentcentersforeye Refractiveerror-visualacuitylessthan6/6whichimproves checkupbytheophthalmologist.Thiscross-sectional withpinhole/glasses. prospectivestudywascarriedoutduringtheweekends -difficultyinnearvision/readingsmallprint. (onceamonth)overaperiodofthreeyears. WHOcategoriesofvisualimpairment[4]:novisualimpairment Thepatientswereexplainedthepurposeandconductofthe (6/6-6/18),visualimpairment(<6/18-6/60),severevisual study,andconsentwastakenforeyeexamination.They impairment(<6/60-3/60),blind<3/60-perception/noperception wereexaminedintheirrespectivetreatmentcenters.Age oflight). andgenderofpatients,typeanddurationofthediseaseand Potentiallysightthreatening(PST)lesions[5]-lagophthalmos, anyerythemanodosumleprosum(ENL)reactionsand exposurekeratitis,cornealanaesthesia,centralcornealulcer/ treatmenttakenwerenoted.Thedetailedexaminationwas opacity,chroniciridocyclitiswhichcancauselossofvision donebyophthalmologist.Aftertakingthehistoryofeye andblindnessiftheyarenotmonitoredortreatedcarefully. problems,visualacuitywastestedonSnellenEchartina Academiclesions-/nodules/infiltrationofeyebrows/ wellilluminatedroom.Thosewithvisionlessthan6/6were ,superficialkeratitis,cornealopacityintheperiphery testedagainusingpinholeorwithspectaclesinpatients sincetheyusuallydonotcauselossofvision. usingglasses,toseeforfurtherimprovementofvision. RESULTS Detailedexaminationoftheocularadnexa(eyebrows, Atotalof1004patientswereexaminedinallthetreatment eyelids,lacrimalsac),anteriorsegmentoftheeye(, centers,ofwhom766(76.3%)weremalesand238(23.7%) ,,anteriorchamber,,,)wasdone werefemales;530(52.8%)weresufferingfromlepromatous withtorchlightandbinocularloupe(EagleFocusTM 2.25x, leprosy,413(41.1%)fromtuberculoidleprosyand61 EagleVision,Memphis,USA). (6.1%)fromborderlineleprosy.Themeanageofpatients Lagophthalmoswastestedbyaskingthepatienttoclosethe was48.5years(range14-76years);79.5%ofthemwere eyelidsgentlyandanyexposureofsclera/corneawasnoted. abovetheageof40years(Table1).Themeandurationof ThepresenceorabsenceofBell'sphenomenawasnotedfor thediseaseinLLpatientswas13.6years(range6/12-38 considerationoftreatmentinthesepatients. Corneal years),inTLpatients12.8years(range4/12-32years)and sensationwastestedwithasterilefinecottonwhip.Ifthere inBLpatients5.9years (range2/12-6years).Patients waslagophthalmospreventingblinkreflex,theywereasked withmorethan10yearsdisease(759,75.6%)completed aboutsubjectivesensationoftouchon thecornea. dapsonemonotherapy,andtherestweretaking/completed IntraocularpressurewasmeasuredwithSchiotztonometer multidrugtherapyatthetimeofexamination. undertopicalanaesthesia(xylocaineeyedrops40g/L). Ocularlesionsrelatedtoleprosy(atleastonepathologyin Then,bothpupilsweredilatedwithtropicamideeyedrops oneeye)wereseenin606(60.3%)patients;66.6%inTL (10g/L)andfundusexaminationwasdonewithdirect patients(275outof413),58.3%inLLpatients(309outof ophthalmoscopeinasemidarkroom.Allthefindingswere 530)and36.1%inBLpatients(22outof61).Corneal documentedonaproformaforanalysis.Patientsrequiring lesionswerethemostcommon(81.1%)seeninleprosy medicaltreatmentweretreatedatthecentreitself.Those patients,followedbyeyelidlesions(42.1%).Academic requiringprescriptionofglasses,surgeryforlagophthalmos lesionssuchaspartialortotalmadarosis/nodules/infiltration 368 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 2熏晕燥援 4袁 Dec援18袁圆园园9 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押陨允韵援圆园园园岳员远猿援糟燥皂

Table 1 Sex and age distribution of patients (n =1004) Table 2 Prevalence of ocular lesions in leprosy (n=1004) Lepromatous Tuberculoid Borderline LL TL BL Total Total Eye lesions % leprosy leprosy leprosy (n=530) (n=413) (n=61) (n=1004) (n=1004) (n =530) (n =413) (n =61) Eyebrows Sex Total madarosis 148 8 3 159 15.8 Males 419 296 51 766 Partial madarosis 79 22 6 107 10.6 Females 111 117 10 238 Infiltration 46 13 2 61 6.1 Nodules 28 - - 28 2.8 Age (yr) Eyelids 11-20 18 15 1 34 Total madarosis 121 4 2 127 12.6 21-30 60 62 5 127 Partial madarosis 44 5 1 50 5.0 31-40 149 107 16 272 Nodules 9 - - 9 0.9 41-50 186 129 23 338 Patch on the lids 5 - - 5 0.5 51-60 93 82 13 188 Lagophthalmos 69 95 10 174 17.3 61-70 20 16 2 38 Unilateral 25 38 3 66 6.6 71-80 4 2 1 7 Bilateral 44 58 6 108 10.7 of lower lid 19 36 2 57 5.7 Conjunctiva Chronic 17 6 1 24 2.4 ofeyebrows/eyelids,superficialkeratitiswereobservedin Conjunctival leproma 1 - - 1 1.0 Sclera 54.7% ofpatients, whilethePSTlesionssuchas 10 1 1 12 1.2 lagophthalmosin17.3%,cornealanaesthesiain36.1%,and Scleritis 14 1 - 15 1.5 Cornea iridocyclitisin14.7%ofpatients.Noneofthepatients Corneal anaesthesia 152 192 19 363 36.1 Corneal hypoesthesia 108 141 34 283 28.2 showedanyfunduschangesrelatedtoleprosy.Multiple Exposure 19 31 4 54 5.4 3 7 - 10 1.0 ocularlesionswereobservedinoneorbotheyesofthese Band shaped keratopathy 8 1 - 9 0.9 patients.Hence,thetotalnumberoflesionsshowninTable2 20 25 4 49 4.9 Sclero keratitis 6 - - 6 0.6 aremuchmorethanthenumberofpatientsexamined. Superficial keratitis 4 4 - 8 0.8 Interstitial keratitis 8 3 - 11 1.1 Inadditiontolagophthalmos,lowermotorneurontypeof Healed pannus 18 4 1 23 2.3 Iris and Pupil facialpalsywasnotedin12patients(1.2%)inourstudy: Chronic iridocyclitis 104 29 5 138 13.7 ipsilateralin11(7inTLpatientsand4inLLpatients)and Unilateral 35 17 2 54 5.4 Bilateral 69 12 3 84 8.3 bilateralin1LLpatient.Lateraltarsorrhaphywasperformed Acute iridocyclitis 7 2 1 10 1.0 Iris pearls 2 - - 2 0.2 inallthepatientswithexposurekeratitisandprophylactic Iris nodules 2 - - 2 0.2 lubricantsandtopicalantibioticsweregiventoprevent Sluggishly reacting pupil 39 20 8 67 6.7 LL= lepromatous leprosy, TL= tuberculoid leprosy, BL= borderline leprosy cornealulceration.Temporalismuscleslingoperationwas performedinthecaseofbilateralfacialpalsywith Table 3 Ocular lesions in patients with erythema nodosum leprosum reaction lagophthalmosbytheplasticsurgeoninoneoftheleprosy (n=37) Ocular lesion n hospitals.Lagophthalmospatientswith goodBell's Nodules on eyebrows 10 phenomenonwereadvisedlidexcercisesinadditionto Infiltration of eyebrows 7 Nodules on eyelids 5 topicallubricants.Ectropionoflowerlidwascorrectedby Lagophthalmos 10 lateraltarsalstripprocedure. Episcleritis 2 Thirty-sevenoutof54patients(68.5%)whohadENL Scleritis 2 Acute iridocyclitis 3 reactionshowedoneormoreocularlesionsrelatedtothe Chronic iridocyclitis 7 reaction(Table3).Amongtheocularlesionswhicharenot Iris pearls 2 relatedtoleprosy,cataract (immature/mature/traumatic Conjunctival leproma 1 cataract)wasthemostcommoneyedisease(177,17.6%) Table 4 Ocular lesions not related to leprosy (n=1004) followedbyrefractiveerrors(Table4).Therewereanother n 33patientswhowereoperatedforcataractinoneorboth /presbyopia 148 eyes(usingaphakicglasses)inthisstudy.Inpatientswho Immature cataract 124 Mature cataract 46 hadunilateralaphakia,intracapsularcataractextractionwas 33 performedintheothereyeandglasseswereprescribedafter Tr. Cataract with adherent leucoma 7 sixweekspostoperatively.Inotherpatientswithmature 63 Bitot spots 13 cataract,standardextracapsularcataractextractionwith pigmentosa 6 posteriorchamberintraocularlens implantationwas Chronic simple 5 performed.Therewerenosignificant postoperative 2 Blepheritis 1 complicationsinthesepatients. Divergent squint 1 Forvisualacuitypurpose,theeyesaretakeninto Synchisis scintillans 1 Coloboma of iris and 1 considerationbecausevisionmaybegoodinoneeye,and

369 Ocularinvolvementinleprosy poorintheothereyeofthesamepatient.Thus,onepatient Table 5 , according to WHO criteria, at the time of examination in 2008 eyes of 1004 patients maybeblindinoneeyeonly,andotherpatientmaybe Who categories Level of vision n % blindinbotheyes.Thevisualimpairmentaccordingto No impairment 6/6–6/18 841 41.9 WHOcriteria,in2008eyes(1004patients)atthetimeof Visual impairment <6/18–6/60 456 22.7 Severe visual impairment <6/60–3/60 417 20.8 examinationisshowninTable5.Severevisualimpairment Blind <3/60–PL/NPL 294 14.6 wasobservedin20.8%ofeyes.Outof294eyeswithvision PL =perception of light, NPL =no perception of light lessthan3/60,22eyeshadnoperceptionoflight(dueto Table 6 Causes of blindness in leprosy (n =1004) anteriorstaphyloma/phthisisbulbifollowingperforated Unilateral Bilateral Eye disease Total % cornealulcer,secondaryglaucoma/atrophicbulbifollowing blindness blindness chroniciridocyclitis). Lesions related to leprosy Chronic iridocyclitis 59 39 98 9.8 Blindnessduetoocularlesionsrelatedtoleprosywasseen Lagophthalmos with 24 5 29 2.9 in16.8%ofpatients;12.4%ofpatientswereblindinone Corneal ulcer/opacity Corneal diseases 35 4 39 3.9 eyewhile4.8%wereblindinbotheyes(Table6).Chronic Scleritis 3 - 3 0.3 iridocyclitiswithitscomplications(bandkeratopathy, Lesions not related to leprosy secondaryglaucoma,atrophicbulbi,complicatedcataract) Cataract 62 41 113 11.2 Uncorrected high - 3 3 0.3 wasthemostcommoncauseofblindnessfollowedby - 3 3 0.3 lagophthalmoswithitscomplications(exposurekeratitis/ Chronic simple glaucoma - 2 2 0.2 cornealulcer/opacity). Thecorneallesions included interstitialkeratitis-8,perforatedcornealulcerresultingin above.Theprevalenceofocularlesionsseeninourstudy phthisisbulbi-10,/adherentleukome-14,/anterior (60.3%)islowerthaneightstudies,buthigherthansixteen staphyloma-7).Cataract (notrelatedtoleprosy)was studiesgivenintheabovetable. responsibleforvisionlessthan3/60in11.2%ofpatients. Bilaterallagophthalmoswasseeninmuchmorefrequently DISCUSSION inTLpatients(14%,58outof413)thaninLLpatients Theprevalenceofocularinvolvementinleprosyisinflu- (8.3%,44outof513).However,inasurveyof2114 encedbymanyvariablessuchasgeographicalregions,climate, lagophthalmoscasesYan [36] reported61%cumulative environmentalconditions,ethnicgroups,socialstatus [6] ;type incidenceofbilaterallagophthalmosin multibacillary anddurationofthedisease,typeanddurationoftreatment patientsandonly35%ofthesameinpaucibacillarypatients. received,typeandnumberofreactionsofleprosy [7-10];newly Bilaterallowermotorneuronfacialnervepalsywasnotedin diagnosedpatients[11,12] /institutionalizedpatients[13]/noninstit- oneofourtuberculoidleprosypatient.Asimilarobservation utionalizedpatients [14].Whenalltypesofocularlesions wasreportedintwopatientsofborderlinetuberculoid (cataract,glaucoma,pterygium,retinallesions which leprosybyInamdarandPalit[37] . arenotrelatedtoleprosy)areincludedinthereportthe TheocularlesionsrelatedtoENLreactionwereseenin prevalenceofeyelesionsinleprosywillbehigher;similarly 68.5%(37outof57)ofpatientswithsuchreaction.A whenthepercentageofeyefindingsarecalculatedamong higherpercentageofsuchlesions(89.7%,44outof54) thepatientswithocularinvolvementonly (andnotamong werereportedinsimilarpatientsbyShorey [10].Acute thetotalnumberofpatientsexamined)theprevalencerate infiltrationoftheiriscanresultinirispearls:small, ofeyelesionswillbeagainhigherthantherealfigures [15]. glistening,whitelepromasthatusuallyformnearthe Theexpertiseoftheperson(ophthalmologistormedical papillarymargin.Sometimestheydetachfromtheirisand officer/fieldstaffworkinginleprosy)examiningtheeyes floatintheanteriorchamber [38].Irispearlswereseenintwo willalsodeterminethefrequencyofeyelesionsinleprosy ofourpatientsoflepromatousleprosywhohadENLreaction. becausetheophthalmologistcandiagnosetheocularlesions Asmallconjunctivallepromaintheinferiortemporal atanearlystage,andthustheprevalenceoftheselesions quadrantnearthelimbuswasseeninalepromatousleprosy willbehigherwhencomparedtoothertwogroupsofpeople. patientwithENLreactioninourstudy.RathinamandPrajna[39] Theprevalenceofocularlesions,academiclesions recentlyreportedalepromatousleprosy patientwith (madarosis),PSTlesions(lagophthalmos,cornealanaesthesia, subconjunctivalleproma,anterioruveitis,hypopyonand anterioruveitis)inleprosy(%)reportedfromdifferent leprosygranulomaovertheiris,whohadrecurrentepisodes countriesisshowninTable7.Thewidevariationofthe ofENLreaction.Spaide [30] reportedthatpupilin prevalenceoftheocularlesionsintheabovetablecould leprosypatientsreactlesstothelightstimulation;andwe probablybeduetoacombinationofthevariablesdescribed alsofoundsimilarobservationofsluggishlyreactingpupilin 370 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 2熏晕燥援 4袁 Dec援18袁圆园园9 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押陨允韵援圆园园园岳员远猿援糟燥皂

Table 7 Prevalence of ocular lesions in leprosy reported from different countries (%) Ocular Lagoph- Corneal Anterior Country n Madarosis lesions thalmos anaesthesia Brazil [16] 100 72.0 59.0 13.0 36.0 19.0 Burma [20] 256 69.5 48.0 12.5 3.1 - Cameroon [33] 218 77.5 25.7 10.1 13.5 2.3 Ghana [18] 250 46.0 12.8 8.4 3.6 - India [19] 385 46.2 - 1.8 - 17.1 India [27] 430 24.6 5.8 0.4 - 0.7 India [32] 742 23.8 18.1 4.0 3.2 2.3 Kenya [31] 199 52.7 19.0 34.1 20.0 7.5 Malawi [23] 8325 6.4 - 3.1 2.9 1.7 Malaysia [25] 444 51.8 25.0 47.0 0.4 0.6 Nepal [11] 260 37.3 10.0 34.6 0.4 1.1 Nepal [29] 466 74.2 33.0 27.2 - 5.1 Nepal [34] 58 57.0 22.4 10.3 15.5 10.3 Nigeria [35] 456 48.0 - 12.6 - 2.2 Pakistan [13] 143 73.0 65.7 25.0 30.8 21.6 Papua New Guinea [28] 109 52.3 44.9 5.5 12.8 6.4 Sri Lanka [21] 630 47.1 - 6.3 - 17.4 South Africa [22] 223 61.4 30.5 19.7 7.6 0.9 Tanganyika [17] 1212 8.3 - 17.3 - 28.8 Uganda [24] 890 21.1 8.2 5.6 - 3.1 USA [14] 61 74.0 - 11.0 16.0 7.0 USA [30] 55 74.5 58.2 3.6 60.0 20.6 Vietnam [26] 51 76.4 15.7 27.4 - 19.6 PRESENT STUDY 1004 60.3 44.1 17.3 36.1 14.7 thesepatients.Thiscouldprobablybeduetoautonomic raised,rounded,yellowishlesioninthelowertemporal dysfunctionoftheirisassuggestedbySwiftandBauschard[40]. periphery,onequarterdiscsize,posteriortooraserrata [45]. Thoughcompletionofappropriatecourseofantileprosy Wedidnotfindanysuchlesionsinanyofourpatients. treatmentchangesthestatusoftheindividualpatientfrom Alowerprevalenceofblindness(2.9%,33outof1137 'underactivetreatment'to'cured'intheregistersofmany patients [46] and10.4%,50outof480patients [35])hasbeen leprosycontrolprograms,itdoesnotpreventsubsequent reportedinleprosypatientsthanobservedinourstudy developmentofdisablingcomplications,particularlythose (16.8%).Theprevalenceofblindnessduetolesionsrelated oftheeye [41,42].Thepresenceofocularlesionsinpatients toleprosy(bilateral12.4%andunilateral4.8%ofpatients) whohavecompletedtreatmentinthepresentstudycanbe observedinourstudyismuchhigherthan6%ofbilateral explainedbythishypothesis. and2.6%unilateralblindnessofthesamereportedbyZhang Althoughocularleprosyisbasicallyananteriorsegment [47] intheirstudyof1045patients.Othercausesnot disease,lesionsofposteriorsegmentbehindtheoraserrata relatedtoleprosywasresponsibleforblindnessin12%of Althoughocularleprosyisbasicallyananteriorsegment ourpatientswhilethesamewasreportedtobein3.3%of disease,lesionsofposteriorsegmentbehindtheoraserrata patientsbytheaboveauthors.Approximately0.5%-1%of dooccasionallyoccurbydirectspreadfromciliarybody. leprosypatientswouldbeblindowingtothelesionsrelated Fourtypesofretinallesionshavebeendescribedinthe tothedisease,andanadditional1%-2%owingtocauses literatureinleprosypatients-(i)descrete,circular,waxy, otherthanleprosy [3].Themostcommoncausesofvisual occasionallypedunculatednodulesontheretinaprojecting disabilityandblindnessinleprosyarecornealdisease intothevitreous,whichareofthesamesizeandappearance secondarytolagophthalmosandcornealanaesthesia,chronic ofirislepromatouspearls,(ii)white,waxy,highlyrefractile anterioruveitisandcataract.Inourstudy,chroniciridocy- depositsintheperipheryofretinawithsheathingof clitiswithitscomplicationswasthemostcommoncause neighbourhoodretinalvessels.Thesearepresentwhenthe relatedtoleprosy,responsibleforblindnessinthesepatients. restoftheeyeisheavilyinfected [43],(iii)dull,hypopig- Inconclusion,earlydetection,effectivetreatment,and mentd,flatanddescretepatchesofdotstoonequarterofthe propercontrolofreactionsareessentialtoreducetheeye discsizewhicharedeeptotheretinalvessels,scatteredall complicationsinleprosypatients.Theexistingeyelesions overthefundus,groupedatplacesbutsparselysituatedat maydeteriorateanddormantlesionsmayrecurinpatients themaculaandintheextremeperipheryofretina [44];(iv)a afterreleasefromtreatment.Therefore,followupofthese 371 Ocularinvolvementinleprosy patientsforlifeisequallyimportanttopreventblindnessin 18ChatterjeeS,ChaudhuryDS.Patternofeyediseasesinleprosypatientsof thesepatients.Improvingprimaryeyecaretrainingofhealth northernGhana. 1964;32:53-63 19BalakrishnanE.Surveyofocularcomplicationsinlepromatousleprosy. workersofleprosycontrolunits/leprosyhospitalssothat 1966;14(5):214-216 theycandetectocularinvolvementearlyandreferthepatients 20GyiK.Theeyeinleprosy.UnionBurma. 1968;1(2):248-249 toeyespecialist;frequentregulareyecheckupofleprosy 21WeerekoonL.OcularleprosyinCylone. 1969;53(7):457-465 22WelshNH,PretoriusM.Theocularsignsinleprosy:resultsofasurveyina patientsbyophthalmologist;in-timetreatmentofpotentially leperinstitute. 1970;44(Suppl):9-12 sightthreateninglesionsandunrestricteduseofcataract 23TichoU,BenSiraI.OcularleprosyinMalawi. 1970;54(3): surgicalservicesinthehospitalswillreducetheprevalence 107-112 ofvisualimpairmentandblindnessinleprosypatients. 24EmiruVP.OcularleprosyinUganda. 1970;54(11):740-743 25WeerekoonL.OcularleprosyinWestMalaysia. 1972;56(2): ACKNOWLEDGEMENTS 106-113 TheauthorsexpresstheirsincerethankstotheDirectorof 26HornblassA.Ocularleprosyinsouthvietnam. 1973;75(3): MedicalandHealthServices,GovernmentofAndhra 478-480 Pradeshforgivingpermissiontoconductthisstudy;toall 27SehgalVN,AggarwalDP,SehgalN.Ocularleprosy. 1976;64 (11):1600-1606 themedicalofficers,nonmedicalsupervisorsandnon 28DethlefsR.PrevalenceofocularmanifestationsofleprosyinPortMoresby, medicalassistantsworkingingovernmentleprosycontrol PapuaNewGuinea. 1981;65(4):223-225 units,andtoallthestaffworkinginleprosymissionhospitals 29MallaOK,BrandtF,AntenJGF.Ocularfindingsinleprosyinaninstitutionin ofEastandWestGodavaridistrictsofAndhraPradeshstate Nepal(Khokna). 1981;65(4):226-230 30SpideR,NattisR,LipkaA,D'AmicoR.Ocularfindingsinleprosyinthe fortheirco-operationinsuccessfulcompletionofthisstudy. 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