OCULAR MANIFE STATIONS

OF L EPR OSY

Devi H Putri, SpM

Leprosy remains one of the world’s major blinding diseases
Leprosy patients develop sight-threatening lesions and blindness

Ocular changes were common in patients with duration of

leprosy for more than 15 years.
 Ocular lesions were found more in lepromatous leprosy
followed by borderline leprosy and tuberculoid leprosy.
The ocular lesions of leprosy can be classified into 4 categories:
Lesions following direct invasion of the eye by M. leprae
Inflammatory lesions consequent to sensitization of ocular tissue to M. leprae
antigens and due to formation of intravascular immune complexes
Secondary lesions following granulomatous infiltration of the V and VII
cranial nerves
Secondary lesions following granulomatous infiltration of contiguous
structures – eyebrows, eyelids, lid glands, lacrimal drainage system.
I. Direct Invasion of the eye by M. leprae

Cornea

The 3 common lesions are

Thickening and beading of corneal nerves

Superficial punctate keratitis (SPK)

Interstitial Keratitis
 K E R AT I C P R E S I P I TAT

Superficial punctuate keratitis

 CORNEAL THICKENING

Beads on a string’ appearance of thickened corneal nerves

 UVEA
Insidious chronic anterior uveitis

Posterior synechia, keratic precipitates, iris pearls

CONJUNCTIVA
A mild conjunctival inflammation with edema and dilated blood
vessels .
Pterygium, with collections of macrophages containing M. leprae.
 IRIS PEARLS

Iris pearls
 ANTERIOR UVEITIS

Lepromatous iridocyclitis
 EPISCLERA AND SCLERA
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.
POSTERIOR SEGMENT
The choroid and retina are not ordinarily involved in leprosy.

CATARACT
Chronic iridocyclitis
Steroids, formation of subcapsular cataract.
 SCLERITIS

Scleritis
 CHOROIDITIS

Choroidal involvement
II. Sensitization M.leprae antigens immunecomplexes

Acute uveitis has been considered to be an immune complex

disease within uveal vessels
Hipersensitivity Reaction type III & IV
III. Secondary lesions of the trigeminal and facial nerves
Lepromatous leprosy, involvement of both V and VII cranial nerves
is bilateral but total paralysis is rare.
In tuberculoid types, the involvement of both nerves is usually
unilateral and depends on location of the skin lesion.
N V sensations impairment of the face,conjunctiva and cornea.
N VII the zygomatic branch paralysis of the orbicularis oculi.
IV. Secondary lesions of eyebrows, eyelids, lid glands, lacrimal drainage
system.
The eyebrow, starting from its lateral aspect may lose hair (madarosis),due
to hair root infiltration with lepromatous granuloma, not so common.
Lagophthalmos often causes ectropion and causing epiphora.
Bilateral Chronic dacryocystitis and blefaritis granulomatous infiltration of
the lacrimal and meibomian glands in lepromatous leprosy and lacrimal gland
in tuberculous leprosy is seen.
 OCULAR LEPROSY SIGN
Lids Madarosis Blepharochalasis
Nodules Ectropion Lagophthalmos 0
Reducedblinking Entropion
Trichiasis
Ciliarybody Lossofaccommodation
Lacrimalsystem Acutedacryocystitis
Chronicdacryocystitis
Hypotonia* Phthisis
Chroniciritis:0 Irispearls Irisatrophy
Miosis Corectopia Polycoria ?
Secondarycataract
Cornea Thickenedcornealnerves
Superficialstromalkeratitis
Sclera Episcleritis Scleritis* Nodules Cornealanaesthesia@ Pannus
* potentiallysight-threatening
Staphyloma* Exposure keratopathy *
Interstitialkeratitis Band-
shapedkeratopathy Cornealleproma
Fundus Peripheralchoroidallesions ? Synechiae Secondaryglaucoma
Iris Acuteiritis:a
Retinalvasculitis ?Papilitis Secondarycataract Seclusio pupillae
Irisleproma Lens ?Catarac
 GRADING

Grade-I: Insensitivity of cornea is not very severe in itself. Long

standing neglect can render it serious.
Grade-II: Lagophthalmos by itself is not serious but due to the
exposure of cornea is capable of producing exposure keratitis.
LAGOPHTHALMOS
Grade-III: Lesions like Keratitis, Iritis, Scleritis produce visual impairment

Grade IV the disease induces a progressive blurring of vision; Corneal

Perforation, iridocyclitis chronic, secondary glaucoma .

Grade-V: Signifies a burnt out disease in eyes with development of

unilateral or bilateral phthisis bulbi (blind eye).
S E C O N D A RY C ATA R A C T
The four potentially sight threatening lesions (PST lesions) in leprosy
are:

• Lagophthalmos and exposure keratitis

• Corneal hypo/anaesthesia

• Acute and chronic iritis

• Cataract (secondary)
 THERAPY
Ocular
leprosy

complicatio
n

medical surgical
 THERAPY

Medical Surgical

Lubricant Tarsoraphy, ectropion

Siclopegia Trabekulektomi,cataract extraction

Steroid Keratoplasty
 CONCLUSIONS

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 affecting , especially
since M. leprae can survive in the iris and ciliary body long after
skin lesions have become negative.
Thank you