OCULAR

MANIFESTATIONS IN
LEPROSY
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Introduction
◦ Leprosy or Hansen’s disease is an infection caused by Mycobacterium leprae that primarily affects the
skin, the peripheral nerves and the eyes, causing chronic granulomatous inflammation

◦ The Prevalence of leprosy is declined in India, still a total of 1.35 Lakh new cases of leprosy were
detected during the year 2016-17

◦ Ocular involvement is more common in lepromatous leprosy, where direct invasion of the globe by M.
leprae can occur, probably through the bloodstream

◦ M. leprae has a for cooler parts of the body, therefore the anterior segment of the eye is commonly
involved

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Introduction
◦ Ocular lesions of leprosy include:
◦ Cutaneous nodules
on eyelids
◦ Madarosis
◦ Interstitial Keratitis
◦ Leprotic uveitis
◦ Dacryocystitis

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Leprotic Uveitis
◦ The most frequent ocular manifestation in lepromatous leprosy is uveitis
◦ Occurs in two forms
1. Acute iritis:
Due to antigen-antibody deposition and is characterised by severe exudative reaction

2. Chronic granulomatous iritis:

It occurs due to direct organismal invasion and is characterised by presence of small glistening “iris pearls” near the
pupillary margin in a necklace form.

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Small pearls coalesce to form
larger pearls

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Conjunctival Involvement
◦ Conjunctival involvement in leprosy is not uncommon
◦ Leprosy causes granulomatous inflammation, characterised by proliferative lesions which usually tend
to remain localised to one eye and are mostly associated with regional lymphadenopathy
◦ The differentials for granulomatous inflammations are
◦ Tuberculosis
◦ Sarcoidosis
◦ Syphilitic
◦ Leprotic
◦ Ophthalmia nodosa (Caterpillar hair conjunctivitis)

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Corneal involvement
1) Neurotrophic keratopathy
◦ Occurs due to damage to trigeminal nerve which leads to decreased corneal sensations.
◦ Typically characterized by marked signs and minimal symptoms.
◦ Red Eye
◦ Swollen eyelids
◦ Defective Vision
◦ No pain + no tearing
◦ Signs include:
◦ Ciliary congestion marked
◦ Sensations are decreased and sheen is lost
◦ May be presence of corneal ulcer, frank epithelial defect or punctate epithelial erosions

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Progression of neurotrophic
corneal ulcer with
treatment.

Note the typical

involvement of the lower
third of the cornea

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Corneal involvement
2) Neuroparalytic Keratopathy
◦ This is seen in facial nerve palsy as occurs in Bell’s palsy.
◦ When the eyes are covered insufficiently by the lids and there is loss of protective mechanism of
blinking.
◦ There may be ectropion due to paralysis of facial nerve.
◦ There is Lagophthalmos leading to:
◦ Drying of cornea
◦ Punctate epithelial defects
◦ Corneal ulcerations

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Lagophthalmos

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Diagnosis
◦ Diagnosis of leprosy is made through clinical criteria, namely the existence of: hypopigmented or
reddish skin lesions with definite sensory loss, with or without thickened peripheral nerves and acid-fast
bacilli identified on skin smears or biopsy samples
◦ Patients typically present with skin lesions, muscle weakness or ulcer in a limb, associated with
peripheral neuropathy.
◦ Impairment of sensitive and motor nerve functions causes early dysfunction and later limb deformity.

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Hypopigmented Patch

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Key points
◦ Leprosy typically involves the anterior segment of the eye.
◦ Uveitis is the most common manifestation in lepromatous leprosy
◦ The 5th and 7th nerve are generally involved leading to various manifestations.
◦ There is reduced corneal sensations.
◦ Orbital Adnexa may also be involved.

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