Summary Our studies indicate that the patient with leprosy is at risk for developing keratoconjunctivitis sicca. The cause of keratoconjunctivitis sicca in our patients suggests that the aqueous layer of the tear film may be decreased as a result of a decrease in secretion of tears from the accessory lacrimal gland of the conjunctiva although it could also be decreased due to a diseased afferent arc to the lacrimal gland or to a diseased lacrimal gland both resulting in decreased aqueous production. In addition the stability of the precorneal tear film is probably affected due to a decrease in corneal sensation and to lagophthalmos both of which result in decreased blinking, as well as fa ilure of the lid to resurface the tears because of irregularity of the conjunctiva or cornea.Our results suggest that patients with leprosy should be fo llowed closely for keratoconjunctivitis sicca and that treatment directed towards this problem should be initiated early.Absence of the precorneal tear film is a potentially seri o us problem in ocular leprosy, and this combined with corneal exposure is a major cause of blindness in these patients. In an effort to identify the individual components of keratoconjunctivitis sicca which might lead to corneal damage, we have carried out complete ocular examinations on 73 consecutive patients with biopsy proven leprosy who were seen at the Hansen's Disease Clinic in the San Francisco Bay Area. In the study we fo und a significant number with a decrease in the precorneal tear film.Leprosy commonly affects the eyes. Moreover, ffytche has stated that leprosy affects the eyes more frequently than any other systemic disease.' Estimates of ocular complications in leprosy vary from 6% to 93%2.3 and of the I ()"" 15 million who suffer from the disease4 possibly 5% are blind.5 The periocular structures including the skin as well as the anterior segment of the eye are most freq uently involved in leprosy, but the greatest threats to vision arise from lagophthalmos, chronic iridocyclitis, and keratitis. In our studies we therefore directed much of our attention toward determining the severity and frequency of exposure keratitis and loss of the precorneal tear film. The various parameters we studied included: the Schirmer tear test, tear lysozyme, corneal sensation, 0305-751 8/87/0584.13 + 05 SO 1.00
The present situation with regard to leprosy control in the Yemen Arab Republic (North Yemen) is briefly reviewed. It is believed that there are currently about 1800 registered cases, of whom 1200 have active disease. The authors estimate that there are between 6000 and 8000 cases in the country. There is a 130bed hospital in Taiz, called the City of Light, which acts as a central leprosarium. Facilities for diagnosis and treatment are also available in other parts of North Yemen, but the overall situation with regard to the competence of health staff, laboratory facilities, chemotherapy, reactions, eye complications, deformities and rehabilitation is far from satisfactory. A plea is made for the appointment of a leprosy specialist and the urgent development of a national leprosy control programme, including the appropriate training of personnel. The Yemen Arab Republic (North Yemen) is located on the southwest edge of the Arabian Peninsula and has a population of about 8• 6 million. It is bordered on the north by Saudi Arabia, on the west by the Red Sea, on the south and southeast by People's Democratic Republic of Yemen, (South Yemen), and the east by the Great Arabian desert. It encompasses about 200,000 km.2 Geographically, North Yemen can be conveniently divided into 4 divisions, each having its own characteristic altitude, climate, and vegetation. These divisions are: (I) the coaslal lowlands of Tihama which stretch along the Red Sea from Saudi Arabia in the north to Bab-el Mandab in the south. Hodiedah, with a population of 120,000, is the capital of this region; (2) the fo othills and middle heights, at an altitude of 200-1500 m and situated between the Tihama and the central highlands; (3) the central highlands which exceed 1500 m in elevation and include Nabi Shu'ayb (3760 m), the highest mountain in North Yemen, Sana'a (population about 280,000), the capital of North Yemen, Taiz (population about 120,000), the second largest city in the country, and Ibb (population about 34,000), are all situated in the central highlands; (4) the eastern semi-desert
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