Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy

Daniel, Ebenezer; Ffytche, T. J.; Kempen, John H.; Rao, P S S; Diener‐West, Marie; Courtright, Paul

doi:10.1136/bjo.2006.094870

Cited by 35 publications

(27 citation statements)

References 9 publications

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“…Ophthalmic complications (Table 1) are well recognized but rarely the presenting feature; however, 2.8% of patients with MB leprosy are visually impaired at presentation, and 11% have potentially blinding pathology (3). In addition, patients with MB leprosy who have completed treatment remain at risk of the development of new ocular complications, such as corneal opacity, that may be sufficiently severe as to be sight threatening (4).…”

Section: Discussionmentioning

confidence: 99%

Progressive Facial Palsy With Ipsilateral Fasciculation and Sensory Neuropathy

Elston

Venning

Parks

et al. 2012

Journal of Neuro-Ophthalmology

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A 69-year-old woman presented with an 18-month history of progressive facial asymmetry, the right eye appearing more prominent than the left. She also complained of tearing of the right eye and inability to close the eye tightly. She had noted recurrent focal superficial red skin lesions on the right brow that initially blistered and then healed over 2-3 weeks. She described similar lesions occurring on her hands and lower legs over the past 2 years that resolved after local steroid cream treatment prescribed by her primary care physician. The patient denied any disturbance in her vision, headaches, or other neurologic symptoms. Hearing was normal. Her medical history was unremarkable, and she was taking no current medication. She had smoked 15-20 cigarettes a day for 50 years. She had lived and worked in Lombok, Indonesia, for 8 years, returning to live in the United Kingdom 3 years before presentation.On examination, the patient's best-corrected visual acuity was 20/20 bilaterally with normal visual fields. Extraocular movements were full, and the patient was orthophoric. There was no proptosis. The anterior and posterior segments of each eye were normal. There were foci of erythema and blistering on the right brow ( Fig. 1A). Right facial weakness was evident and involved the orbicularis oculi disproportionately (Fig. 1B). Left facial nerve function was normal. After forceful bilateral eye closure, mid-facial fasciculations lasting 5-10 seconds were seen on the right side. Trigeminal sensory function was reduced in the first and second divisions on the right, including corneal sensation; motor function was normal. Bell phenomenon was preserved, and all other cranial nerve function was intact.Routine hematologic and biochemical studies, including liver function tests, revealed no abnormalities. Serum immunoglobulins were normal as were inflammatory markers, including eosinophil sedimentation rate and c-reactive protein. The antinuclear antibody test and an autoantibody screening were negative. Varicella zoster virus-specific IgM antibody was negative as were both Lyme and treponemal serologies. Chest radiography was normal. MRI revealed no abnormalities other than agerelated involutional changes and T2 hyperintensities consistent with microvascular disease in the deep white matter of both cerebral hemispheres. The orbits were normal. There was no space-occupying or inflammatory lesion in the pons, and both facial nerves and trigeminal nerves had normal imaging characteristics.The patient's clinical signs gradually progressed. The right facial palsy increased, and she developed a right lower lid entropion. She also developed numbness in the distal lower limbs and increased frequency and persistence of the skin lesions. Neurological examination showed reduced sensation to temperature and touch below the knees and an anesthetic patch on the left palm. Knee flexion and extension were weak. The patient was referred for a dermatological assessment. Drs Venning and Parks:Dermatological examination revealed that the fa...

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Section: Discussionmentioning

confidence: 99%

Progressive Facial Palsy With Ipsilateral Fasciculation and Sensory Neuropathy

Elston

Venning

Parks

et al. 2012

Journal of Neuro-Ophthalmology

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“…4 During the course of MDT, approximately 6% of patients developed potentially blinding leprosyrelated pathology 11 and in the 5 years after the completion of MDT another 4% developed such pathology. 12 This means that approximately 20% of patients with MB disease, even if treated with MDT will end up with potentially blinding leprosy-related eye conditions. Baseline prevalence and incidence after treatment for the 2 most important complications are shown in Figure 2.…”

Section: The Magnitude Of Blindness In Leprosymentioning

confidence: 99%

A Overview of Ocular Leprosy After 2 Decades of Multidrug Therapy

Lewallen

Courtright²

2007

International Ophthalmology Clinics

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“…The global elimination campaign has led to a 90% reduction in the global prevalence since 1991, largely by providing free multidrug treatment (rifampicin, clofazimine and dapsone) [137]. The most common neurologic manifestations of leprosy are peripheral mononeuritis, mononeuritis multiplex, and polyneuropathy, although cranial neuropathy (most commonly nerves V and VII), and autonomic neuropathy also occur frequently [137,138]. Nerve abscess and T2 hyperintensities in the spinal cord on MRI have been rarely reported [136,139].…”

Section: Leprosy (Mycobacterium Leprae)mentioning

confidence: 99%