Keratoconjunctivitis sicca in leprosy

Abstract

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

Modified tarsorrhaphy versus gold weight implant technique for paralytic lagophthalmos treatment in patients with leprosy: One-year observation of a randomized controlled trial study

“…In addition, lagophthalmos could cause conjunctival goblet cell impairment, which leads to a decrease in mucin production. A study showed that human goblet cells did not have nerve endings, but their secretion could be activated with sympathetic and parasympathetic nerve stimulation ( 10 ). Patients with leprosy had a high prevalence of Meibomian gland dysfunction due to Mycobacterium leprae infiltration and infection.…”

Ocular conditions in newly diagnosed and post-treatment leprosy patients at a National Reference Center in Brazil

“…This may be due to either reduced tear secretion from the accessory lacrimal gland of the conjunctiva or autonomic denervation of the afferent arc of the lacrimal gland. [31][32][33] Madarosis was most common in LL patients. It is considered a benchmark of this form of the disease.…”

Infectious keratitis in leprosy

“…Intact corneal sensation is also an important factor in tear production and it is known that with a decrease in corneal sensation there is a decrease in tear secretion 4. Patients with leprosy are at risk of developing keratoconjunctivitis sicca or dry eye 5. Foreign body sensation, a major symptom in this condition can induce the patient to rub the eye excessively.…”