Ocular changes in reactions in leprosy

Abstract

Summary A study of ocular changes in reactions in leprosy was undertaken to assign these changes, their proper place in the wide spectrum of ocular morbidity in leprosy. 76· 1 % of eyes of Type I reaction and 89·7% of eyes with Type II reaction showed some ocular involvement. Corneal hypoaesthesia, superficial punctate keratitis,. a decrease of corneal film break up time (BUT), prominent corneal nerves, pigment on the endothelium of the cornea and a pigmented trabecular meshwork were the common ocular findings. The incidence of iridocyclitis in Type II reactions was low (8· 1 %). The significance of the ocular involvement in reactions in leprosy and the pathogenesis of iridocyclitis in Type II reactions is discussed.Ocular leprosy presents a formidable challenge to the leprologist as it is still responsible for some of the most distressing aspects of the disease. Around one million people of the world's leprosy population are blind. 1The potentially sight-threatening lesions of leprosy are iridocyclitis and its sequelae; corneal anaesthesia, exposure keratitis due to lagophthalmos, leprous keratitis, scleritis and secondary glaucoma.2.3Leprosy patients may suffer from a variety of reactions, the most common being the reversal reaction (Type I) and the erythema nodosum leprosum (Type II). Reversal reactions are episodes of increased inflammatory activity in the skin lesions, peripheral nerves or both. Type II reactions are generated against intravascular and extravascular immune complexes and are characterized by acute inflammations in any organ or tissue where the My cobacterium leprae are fo und.Though textbooks on leprosy cover the ocular changes in reactions in leprosy, 1.4 as yet, there has been no systematic study of these changes. Some reports are anecdotal,5.6 while others are by nonophthalmologists where the assessment of the eye may not have been adequate.7,sWe undertook a study of the incidence of the ocular changes in reactions in leprosy so that these changes could be assigned their proper place in the wide spectrum of ocular morbidity in leprosy.

A Overview of Ocular Leprosy After 2 Decades of Multidrug Therapy

“…Among 25 Indian patients undergoing type II reaction, only 1 patient had acute uveitis, whereas an additional 2 to 3 patients had subacute uveitis. 25 There were no cases of acute uveitis among the 292 MB Indian patients followed during MDT in LOSOL. 11…”