Authors: Kathryn Sarao-Nazario, MD, DPDS, Eugenio R. Pipo III, MD, FPDS, Ma. Teresita Gabriel, MD, FPDS, Leilani R. Senador, MD, FPDS, Gracia B. Teodosio, MD, FPDS, Rodrigo J. Senador, MD, MBA, DPBO, Arturo B. Capulong,MD, DPBO, Tricia Katrina T. Allas, DPBO

Abstract

Background: Ophthalmologic evaluation is often neglected in routine screening of Hansen’s disease patients. In line with the global aim of reducing grade 2 disability, eye examination should be an essential part of routine examination of Hansen’s disease patients.

Objective: To describe the ophthalmologic profile of patients with Hansen’s disease seen in a tertiary hospital.

Methods: A point-prevalence survey was conducted. Sixty-six Hansen’s disease patients, aged 18 and above, underwent complete ophthalmologic examination including visual acuity, refraction, external eye examination, intraocular pressure determination, dilated pupil examination, palpebral aperture measurement, corneal sensation testing, and tear breakup time determination. Statistical analysis was done.

Results: All patients had ocular findings with lepromatous leprosy (62%) being the highest. Fifty-three percent had Type 2 lepra reaction. Most were males, disease duration in majority was < 5 years and bacillary morphologic index was 4.0 – 4.99. Patients with Grade 1 and Grade 2 disability of the eyes were 62% and 17% respectively. The most common ocular complications were: abnormal tear breakup time (79%), cataracts (53%),blepharitis (47%), madarosis (39%) and corneal opacities (24%).

Conclusion: There is a significant number of ocular findings among leprosy patients in this study. The highest number of ocular complications is among patients in the lepromatous pole. There is a preference of M. leprae for cooler areas; hence, the anterior chamber was greatly affected.

Keywords

leprosy, Hansen’s disease, ophthalmologic examination

1. Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH. Methods for classification of leprosy for treatment purposes. Clin Infect Dis. 2007 Apr 15;44(8):1096-9.

2. Coates E, Judd J, Gisjbers K, Scott L and Krause V. Department of Health and Families. Guidelines for the Control of Leprosy in the Northern Territory, 3rd ed; 2010.1-58.

3. Malik AN, Morris RW, Morris RW, Ffytche TJ. The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years. Eye (Lond). 2011 Jun;25(6):740-5.

4. Fasal P: A primer of leprosy. Cutis. 1971; 7:525.

5. World Health Organization. WHO Weekly Epidemiol Rec.1998; 73:169-176.

6. Courtright P, Daniel E, Sundarrao, Ravanes J, Mengistu F, Belachew M, Celloria RV, Ffytche T. Eye disease in multibacillary leprosy patients at the time of their leprosy diagnosis: findings from the Longitudinal Study of Ocular Leprosy (LOSOL) in India, the Philippines and Ethiopia. Lepr
Rev. 2002 Sep;73(3):225-38.

7. Ebeigbe JA, Kio F. Ocular leprosy in institutionalized Nigerian patients. Ghana Med J. 2011 Jun;45(2):50-3.

8. Reddy SC, Raju BD. Ocular involvement in leprosy: a field study of 1004 patients. Int J Ophthalmol 2009;2(4):367-372.

9. Wani J, Sabia R, Muzaffar S, Nasti AR. Ocular Manifestations of Leprosy – A Clinical Study. JK-Practitioner. 2005. 12:14-17

10. Ebeigbe JA, Kio F (2011) Ocular leprosy in institutionalized Nigerian patients. Ghana Med J 45(2):50-53 ; Rajan MA. Eye in multidrug therapy. Ind J Lepr 1990; 62(1):33-38.

11. Fiftche TJ. Residual sight threatenibg lesions in leprosy patients completing multidrug therapy and sulphone monotherapy. Lepr Rev 1991;62(1):35-43.

12. Hogeweg M, Kiran KU, Suneetha S. The significance of facial patches and type Ireaction for the development of facial nerve damage in leprosy: a retrospective study of 1226 paucibacillary leprosy patients. Lepr Rev 1991;62(2):143-149.

13. Shorey P, Krishnan MM, Dhawan S, Garg BR. Ocular changes in reactions in leprosy. Lepr Rev 1989;60(2):102-108.

14. Kusagur, Shivayogi R, Kusagur MS, Guraraj KJ. A clinical study of ocular manifestations in leprosy. J Med Dent Sci 2013. 36(2):6816-6823.

15. E Daniel, T J ffytche, P S S Sundar Rao, J H Kempen, M Diener‐West, and P Courtright. Incidence of ocular morbidity among multibacillary leprosy patients during a 2 year course of multidrug therapy. Br J Ophthalmol. May 2006; 90(5): 568–573.

16. Krishnan A and Kar S. Bilateral madarosis as the solitary presenting feature of multibacillary leprosy. International Journal of Trichology. 2012; 3(4):179-180.

17. Khong JJ, Casson RJ, Huilgol SC, Selva D. Surv Ophthalmol. Nov-Dec 2006; 51(6):550-60.

18. Mohammad S and Kakakhel K. Ocular complications in leprosy patients from leprosy hospital, Balakot, Hazara, Pakistan. Pakistan J Ophthalmol. 1986; 2:43-45.

19. Daniel, E. and Brand, M. An unusual presentation of recurrent corneal abrasion in a lepromatous patient with impaired corneal sensation. Int. J. Lepr. 63 (1995) 450-452.

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