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Pradnya Gogate B. Optom,

LEPROSY
PART 2

To view more presentations and articles, visit www.eyenirvaan.com
LEPROSY : OPHTHALMIC
STRUCTURES INVOLVED






Cornea
Sclera
Iris
Ciliary body
Lens

 Ocular

adnexa
To view more pr...
EYE COMPLICATIONS


Leprosy: Potentially Blinding Lesions
 Lagophthalmos

(whole spectrum)
 Corneal hypoaesthesia (whol...
LAGOPHTHALMOS
 Due

to

 damage

to the facial

nerve
 late result of
infiltration and
secondary atrophy of
the facial ...
HOW IS LAGOPHTHALMOS
ASSESSED?


Observe the Frequency and Extent of Blinking



Ask the Patient to Close the Eyes 'As i...


Treatment of Lagophthalmos is Dependent On:
 1.

Duration of the lagophthalmos
 2. Width of the eyelid gap, and expos...


Duration of lagophthalmos ≤ 6
months: prednisolone 40mg/day
slowly reducing over 12 weeks



Duration of lagophthalmos...
EXPOSURE KERATITIS

To view more presentations and articles, visit www.eyenirvaan.com
damage to the lower, exposed
part of the cornea, due to
dryness
 superficial punctate keratitis
 deeper corneal defect
...
TREATMENT


antibiotic eye ointment



an eye shield



An exposure ulcer is a definite indication for
eyelid surgery.
...
CORNEAL HYPOAESTHESIA

To view more presentations and articles, visit www.eyenirvaan.com
CAUSES OF CORNEAL
HYPOAESTHESIA
 As

a result of reversal reaction in the
trigeminal nerve (V cranial nerve).



As a re...
TREATMENT



no cure for corneal hypoaesthesia

To view more presentations and articles, visit www.eyenirvaan.com
Patients should receive good health education
 protection of the eyes with glasses or sunglasses
 regular blinking exerc...
ACUTE IRITIS


only in MB patients



evidence of ENL reaction inside the eye



recur at any time

To view more presen...
SIGNS AND SYMPTOMS
 redness,

pain,
photophobia, reduced
visual acuity

 haziness

of the cornea
and secondary
glaucoma
...
TREATMENT

 atropine

sulphate 1% twice daily, steroid eye
drops 6 times daily and steroid ointment at
night time

 Syst...
SIGNS OF MB LEPROSY






(temporal) madarosis of eyebrows
early collapse of the nose
nodules on the ears

To view more...
TYPE 2 REACTION: ACUTE
EPISCLERITIS AND SCLERITIS

To view more presentations and articles, visit www.eyenirvaan.com
EPISCLERITIS
 is

a transient condition

 often

as a precursor of a systemic ENL
reaction

 resolves
 Tx:

spontaneou...
SCLERITIS
bilateral
 in combination with a
severe ENL reaction
 may be nodular or diffuse
and occurs with or without
acu...


painful



ciliary nerves may become damaged and pain
becomes less



ciliary staphylomas



subsequent scleral tran...
TREATMENT
 Acute

scleritis is treated topically with
steroids

 Oral

non steroidal anti-inflammatory drugs
(NSAID's), ...
MASSIVE BACILLARY INFILTRATION:
PERI-ORBITAL COMPLICATIONS

Abnormalities occur around the eye due to infiltration
by baci...
LESIONS AROUND THE EYE


loss of eyebrows



eyelashes also become atrophic and
scanty (madarosis), and trichiasis



c...
LESIONS WITHIN THE EYE
 Ocular

leproma

 Superficial

pearls

 Iris

lepromatous keratitis and iris

atrophy and pinpo...
OCULAR LEPROMA


Lepromatous nodule in the eye, usually in the region
of the lateral limbus



a ring of nodules



pin...
PUNCTATE AVASCULAR LEPROUS KERATITIS
AND IRIS PEARLS
PUNCTATE LEPROUS KERATITIS
faint discrete superficial infiltrates in ...
IRIS PEARLS


tiny white clumps (like grains of salt) extruding from the
surface of the iris



histology shows M. lepra...
MASSIVE BACILLARY
INFILTRATION: OCULAR
ATROPHIC CHANGES

To view more presentations and articles, visit www.eyenirvaan.com
IRIS ATROPHY AND PIN-POINT PUPIL
 The

iris crypts flatten
 the stroma thins
 deep pigmented layer of the iris become v...
TREATMENT


dilate the pupil with phenylephrine 2.5 - 5%



sector iridectomy

To view more presentations and articles, ...
CHRONIC IRITIS


no redness



flare and cells in the anterior chamber



small keratic precipitates



greyish exudat...
ATROPHY OF THE CILIARY
BODY


ciliary body is believed to be the port of entry of M.
leprae into the eye



loss of acco...
LEPROSY AND CATARACT

To view more presentations and articles, visit www.eyenirvaan.com
Prevention of blindness due to leprosy


Early diagnosis of leprosy and timely
MDT treatment



Early recognition of rea...
WAYS OF APPROACH


Medical



Surgical



Social



Educational



vocational

To view more presentations and article...
THANK YOU

To view more presentations and articles, visit www.eyenirvaan.com
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Leprosy - Part 2 - a presentation at www.eyenirvaan.com

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Leprosy - Part 2 - a presentation at www.eyenirvaan.com

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Leprosy - Part 2 - a presentation at www.eyenirvaan.com

  1. 1. Pradnya Gogate B. Optom, LEPROSY PART 2 To view more presentations and articles, visit www.eyenirvaan.com
  2. 2. LEPROSY : OPHTHALMIC STRUCTURES INVOLVED      Cornea Sclera Iris Ciliary body Lens  Ocular adnexa To view more presentations and articles, visit www.eyenirvaan.com
  3. 3. EYE COMPLICATIONS  Leprosy: Potentially Blinding Lesions  Lagophthalmos (whole spectrum)  Corneal hypoaesthesia (whole spectrum)  Acute iritis and scleritis (MB leprosy)  Chronic iritis and iris atrophy (MB leprosy)  Cataract (whole spectrum) To view more presentations and articles, visit www.eyenirvaan.com
  4. 4. LAGOPHTHALMOS  Due to  damage to the facial nerve  late result of infiltration and secondary atrophy of the facial nerve and orbicularis muscle To view more presentations and articles, visit www.eyenirvaan.com
  5. 5. HOW IS LAGOPHTHALMOS ASSESSED?  Observe the Frequency and Extent of Blinking  Ask the Patient to Close the Eyes 'As in Sleep'  Ask the Patient to Close the Eyes Tightly To view more presentations and articles, visit www.eyenirvaan.com
  6. 6.  Treatment of Lagophthalmos is Dependent On:  1. Duration of the lagophthalmos  2. Width of the eyelid gap, and exposure of the cornea  3. Presence or absence of corneal hypoaesthesia To view more presentations and articles, visit www.eyenirvaan.com
  7. 7.  Duration of lagophthalmos ≤ 6 months: prednisolone 40mg/day slowly reducing over 12 weeks  Duration of lagophthalmos > 6 months with eyelid gap < 6 mm: Conservative treatment, e.g. sunglasses, 'think blink‘  Duration of lagophthalmos > 6 months with eyelid gap ≥ 6 mm: eyelid surgery To view more presentations and articles, visit www.eyenirvaan.com
  8. 8. EXPOSURE KERATITIS To view more presentations and articles, visit www.eyenirvaan.com
  9. 9. damage to the lower, exposed part of the cornea, due to dryness  superficial punctate keratitis  deeper corneal defect  secondarily infected  blindness by scarring or perforation  Chronic exposure may lead to progressive scarring  To view more presentations and articles, visit www.eyenirvaan.com
  10. 10. TREATMENT  antibiotic eye ointment  an eye shield  An exposure ulcer is a definite indication for eyelid surgery. To view more presentations and articles, visit www.eyenirvaan.com
  11. 11. CORNEAL HYPOAESTHESIA To view more presentations and articles, visit www.eyenirvaan.com
  12. 12. CAUSES OF CORNEAL HYPOAESTHESIA  As a result of reversal reaction in the trigeminal nerve (V cranial nerve).  As a result of exposure of the cornea in lagophthalmos.  As a result of severe scleritis and damage to the ciliary nerves (often bilateral).  As a result of bacterial infiltration and secondary atrophy of ciliary and corneal nerves (often bilateral). To view more presentations and articles, visit www.eyenirvaan.com
  13. 13. TREATMENT  no cure for corneal hypoaesthesia To view more presentations and articles, visit www.eyenirvaan.com
  14. 14. Patients should receive good health education  protection of the eyes with glasses or sunglasses  regular blinking exercises  regular inspection of the eyes  Corneal hypoaesthesia may be an indication for early eyelid surgery in lagophthalmos To view more presentations and articles, visit www.eyenirvaan.com
  15. 15. ACUTE IRITIS  only in MB patients  evidence of ENL reaction inside the eye  recur at any time To view more presentations and articles, visit www.eyenirvaan.com
  16. 16. SIGNS AND SYMPTOMS  redness, pain, photophobia, reduced visual acuity  haziness of the cornea and secondary glaucoma  unilateral or bilateral To view more presentations and articles, visit www.eyenirvaan.com
  17. 17. TREATMENT  atropine sulphate 1% twice daily, steroid eye drops 6 times daily and steroid ointment at night time  Systemic steroids if there is ENL reaction To view more presentations and articles, visit www.eyenirvaan.com
  18. 18. SIGNS OF MB LEPROSY    (temporal) madarosis of eyebrows early collapse of the nose nodules on the ears To view more presentations and articles, visit www.eyenirvaan.com
  19. 19. TYPE 2 REACTION: ACUTE EPISCLERITIS AND SCLERITIS To view more presentations and articles, visit www.eyenirvaan.com
  20. 20. EPISCLERITIS  is a transient condition  often as a precursor of a systemic ENL reaction  resolves  Tx: spontaneously and completely topical steroids To view more presentations and articles, visit www.eyenirvaan.com
  21. 21. SCLERITIS bilateral  in combination with a severe ENL reaction  may be nodular or diffuse and occurs with or without acute iritis  To view more presentations and articles, visit www.eyenirvaan.com
  22. 22.  painful  ciliary nerves may become damaged and pain becomes less  ciliary staphylomas  subsequent scleral translucency  thinning of the sclera  In sclerosing keratitis the whole cornea may become opaque
  23. 23. TREATMENT  Acute scleritis is treated topically with steroids  Oral non steroidal anti-inflammatory drugs (NSAID's), such as Ibuprofen (400 mg four times daily)  Treatment of the ENL reaction will require high doses of systemic steroids and clofazimine To view more presentations and articles, visit www.eyenirvaan.com
  24. 24. MASSIVE BACILLARY INFILTRATION: PERI-ORBITAL COMPLICATIONS Abnormalities occur around the eye due to infiltration by bacilli and secondary atrophy To view more presentations and articles, visit www.eyenirvaan.com
  25. 25. LESIONS AROUND THE EYE  loss of eyebrows  eyelashes also become atrophic and scanty (madarosis), and trichiasis  collapse of the nose and secondarily blocked lacrimal sac  loose skinfold in the upper eyelids (blepharochalasis) To view more presentations and articles, visit www.eyenirvaan.com
  26. 26. LESIONS WITHIN THE EYE  Ocular leproma  Superficial pearls  Iris lepromatous keratitis and iris atrophy and pinpoint pupil  Chronic iritis  Atrophy of the ciliary body To view more presentations and articles, visit www.eyenirvaan.com
  27. 27. OCULAR LEPROMA  Lepromatous nodule in the eye, usually in the region of the lateral limbus  a ring of nodules  pinkish red or yellowish and fleshy  pinkish red or yellowish and fleshy  painless  pupil may be deformed
  28. 28. PUNCTATE AVASCULAR LEPROUS KERATITIS AND IRIS PEARLS PUNCTATE LEPROUS KERATITIS faint discrete superficial infiltrates in the upper outer quadrant of the cornea  consist of clumps of bacilli-laden cells  become tiny white opacities  finally coalesce in a diffuse haze  bilateral and asymptomatic.  Beading of the corneal nerves (diagnostic for leprosy) To view more presentations and articles, visit www.eyenirvaan.com
  29. 29. IRIS PEARLS  tiny white clumps (like grains of salt) extruding from the surface of the iris  histology shows M. leprae  dislodge into the lower angle of the anterior chamber, where they may be absorbed or give rise to anterior synechiae   Iris pearls are pathognomonic for leprosy. seen in longstanding MB leprosy
  30. 30. MASSIVE BACILLARY INFILTRATION: OCULAR ATROPHIC CHANGES To view more presentations and articles, visit www.eyenirvaan.com
  31. 31. IRIS ATROPHY AND PIN-POINT PUPIL  The iris crypts flatten  the stroma thins  deep pigmented layer of the iris become visible  full thickness iris holes appear  prominent in the stroma of the iris dilator muscle  pupil becomes pin-point  bilateral patient will become 'night blind'. To view more presentations and articles, visit www.eyenirvaan.com
  32. 32. TREATMENT  dilate the pupil with phenylephrine 2.5 - 5%  sector iridectomy To view more presentations and articles, visit www.eyenirvaan.com
  33. 33. CHRONIC IRITIS  no redness  flare and cells in the anterior chamber  small keratic precipitates  greyish exudates along the pupillary margin  the pupil constricts  posterior synechiae may form To view more presentations and articles, visit www.eyenirvaan.com
  34. 34. ATROPHY OF THE CILIARY BODY  ciliary body is believed to be the port of entry of M. leprae into the eye  loss of accommodation  intraocular pressure tends to be low i To view more presentations and articles, visit www.eyenirvaan.com
  35. 35. LEPROSY AND CATARACT To view more presentations and articles, visit www.eyenirvaan.com
  36. 36. Prevention of blindness due to leprosy  Early diagnosis of leprosy and timely MDT treatment  Early recognition of reactions and effective treatment of reactions with systemic steroids  Regular eye examination and treatment of any complications  Lagophthalmos surgery in all patients with a eyelid gap of ≥ 6 mm  Lens extraction in any leprosy patients who develop blinding cataract To view more presentations and articles, visit www.eyenirvaan.com
  37. 37. WAYS OF APPROACH  Medical  Surgical  Social  Educational  vocational To view more presentations and articles, visit www.eyenirvaan.com
  38. 38. THANK YOU To view more presentations and articles, visit www.eyenirvaan.com

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