Ophthalmology Department

Hasanuddin University

Introduction
Leprosy is a chronic granulomatous

disease caused by the intracellular acidfast bacillus Mycobacterium leprae,

whose clinical manifestations are largely
confined to the skin, peripheral nervous
system, upper respiratory tract and eyes.
It is estimated that 1.5-2% of the total
are blind from leprosy related causes and
another 2 percent are blind from nonleprosy causes.

 leprosy patients can be regarded as a

spectrum determined by the cell-mediated

immunity of the individual.
Patients are either paucibacillary (smear
negative) or multibacillary (smear positive).
Generally in paucibacillary cases, damage
to the eye is caused indirectly by M.leprae
either secondary to motor or sensory nerve
damage.
In multibacillary cases, eye is damaged due
to infiltration by M.leprae.
For simplicity, ocular lesions can be
classified in to two groups.
1. potentially sight threatening lesions .
2. academic lesions.

Potentially sight threatening

lesions
Lagophthalmos (whole spectrum)
Corneal hypoaesthesia (whole

spectrum)
Acute iritis and scleritis (MB
leprosy)
Chronic iritis and iris atrophy
(MB leprosy)
Cataract (whole spectrum)

Academic lesions
No visual significance but contribute

to the stigma which these patients

endure.
Such as loss of eyebrows and
eyelashes.
Hair loss is due to hair root
infiltration with lepromatous
granuloma.

Ocular complication
1. Extra ocular

Cilia

Palpebra

Lacrimal gland

2. Ocular

Anterior segment
Posterior segment

Extra ocular
Complication
Madarosis supercilia

Result of damage to the cilia root due to

leprosy bacilli and generally on the old
type lepromatous
Palpebral atrophy
This situation can aggravate ectropion
Lagophtalmos
Caused by orbicularis oculi muscle
paralysis as the effect of N. VII
(infiltration of leprosy bacilli to the
nerve) damage

Extra ocular
Complication
Lacrimal secretion disorders
Triggered to various causes:
Palpebral dysfunction
Loss of blinking reflex
Ectropion

Acute and chronic Dacryocystitis

Secondary organisms and destruction of

the nasal bones resulting in obstruction

of the nasolacrimal duct.

Ocular complication
Most of the ocular complications caused by :

Conjuctiva
Cornea
Episclera
Anterior sclera
Iris
Cilliary Body
Lens

Complications occur depends on:

Immunological status of patients
Type of leprosy

Ocular complication
Conjuctiva
A mild conjunctival inflammation
with edema and dilated blood
vessels may be seen.
Pterygium, with collections of
macrophages containing M. leprae,
has been reported.

Ocular complication
Cornea
M. leprae can invade the structure only by
direct extension from surrounding tissues.
The 3 common lesions are
Thickening and beading of corneal nerves
Superficial punctate keratitis (SPK)
Interstitial Keratitis

corneal pearls characteristic of

lepromatous leprosy.
The V nerve involvement results in
impairment of corneal sensibility
predisposing to corneal ulcers.

Ocular complication
Episclera and Sclera
This involvement is common in
untreated lepromatous patients.
Presenting with nodules up to 5 mm
in diameter at the sclerocorneal
junction.
Scleritis is mostly seen in advanced
untreated lepromatous patients and
may weaken the globe.

Ocular complication
Ciliary bodyandIris
Lepromatous iridocyclitis is one of the
commonest causes of blindness in leprosy.
Acute iridocyclitis is a common
complication of erythema nodosum
leprosum (ENL) reactions.
Miliary lepromas or iris pearls near the
pupillary margins pathognomonic.
Destruction of the tissues of the iris and
ciliary body causes atrophy and shrinkage
of the globe known as pthisis bulbi.

Ocular complication
Lens
Chronic iridocyclitis may be
responsible for the early formation of
cataract.
Steroids, used in the treatment of
lepra reactions may hasten the
formation of subcapsular cataract.

Ocular complication
Posterior segment
The choroid and retina are not
ordinarily involved in leprosy.
There have been a few anecdotal
reports of extensions of lepromatous
lesions form the ciliary body to the
choroid which appear as minute
nodular lesions.

Ocular complication
(image)

Ocular complication
(image)

Conclusion
The eye is involved in all forms of

leprosy, more in lepromatous than

tuberculous leprosy.
Repeated and careful examination of
the eye especially of those with
lepromatous leprosy and those with
nerve involvement affecting the eye
cannot be overemphasized.