Ocular manifestations in lepromatous and tuberculoid leprosy

Abstract

Ocular manifestations of leprosy in 100 patients examined were reported on; -80% were suffering from the lepromatous type of the disease. The most frequent change was loss of eyebrows (40%) which was seen mainly in lepromatous patients. The sclera and cornea were rarely affected separately, but sclerokerato-iridocyclitis was found in 3%. On the other hand, the iris was involved rather more often -16% (atrophy of the iris -4, atrophy of the pupillary margin -3, miosis -1, posterior synechiae -6, keratic precipitates -1, and iris "pearls" -1). The iritis always had an insidious chronic evolution. The origin of the iritis is probably multifactorial: a) neuroparalytic due to involvement of the autonomic nerves supplying the iris muscles, primarily dilator; b) direct effect of Mycobacterium leprae on the iris tissue; and c) immune or auto-immune mechanisms. The posterior uvea was rarely affected (2%). No case of primary glaucoma was detected, but secondary glaucoma due to sclerokerato-iridocyclitis was found in 2 cases. Cataract seems to occur more frequently in leprosy patients (20%) than in the general population. The anterior segment was mostly affected (21%), and all these cases belonged to the lepromatous (16) or borderline lepromatous (5) type.