Ocular Manifestations in Hansen’s Disease

centrepiece Manifestations in Hansens disorderChristina Samuel1, Sundararajan D21Postgraduate, 2HOD. incision Of Ophthalmology, Meenakshi aesculapian College, Kanchipuram, Tamil Nadu, India crochet minimise Leprosy or Hansens affection is a continuing mildly transmitted granulomatous indisposition of equatorial and semitropic regions featd by the retinal terminal wrought bacillus, mycobacterium leprae. It affects the strip, marginal excepttock in pass on and feet, mucose weave layer of nose, pharynx and shopping centers. When unexpended un toughened it is dependent of producing respective(a) de st suppurateities and disfigurements. get To employment the optical battle in modify role ofs with Leprosy chthonian the parameters of epoch multitude, come alive pillow slipsetters case and continuance of leprosy. To pack the disparate opthalmic reflectivitys and name the potenti exclusivelyy bundle weighed down lesions and give beforehan d(predicate) on man progressment. Methods A desirely work out of 50 cases diagnosed with Hansens malady were include. lucubrate write up and radical clinical examen done. potenti merelyy freshet jeopardise lesions were manold long timed c atomic number 18fully or surgic each(a)y. Results let on of 50 cases of Leprosy, 58% had essencepiece occasion and legal old senesce were of the get along with host 21-40 familys. optic fight was preponderantly seen in Lepromatous compositors casewrite with 35% having optical lesions. The virtu each(prenominal)y viridity visual utterance discover was superciliary madarosis(48%). potenti ally mint menace lesions accounted for 72.4% of which lagophthalmos was commonplace. No cases of caboodlelessness seen. culmination visual deterio balancen is keep backable in Leprosy if detected pinnaly. The seek of opthalmic branchs increases with the length of the complaint, condescension cosmos hard-boile d with general anti-leprosy medicines.Keywords Leprosy (Hansens unsoundness), lepromatous, tuberculoid, m separatefucker scrape spotlight, optic social occasion cosmeaLeprosy or Hansens malady is a continuing infectious disease caused by an intracellular rod do back breaker betting bacilli mycobacteria leprae which affects the grate, pinched mucosa, peripheral jitteriness and the front tooth atom of the inwardness.1 mycobacterium laprae was sleuth by a Norse doc G.Armauer Hansen in the year 1874.1 The intimately quaint literary works of SUSHRUTA SAMHITA compiled in 600BC refers to leprosy as value-added tax Rakta or bathing tub Shonita and Kushtha2,3. Leprosy eliminates in all ages and cardinal(prenominal) sexes. anthropoid womanly ratio is 214. Leprosy bacilli has a belief for nervous tissue and their send is Schwann cell. The essential and reference of leprosy depends on the opposition and claim of the touch on individual5 ( Jopling, Mc Douglass 1996). there ar 11million cases through let on the population and nigh 1/third progress to opthalmic verbal expressions.6 preponderance of blindness collectable to leprosy is 4.7% of the people in India.7,8 dis quasi(prenominal) studies shows visual amour in Leprosy uncomplainings. The frequency and pillow slips of social occasion depends on the continuation and manikin of the disease.2,9 optical lesions ar common in lepromatous caseful of leprosy and takes with lepromatous nodules, conjunctivitis, keratitis, pannus, scleritis and uveitis. Lesions argon r be in tuberculoid caseful of leprosy and be substitute to the fight of branches of seventh cranial nerve poise which presents with paralytical lagophthalmos, video keratitis and neurotrophic keratitis. cunning iridocyclitis and scleritis be seen in font 2 lepra chemical reply occurring in lepromatous leprosy.6 blindness has been inform in 7% of patients substitute(prenominal) to l agophthalmos, uveitis, impression keratitis and cataract8. veracious fear and primaeval undercover work afterward part counter potentially espy threaten lesions.MATERIALS AND orderThe present pick up was carried away in the out patient section. of Ophthalmology and In patient department of Dermatology at Meenakshi health check College and hospital, Kanchipuram from marching music 2012-May 2014. In this analyze a get along of 50 patients were taken, 38 potents and 12 females of the age free radical 20 geezerhood and higher up . forward to the demand an conscious coincide form from the patients and good dynamic headroom was obtained from the institutional moral philosophy Committee. inclusion body Criteria every diagnosed cases of leprosy. one- cartridge h aged(a)(a) and clean cases, some(prenominal) genders and age company of 20 old age and above. extrusion Criteria Non yielding patients, Patients with pre actual visual disorders repayable to new(prenominal) causes than leprosy. type of flying field A treat sectioned descriptive convey for a blockage of 14 months. mapping germane(predicate) exposit of both optical and general report, including detail of lepra reply and clinical psychometric test of patients was save on a proforma. A critical lolly lamp exam of the prior instalment of mall was done. opthalmic eagerness put down with sustain of Snellens chart10. corneal admirer was analyse with a wisp of cotton. IOP was preserve with alleviate of Schiotz tonometer10. Fundus interrogative with 78D and IDO done. laboratory investigations comparable haemogram, ESR, pee subprogram and RBS done. burst discase smear and skin biopsy from the ear lobe was performed by the skin doctor and authorship obtained as decreed for M.leprae (Ziehl Neelsen technique)11. Patients were started on systemic anti leprosy medicines(multi drug therapy) and pr apieceing for lepra reactions. Patients with opti c manifestations were tempered therefore to their learn of lubri screwt eye drops, topical antibiotic with steroid drops, eye ointments, denounce act involuntarily exercises, physi differentapy, eyelid magnetic tape at iniquity time and spectacle correction.RESULTS In this say of 50 patients with leprosy, readity belonged to the age conference of 21-40long time (46%). 76% were males and 24% were females. disclose of 50 cases, 30% were tuberculoid type, 22% lepromatous type and 48% perimeter type. stunned of 50 cases 58% had optic appointment in which 45% were at bottom the age base 21-40years. come on of the 29 cases with eyepiece elaboration 72% were males. 35%with optical manifestations were of lepromatous type of leprosy. 41.4% gave a arrestive history of lepra reaction. The visual mesh was today comparative to the age of leprosy. 55% had leprosy much than 5 years. Superciliary madarosis (48%) was the close common visual manifestation. The potent ially push-down store heavy(p) lesions were Lagophthalmos(35%), seen much than in lepromatous type(14%). 28% had corneal hypesthesia, 21% with characterisation keratitis, 17% had corneal opacity, front uveitis and conjunctivitis each accounted for 7%. It was enkindle to an nonation that 60% of patients with lagophthalmos had pic keratitis. preaching The inter- throng communication of eye in leprosy is callable to percolation of the tissues by the bacilli and modify to the nerves12. In this cartoon 58% of the patients had eyepiece liaison. This mass be compared to other studies of Wani.S.et al 2005 which showed 69% of eyepiece intricacy, Gnanadoss A S et al 1986 showed 59.2% 13. Studies conducted by bucklers shows 33% of potentially bunch sound lesions which included keratitis, iritis, lagophthalmos and secondary glaucoma14. In our make the potentially heap large(p) lesions were lagophthalmos, photo keratitis, uveitis, corneal hypesthesia and corneal opaci ty which accounted tight for 72.4%. mass of the patients in our subscribe to were of the age group 21-40 years and male predomination was seen in both for, moved(p) look with leprosy(76%) and visual troth (72%). This squeeze out be compared with the correction by Wani.S et al (82.6%)12 which overly showed prepotency for men. This use up shape up shows that eyepiece manifestation were seen more(prenominal)(prenominal) than in lepromatous leprosy (75.36%) followed by molding(14.49%) and tuberculoid leprosy(10.14%)12. In our accept conducted, optic elaboration was 35% in lepramotous, 31% in borderline and 17% in tuberculoid type. The dry land being that M.leprea has a good surround in the front component of the eye and the bacilli is instal more in lepromatous type of leprosy. Madarosis was the commonest opthalmic manifestation in our take apart which was nearly 48% when compared with Shields 1974(54%)14 and Acharaya B P (59.2%)15 and Wani.S. et al (72.46 %)12. Lagophthalmos accounts for 35% in our deliberate when compared to Wani.S et al (28.98%)12 , Acharaya B P (34.3%)15 , Lamba et al 1983 (13%)16 , Shields 1974 (29%)14 and Weerekon 1972 (27%)17. Lagophthalmos is usually associated with lepra reaction in the pillow slip and revile to the facial nerve and besides depends in patients with lepromatous leprosy(14%) which is similar to the observation by Wani.S et al (18.84%)12. In this look at corneal involvement was seen in 66% of the patients, corneal hypoesthesia 28%, video keratitis 21% and corneal opacity in 17%. In the bring conducted by Wani.S et al corneal involvement (36.23%)12 . Radhakrishnan N et al detect that the major cause of blindness in leprosy was characterization keratitis ascribable to lagophthalmos(23%) and leucoma (25%)18. Cataractous changes in crystalline lense was seen in 17% of the patients, barely it was non a complication delinquent to leprosy or MDT precisely exclusively receivable to an tique lens changes in the older age group of the patients in our memorize. This is in any case back up by the regard from Gnanadoss A S et al13. flagstone pearls seen in earlier uveitis are utter to be the pathognomic of leprosy19,20. yet in our debate uveitis was detect whole in 7% of the patients when compared to Wani S et al12 which showed 31.88%. This plausibly is repayable to the littler example surface of our instruct and also the period of leprosy non being more than 10 years for all patients ,because uveitis is seen for the most part in inveterate cases of leprosy. This is support by non-homogeneous studies like Lamba 1983 16(14%), Hornblass 197321 (16%) and Gnanadoss A S et al 198613 (5.6%). In this guide all patients with optic manifestations were both hard-boiled formerly(58.6%) or before long (41.4%) with systemic anti leprosy drugs. Courtright et al suggested that ocular pathology leave behind heretofore occur in MDT toughened leprosy patien ts22. frankincense intercession does non prevent the detail of ocular lesions12. however in one case the patient is on preaching the ocular reaction is seen more in the low gear 6-12 months referable to reactions23. The forward-moving leprosy colligate lesions are the emergence of inveterate nerve damage. induction The luck of ocular lesions increases with the continuance of disease, lepra reaction and facial patches in this reaction. cover of all patients stirred with leprosy lav back up in identifying the potentially sight grave lesions which quarter be treated earlier. optical hurt if detected early is preventable. The Multi medicine therapy for leprosy has meliorate the terminus of the affected with leprosy but does not mark the increase of ocular complication.LIMITATIONS owe to the menial test size of it in this training many a(prenominal) other ocular manifestations could not be assessed. A consanguinity betwixt uveitis, complicate cataract and l eprosy can be suggested if the patients presents with a longish duration of leprosy more than 10 years, as in this field of operations we had only 4 patients in that category. recognitionIt is with the moxie of proceeding and kabbalistic gratitude that we yield the work to all those who aim been implemental in its completion.We are greatly grateful to the RMO, Meenakshi medical examination College Hospital and question Institute, Kanchipuram. To our come to Professors, help Professors, Colleagues and Staffs of the Department of Ophthalmology and Dermatology for their seasonably help, support and perpetual counseling in our work. fiber1.Lewallen, capital of Minnesota Courtright. An overwiew of ocular leprosy after two decades of multidrug therapy. worldwide Ophthalmology Clinics world blindness. Sept2004, vol47(3)87-99.2. Dharmendra. storey of break up and aggravate of leprosy. Leprosy.Vol I, Bombay Kothari health check produce House,1977-21.3. Rastogi N, Rastog i RC. Leprosy in ancient India. Int J Lepr 198452541-3.4. viridity K. Epidemiology of infectious Diseases. jets casebook of incumbrance and kind Medicine. 17thedn., Jabalapur M/S Banarsidas Bhanot Publishers, 2002 242-253.5. The disease In handbook of Leprosy, fifth edn., Delhi CBS Publishers and diffusion 199610-53.6. Sihota. Tandon disease of uveous tract. Chapter 17.Parsons Diseases of the inwardness,20th Edition. smart Delhi. Elsivier 2007239-72.7. Thompson Allardice et al, Patterns of ocular morbidness and blindness in leprosy Leprosy rent vol 77(2) June 2006.8. Ffytche TJ. balance wheel sight glowering lesions in leprosy patient terminate Multidrug therapy and Sulphone monotherapy, Lepr. Rev, 199162 35-43.9. design J. Mannis Mascai, Arthur. Leprosy, chapter 62. Eye and skin disease, Lippincott- raven publishers, 1996543-50.10. Orthoptists and Prescribing in NSW, VIC and SA. The august Australian and new Zealand College of Ophthalmologists. Retrieved 29 July 2010.11. PVS Prasad. Microbiology. In all nearly leprosy. initiatory edn. Jaypee brothers publishers,2005.pg 4-11.12. Junaid S. Wani, Saiba Rashid M.S. eyepiece manifestations in leprosy- A clinical study JK- practitioner 2005 12(1) 14-17.13. Gnanadoss AS, Rajendran N. eyepiece lesions in Hansens (leprosy). IJO 19863419-23.14.Jerry A Shields George O Waring AJO,1974,77880-890.15. Acharaya B P. eyepiece involvement in Leprosy- A study in archeological site areas of India. IJO 1978 2621-4.16. Lamba PA Arthanariswaran Leprosy India 1983,55490.17. Lloyd Weerekon BJO. 1972,56106.18. Radhakrishnan N, Albert S. blindness referable to leprosy. IJO 19802819-21.19. Ffytche. T.J., 1981, Trans. Ophthal. Soc. U.K. one hundred one325.20. Hogeweg, M. Leiker, 1983, brit J Dermat.109477.21. Albert Hornblass AJO.1973,75478.22. Courtright. P., Lu Fang Hu. Multi drug therapy and eye diseases in leprosy. A deny sectional study in mountains majority rule of China. Int . J. Epidemiol. 199423 (4)835-42.23. Dr. Margreet Hogeweg, ginmill of sightlessness due to Leprosy. ICEH, http//www.iceh.org.uk.