FREQUENCY OF OCULAR COMPLICATIONS OF LEPROSY IN INSTITUTIONALIZED PATIENTS IN NWFP PAKISTAN
AbstractBackground: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. Methods: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. Results: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73 % of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. Conclusions: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.
Gelber RH. Leprosy. In : Braunwale E, et al (eds) Harison’s Principles of Internal Medicine-1, 15th ed. McGraw-Hill, New York 2001: 1035
Noordenn SK, Brvo LL, Daumerie D. Global review of multi drug therapy (MDT) in leprosy. Wld Hlth Statist Quart; 1991;44
Lewallen S, Narong C, Tungpakorn, Kim SH, Courtright P. Progression of eye disease in “ cured “ Leprosy patients: implications for understanding the pathophysiology of ocular disease and for addressing eye care needs. Br J Ophthalmol 2000; 84: 817-821.
Kanski JJ. Clinical Ophthalmology, 4th ed. Butterworth-Heinemann Oxford Auckland Boston Johannesburg New Delhi 2001: 293-294.
Lamba PA, Santoshkumar D, Arthariswaran R. Ocular Leprosy-a new perspective. Indian J Lepr 1983; 55: 490-5.
Ridley DS, Jopling WH. Classification of leprosy according to immunity, a five group system. Int J Lepr 1966; 34:255-73.
Malla OK, Brandt F, Anten JGF. Ocular findings in leprosy patients in an institution in Nepal (Khokana). Br J Ophthalmol 1981; 65:226-230.
Espiritu CG, Gelber R, Ostler HB. Chronic anterior uvietis an insidious cause of blindness. Br J Ophthalmol 1991; 75:273-275.
Ffytche FJ. Role of iris changes as a cause of blindness in lepromatous leprosy. Br J Ophthalmol 1981; 65:231-139.
Akbar MK, Baig MA, Khan MA. Ocular involvement in various types of leprosy. Pak Armed Forces Med J 1998; 48(1): 11-14.
John D, Daniel E. infectious keratitis in leprosy. Br J Ophthalmol 1999; 83: 173-176.
Hwgweg M, Faber WR. Progression of eye lesions in leprosy: ten-year follow-up study in the Netherlands. Int J Lepr Other Mycobact Dis 1991; 59: 392-397.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.