Ophthalmic consequences make leprosy a compounded handicap

Physician suggests treatments to alleviate suffering in India.

Issue: February 1, 2002

ByRyan DuBosar

Ophthalmic care is offered at a leprosy resettlement village.

JHARKHAND, India – Visual loss in people with leprosy is a compounded handicap, as they frequently have also lost the use of their limbs. However, the striking success of multidrug therapy in eradicating infection, as well as teaching physiotherapy and self-evaluation to patients, has made overall prognosis for sight very good, according to Sanjoy Chowdhury, DO, MS, who started the Eyecare in Leprosy project here in 1998.

Surgeons cannot predict which leprosy patients will have ophthalmic problems. Inaccessibility to the health care system in India complicates treatment by giving rise to high ocular morbidity, so early detection and prompt intervention can reduce ocular complications.

There are 10 million leprosy patients worldwide, of which tens of thousands live in and around Jharkhand. Leprosy sufferers on carts are commonly sighted in endemic areas, as they are denied use of public transportation. Because of these mobility problems, patients must wait for health personnel to come and attend to them.

“Eyecare has to reach their doorstep,” Dr. Chowdhury said. “This disease becomes blinding only if untreated. Around 10,000 persons affected with leprosy live around our small city. We can prevent and treat complications among these poorest of the poor who are denied conventional health care.”

Causes of blindness

Leprosy affects the eye in devastating ways, Dr. Chowdhury said. In his video presentation “Eyecare in Leprosy,” which he presented at the 14th Annual Conference of German Ophthalmic Surgeons in Nuremberg, he illustrated that the disease can rob the eyesight in several ways: corneal, uveal, lenticular and others.

Leprosy reduces corneal sensation, which causes a lack of blinking. Patients typically have lusterless, dull corneas along with reduced blinking and sensation, predisposing them toward corneal ulceration. Also, repeated scleritis can lead to ectasia.

Performing an optical iridectomy can restore workable vision in leprosy patients. Lid deformities such as severe entropion, ectropion and trichiasis, lead to ulceration. Also, lagophthalmos can cause corneal ulcerations. Taping of the lids at night combined with lubricating drops can prevent blindness due to lagophthalmos. Patient awareness is important, and patients must make such preventive measures into rituals, Dr. Chowdhury said.

Lagophthalmos is evident at the lid gap.

Bilateral corneal ulcer with complicated cataract is evident in this patient.

Chronic uveitis with posterior synechia can cause blindness. A depigmented patch on the iris reveals these symptoms in persons afflicted with leprosy (PALs). These patches are a sequelae to iritis.

Age-related cataracts are the most common cause of blindness. Hypermature cataracts with total posterior synechia caused by leprosy frequently tells the story of inaccessibility to the health care system.

During cataract surgery in PALs, perioperative asepsis is important. Dr. Chowdhury uses povidone iodine profusely, followed by proper draping and thermal cautery. Following a peribulbar block, he uses minimal instrumentation for a simple intracapsular procedure. After making an incision with a razor blade fragment, he removes the lens with intracapsular forceps. Capsular rupture is a common complication because of posterior synechia.

Hypotony and rupture of the capsule during intracapsular cataract extraction are common due to chronic iridocystitis and existing posterior synechia. The surgeon should have at hand an irrigation-aspiration cannula with 10 cc syringes. Postop refractive rehabilitation is provided in the form of +10 D aphakic glasses given after a month.

Typical leperomatous ulcers and minor trauma, left untreated, can cause blindness. Lack of access to public health care contributes to preventable blindness caused by trauma, pseudopterygium and bilateral healed corneal ulcerations, among other causes.

Vitamin A deficiency disorders are prevalent in this socioeconomic stratum. Bilateral keratomalcia and malignancy around the eye also tell of inaccessibility to public heath care.

Caring for leprosy

To care for leprosy, patients must perform self-evaluation daily. Dr. Chowdhury recommends that patients stand for 5 minutes daily in front of the mirror. They should examine their lid margins and blinking rates for signs of lagophthalmos. The patients should close their eyes to check the gap. Depigmented patches over the lids are associated with lagophthalmos.

Physiotherapy helps patients, so Dr. Chowdhury demonstrates facial massage techniques. Regular physiotherapy classes are given by a qualified physiotherapist. Regular, thorough and gentle massage done all over the face yields very good results. Patients without fingers are told to do their exercises with the palm or dorsum.

“We have our social obligations, and we must take care of them,” Dr. Chowdhury said.


Patient is blind (left) with a corneal ulcer in the right eye and advanced cataract with lagophthalmos in the left eye. Effects of attempting to close his lids (right).

For Your Information:

Sanjoy Chowdhury, DO, MS, can be reached at 4C/3020 Bokaro Steel City, Jharkand 827004, India; (91) 6542-47272; fax: (91) 6542-47911; e-mail: drsanjoy@hotmail.com.