Evaluation of ocular involvement in patients with Hansen’s disease

Abstract

Hansen's disease (HD) belongs to the group of neglected diseases and can cause physical deformities and disabilities, in addition to leading to social discrimination. Ocular involvement in HD is estimated at 70-75% worldwide. About 10-50% suffer from severe ocular symptoms and loss of vision occurs in approximately 5% of cases. Ocular changes may persist or worsen even after patients are considered cured and it is necessary to better understand these conditions in order to determine the need for additional public policies. The objective of this study was to identify the prevalence of ocular involvement in patients with HD at two specialist referral centers for treatment of the disease. A cross-sectional study was conducted with ophthalmological evaluations of patients with HD from June 2017 to June 2018. Diagnostic ocular findings, corrected visual acuity, and refractive error were described. Findings were correlated with patients' clinical and epidemiological variables. A total of 86 patients were evaluated, with a mean age of 50.1 years, predominantly males (59.3%), and with multibacillary HD (92%). The prevalence of ophthalmologic changes was 100% and the most common were dysfunction of the Meibomian glands (89.5%) and dry eye syndrome (81.4%). Cataracts were observed in 22 patients (25.6%), but best corrected visual acuity was normal or near normal in 84 patients (97.7%) and there were no cases of bilateral blindness. Patients with some degree of physical disability had more ophthalmological alterations, involving both the ocular adnexa (p = 0.03) and the ocular globe (p = 0.04). Ocular involvement is common in patients with Hansen's disease, reinforcing the importance of ophthalmologic examination in the evaluation and follow-up of these patients.

Ocular Findings among Filipino Patients with Leprosy in a Tertiary Hospital: A Cross-sectional Survey

“…The prevalence of ocular involvement from leprosy ranges from 6-100%, varying greatly depending on the study population, method, and clinical profiles. 24 The observed ocular complications in this study were quite low (only 6% for steroid-induced cataracts), and no leprosy-specific findings were detected. In general, the low prevalence of vision loss in patients with leprosy is likely a result of effective MDT and surveillance programs.…”

“…29 In a study in Brazil, a greater than 6 times chance of intense adnexal involvement was seen in patients over the age of 50 years, mainly due to Meibomian gland dysfunction. 24 The most common ocular morbidity detected was error of refraction, with most having good visual acuity. This likely mirrors the general population, wherein refractive errors are the most common cause of visual impairment.…”

“…25 The influence of the disease on cataract formation is unclear, 3,5 but the presence of leprosy triples the risk of cataract formation. 24 Early hypotheses include infiltration of the iris by the mycobacteria and production of quinones, promoting cataractogenesis. 3,32 Inflammation has been purported as a cause upon histological examination of cataracts.…”

Validity and reliability of the NEI VFQ-25 questionnaire in Indonesian leprosy patients

“…Leprosy is a chronic infectious disease with high incidence of physical deformity, including ocular involvement. 1,2 Globally, out of 70-75% cases with ocular involvement, 10-15% suffered severe visual impairment and 5% blindness. 1,2 Indonesia is the third-highest of leprosy new cases annually, after India and Brazil.…”

“…1,2 Globally, out of 70-75% cases with ocular involvement, 10-15% suffered severe visual impairment and 5% blindness. 1,2 Indonesia is the third-highest of leprosy new cases annually, after India and Brazil. World Health Organization (WHO) reported 17.439 new cases of leprosy in Indonesia, among them were 1.121 new leprosy cases with grade 2 disability.…”