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Leprosy of the eye--a general outline.

Summary Ocular complications from leprosy (Hansen's disease) seriously threaten a patient's quality of life. The eye (the anterior segment structures) may be infiltrated and damaged by the mycobacteria directly; may suffer damage from inflammation (Type II reaction), and be damaged as a result of changes in the extraocular structures. These are features of the disease at or near the lepromatous end of the spectrum. In addition to direct damage, the eye in about 15-20% of patients irrespective of their disease type, is subject to abnormal exposure due to nerve damage. This may be motor (c. 7) causing lagophthalmos, or sensory (terminal branches of ophthalmic division ofC.5) causing corneal hypaesthesia. Secondary infection by other pathogens complicates the damage initiated by dryness and trauma. The patient most at risk is the one with active, long-standing lepromatous disease. He/she will possibly have diminished pain sensitivity. Symptoms will be unreliable. Routine objective examination of such patients becomes mandatory. Fortunately, most of the significant pathology is visible with the help of relatively unsophisticated instruments. A useful examination may be done in 2 or 3 minutes once the routine has become established. An outline of pathophysiology, diagnosis and management of the main features of ocular leprosy have been presented in this article. Its aim has been to help the physician or other health worker to assume responsibility for the primary eye care of their leprosy patients and thus reduce the possibility of blindness. Loss of sensation of the extremities is a serious handicap to any individual. Blindness superimposes an intolerable burden.