Decreased Corneal Sensations in Leprosy

Introduction: Leprosy represents a leading cause of blindness from an infectious disease. Broadly there are two type of ocular complications 1. Potential sight threatening complications such as a) Lagophthalmos, exposure keratitis and its sequelae. b) Corneal anesthesia and its sequelae. c) Iridocyclitis and its sequelae; 2. Academic complications such as beading of the corneal nerves, iris pearls, and madarosis. Corneal anaesthesia leads to increased incidence of corneal ulcerations due to foreign bodies and trauma, leading to loss of vision. Beuerman and colleagues have shown that sensory denervation significantly delays healing of experimentally induced epithelial wounds in rabbits. Study: A study of 50 consecutive outpatients of Rawalpindi Leprosy Hospital was done to study the incidence of reduced corneal sensations. Out of the 100 eyes examined, only 10 had visual acuity of less than 3/60. Lagophthalmos was present in 7 (14%) patients (11 eyes). 28 patients (53 eyes) had partial or complete corneal anaesthesia. Acute iridocyclitis was seen in 2 patients (2 eyes). 21 patients (31 eyes) had evidence of uveitis (chronic uveitis, acute uveitis and past uveitis) Significant cataract was found in 9 patients (13 eyes). 70% of the patients had one or more vision threatening complications. 56% of the patients had reduced corneal sensations; these numbers are of particular concern as the ocular care of these patients is limited.