OCULAR MANIFESTATIONS OF LEPROSY IN A NONINSTITUTIONALIZED COMMUNITY IN THE UNITED-STATES

Objective: Our goal was to delineate the epidemiologic and clinical pa tterns of ocular leprosy in an outpatient setting in the United States . Design: Examinations were performed in 61 consecutive outpatients se en in a Midwestern leprosy clinic. Patients: Forty-three male and 18 f emale patients were examined. The patients' origins included Southeast Asia (24 patients [39%]), Latin America (23 patients [38%]), India (n ine patients [15%]), Europe or North America (two patients [3%]), Afri ca (two patients [3%]), and the Middle East (one patient [2%]). Result s: Thirty-nine percent of patients were classified as having polar lep romatous leprosy; 18%, borderline lepromatous leprosy; 3%, borderline borderline leprosy; 36%, borderline tuberculoid leprosy; 2%, polar tub erculoid leprosy; and 2%, indeterminate leprosy. Ninety-six percent of patients had a best-corrected visual acuity of 20/40 or better. Ocula r findings included madarosis (28 patients [46%]), subconjunctival fib rosis (18 patients [30%]),punctate epithelial keratopathy (17 patients [28%]), posterior subcapsular cataract (10 patients [16%]), corneal h ypesthesia (10 patients [16%]), lagophthalmos (seven patients [11%]), corneal pannus (six patients [10%]), entropion (five patients [8%]), p rominent or beaded corneal nerves (four patients [7%]), iridocyclitis (four patients [7%]), focal avascular keratitis (three patients [5%]), scleritis (three patients [5%]), interstitial keratitis (two patients [3%]), iris pearls (two patients [3%]), and ocular clofazimine crysta ls (two patients [3%]). Madarosis, corneal hypesthesia, and posterior subscapsular cataracts were significantly associated with disease dura tion (P<.05). Conclusion: We report herein a relatively low frequency of visual impairment attributable to leprosy in our series compared wi th that seen among institutionalized leprous patients. However, since 48% of subjects had one or more sight-threatening complications as a r esult of their disease, a program of regular ophthalmic follow-up is s trongly advocated for all patients with leprosy.