South American cutaneous leishmaniasis of the eyelids - Report of five cases in Rio de Janeiro State, Brazil

Purpose: To describe American cutaneous leishmaniasis of the eyelids and hi ghlight the main clinical and diagnostic features of lesions, which are rar e in this location. Design: Retrospective, noncomparative case series. Methods: Leishmanin skin test, touch preparations, histopathologic analysis , and culture in appropriate media were used for clinical confirmation and parasitologic diagnosis. Positive cultures were identified by the iso-enzym es technique. All patients were treated with pentavalent antimony applied i ntramuscularly. Results: Leishmanin skin test was positive in all five patients. Touch prep arations, histopathologic analysis, and culture were performed in four pati ents. Touch preparations were positive (presence of Leishman's bodies) in t wo patients; histopathologic analysis showed a granulomatous infiltrate in four patients and parasite was present in two patients; culture was positiv e in three patients, and in two the parasite was identified as Leishmania ( Viannia) braziliensis, Therapy was effective for all patients. Conclusions: Cutaneous leishmaniasis of the eyelids is uncommon in the Amer icas. The disease may present diagnostic difficulties when appearing in non endemic areas. The clues for diagnosis are the clinical aspect of lesions, the epidemiologic data, and a positive Leishmanin skin test. Demonstration of parasite is not always possible. Pentavalent antimonial compounds are th e therapy of choice. Formerly, transmission of leishmaniasis occurred only when humans penetrated forested areas and became an incidental host. Now, e yelid lesions are part of the changing pattern in the transmission of the d isease. With the increase in ecotourism, these lesions may begin to be seen in air travelers returning to other parts of the world. Ophthalmology 2000 ; 107:169-172 (C) 2000 by the American Academy of Ophthalmology.