Progression of eye disease in "cured" leprosy patients: implications for understanding the pathophysiology of ocular disease and for addressing eyecare needs

Background-Ocular damage in leprosy is due either to nerve damage or infilt ration by mycobacteria. There is currently little information about the mag nitude and nature of incident ocular pathology in cured leprosy patients. T his information would increase our understanding of the pathophysiology of ocular involvement in leprosy and help in developing programmes to address the eyecare needs of leprosy patients who have been released from treatment . The cumulative incidence of leprosy related ocular pathology and cataract was measured during an II year follow up period in cured leprosy patients released from treatment in Korea. Methods-In 1988 standardised eye examinations were performed on 501 patient s in eight resettlement villages in central South Korea. In May 1999 standa rdised eye examinations were repeated in this population. Results-Among the patients in whom there was no sight threatening leprosy r elated ocular disease (lagophthalmos, posterior synechia, or keratitis) in 1988, 14.7% developed one or more of these conditions. Overall, among those with no vision reducing cataract in 1988, 26.4% had developed a vision red ucing lens opacity in at least one eye. Among patients examined in both 198 8 and 1999, 14.3% developed visual impairment and 5.7% developed blindness. Conclusion-This study demonstrates that leprosy related ocular pathology pr ogresses in some patients even after they are cured mycobiologically. The p rogressive leprosy related lesions are the result of chronic nerve damage; ocular lesions due to infiltration by Mycobacterium leprae did not develop. Based on the factors found to be associated with development of the most v isually significant findings (posterior synechia, keratitis, and cataract) certain patients should be targeted at discharge for active follow up eye c are. We suggest that patients with lagophthalmos (even in gentle closure), trichiasis, small pupils, and posterior synechiae should be screened regula rly for the development of lagophthalmos in forced closure, keratitis, and cataract.