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Leprosy and the Eye Teaching Set © 1999, revised February 2005 International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Supported by CBM International, Sight Savers International, Tijssen Foundation. INTERNATIONAL CENTRE FOR EYE HEALTH

Section 1: Introduction1. What is leprosy and how is leprosy transmitted?: 

Section 1: Introduction 1. What is leprosy and how is leprosy transmitted?

Section 2: Leprosy around the world 2. Leprosy around the world: 

Section 2: Leprosy around the world 2. Leprosy around the world

Section 3: Clinical presentations 3. Clinical presentations : 

Section 3: Clinical presentations 3. Clinical presentations

Section 3: Clinical presentations 4. Paucibacillary Leprosy and Multibacillary Leprosy : 

Section 3: Clinical presentations 4. Paucibacillary Leprosy and Multibacillary Leprosy

Section 4: Skin smear in diagnosis 5. Skin smear in diagnosis : 

Section 4: Skin smear in diagnosis 5. Skin smear in diagnosis

Section 5: Multidrug therapy6. Multidrug therapy: 

Section 5: Multidrug therapy 6. Multidrug therapy Leprosy treatment regimens Paucibacillary: single skin lesion: 600mg rifampicin single dose 400mg ofloxacin single dose 100mg minocycline single dose Paucibacillary: 2-5 skin lesions: 100mg DDS (dapsone) once daily 600mg rifampicin once per month (supervised monthly: 6 doses to be completed) Multibacillary leprosy: 100mg DDS (dapsone) once daily. 50mg clofazimine (lamprene), once daily. 600mg rifampicin once per month 300mg clofazimine once per month, (supervised monthly: 12 doses to be completed)

Section 6: Leprosy7. Reactions (type 1 and type 2): massive infiltration with M. leprae and secondary atrophy: 

Section 6: Leprosy 7. Reactions (type 1 and type 2): massive infiltration with M. leprae and secondary atrophy Leprosy Top left: Type1 Reversal reaction Top right: Type 2 ENL Reaction Bottom left: Massive infiltration with M. leprae Bottom right: Secondary atrophy

Section 7: Treatment of leprosy8. (1) reactions (2) massive infiltration with M. leprae and secondary atrophy: 

Section 7: Treatment of leprosy 8. (1) reactions (2) massive infiltration with M. leprae and secondary atrophy

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Section 8: Eye complications 9: Eye complications Leprosy: Potentially Blinding Lesions Lagophthalmos (whole spectrum) Corneal hypoaesthesia (whole spectrum) Acute iritis and scleritis (MB leprosy) Chronic iritis and iris atrophy (MB leprosy) Cataract (whole spectrum)

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Section 8: Eye complications 10: Lagophthalmos

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Section 8: Eye complications 11. Treatment of lagophthalmos Duration of lagophthalmos ≤ 6 months: prednisolone 40mg/day slowly reducing over 12 weeks Duration of lagophthalmos > 6 months with eyelid gap < 6 mm: Conservative treatment, e.g sunglasses, 'think blink‘ 3. Duration of lagophthalmos > 6 months with eyelid gap  6 mm: eyelid surgery

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Section 8: Eye complications 12. Lateral Tarsorrhaphy for Lagophthalmos

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Section 8: Eye complications 13. Exposure Keratitis

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Section 8: Eye complications 14. Corneal Hypoaesthesia

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Section 8: Eye complications 15. Type 2 Reaction: Acute Iritis

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Section 8: Eye complications 16. Type 2 Reaction: Acute Episcleritis and Scleritis

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Section 8: Eye complications 17. Massive Bacillary Infiltration: Peri-Orbital Complications

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Section 8: Eye complications 18. Massive Bacillary Infiltration: Ocular Infiltration

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Section 8: Eye complications 19. Massive Bacillary Infiltration: Ocular Atrophic Changes

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Section 9: Leprosy and cataract 20. Leprosy and cataract

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Section 10: Examination of the eyes in leprosy 21. Examination of the eyes in leprosy

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Section 10: Examination of the eyes in leprosy 22. Visual Disability Grading Disability Grade 0: No eye problems due to leprosy; no evidence of visual loss Disability Grade 2: Eye problems due to leprosy present; (1) severe visual impairment (vision worse than 6/60; unable to count fingers at six metres); (2) lagophthalmos;

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Section 11: Patients most at risk of severe eye complications and blindness 23. Patients most at risk of severe eye complications and blindness

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Section 12 24. Prevention of blindness due to leprosy Leprosy: Prevention of Blindness Early diagnosis of leprosy: MDT treatment Early recognition of reactions: effective treatment with systemic steroids Regular eye examination: treatment of any complications Lagophthalmos surgery: all patients with a eyelid gap of ≥ 6 mm Lens extraction: leprosy patients with blinding cataract