Presentation Transcript
Slide1: 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: Introduction 1. 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 therapy 6. 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: Leprosy 7. 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 leprosy 8. (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
Slide10: 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)
Slide11: Section 8: Eye complications 10: Lagophthalmos
Slide12: 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 months with eyelid gap  6 mm: eyelid surgery
Slide13: Section 8: Eye complications 12. Lateral Tarsorrhaphy for Lagophthalmos
Slide14: Section 8: Eye complications 13. Exposure Keratitis
Slide15: Section 8: Eye complications 14. Corneal Hypoaesthesia
Slide16: Section 8: Eye complications 15. Type 2 Reaction: Acute Iritis
Slide17: Section 8: Eye complications 16. Type 2 Reaction: Acute Episcleritis and Scleritis
Slide18: Section 8: Eye complications 17. Massive Bacillary Infiltration: Peri-Orbital Complications
Slide19: Section 8: Eye complications 18. Massive Bacillary Infiltration: Ocular Infiltration
Slide20: Section 8: Eye complications 19. Massive Bacillary Infiltration: Ocular Atrophic Changes
Slide21: Section 9: Leprosy and cataract 20. Leprosy and cataract
Slide22: Section 10: Examination of the eyes in leprosy 21. Examination of the eyes in leprosy
Slide23: 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;
Slide24: Section 11: Patients most at risk of severe eye complications and blindness 23. Patients most at risk of severe eye complications and blindness
Slide25: 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