Cover Image
close this book Combatting Hansen's disease
View the document Table of contents
View the document List of common abreviations
View the document I. Introduction
Open this folder and view contents II. Pertinent physiology and immunology
Open this folder and view contents III. Hansen's disease - Three perspectives
Open this folder and view contents IV. Health education
Open this folder and view contents V. Case finding
Open this folder and view contents VI. Diagnosis - Symptoms and testing in HD
Open this folder and view contents VII. Patient management
Open this folder and view contents VII. Co-operating institutions
Open this folder and view contents IX. Getting started
View the document Appendix I
View the document Appendix II
View the document Appendix III
View the document Appendix IV

Appendix I

This Appendix is to serve as a summary reference for eye involvement in HD, It has two parts.

The first is a summary of eye involvement by anatomical structure. It lists all of the parts of eye involved in HD in the following order and details pathologies

Eyebrows

Eyelids

Eyelashes

Conjunctiva

Sclera

Cornea

Iris

Lens

Eyeball

Optic Nerve

The second part is a chart for differential diagnosis of "red eye" in HD patients.

Summary of Eye Involvement in HD by Anatomical Structure

EYEBROWS

COMPLETE OR PARTIAL DISAPPEARANCE in lepromatous leprosy

 

EYELIDS

LEPROMATOUS NODULES - dangerous for cornea because of the inflammation of the eye.

 
 

LAGOPHTHALMOS - dangerous for cornea, because it exposes a part of it to onjuries. Especially dangerous if the cornea is anaesthetic.

 
 

ENTROPION - dangerous because it brings the eyelashes in contact with cornea: this is called Trichiasis (and especially dangerous if this is anaesthetic)

 
 

ECTROPION OF EFFORT

 

EYELASHES

IN CONTACT WITH CORNEA

 
 

COMPLETE OR PARTIAL DISAPPEARANCE - mostly in lepromatous leprosy, and probably due to lepromatous nodules in the eyelids.

 

CONJUNCTIVA

CONJUNCTIVITIS

 
 

(a) NON -INFECTIOUS

 
 

Caused by trauma (dust, insects) very often not felt by the patient at the time, because of the anaesthesia.

 
 

(b) INFECTIOUS

 
 

Caused by micro-organisms. Here, especially Trachoma. But a great number of germs can invade the conjunctive, especially in case of lagophthalmos.

 

SCLERA

LEPROMATOUS NODULES - can be seen on the sclera. When they are situated just beside the iris, they can cause iritis.

 
 

N. B. Don't confuse Phyctena of Conjunctiva with a nodule in the Sclera.

 
 

SCLERITIS EPISCLERITIS - Probably due to allergy

 
 

Symptoms:

Local tenderness

   

Pain when moving eyeball

   

Localised redness

   

No discharge

CORNEA

Fluoresceine test = + when ulceration is acute

CORNEAL ULCERS caused by:

 
 

(1) lack of protection of cornea (lagththalmos) and anaesthesia of cornea.

 
 

(2) Infection of lacrymal duct, in case of partially distroyed nose. If the lesion is penetrating, the Anterior Chamber may be infected and pus may be seen in the bottom.

 
 

It is called: HYPOPION. Secondary Iritis may occur.

 

CORNEA

Fluoresceine test = generally f

KERATITIS & INTERSTITIAL K. - principally in lepromatous patients. It appears like a sort of white clouds or mist, in the upper part of cornea. White 'beads' can be ace in the affected area. N. B. Look for PANNUS.

 
 

Keratitis seems to be the result of leprosy bacilli in front of the eye.

 
 

Keratitis may also occur in connexion with Iritis. Thus, always carefully examine the" upper part of cornea during an attack of Iritis.

 
 

PUNCTATED KERATITIS - appears like small white flakes, sometimes not to be seen at first examination, and appearing only with Fluoresceine test.

 
 

ABRASION OF CORNEA - can be caused by Trichiasus - and also be Trachoma if this disease is not treated early - and until complete healing. Sometimes the scars of Trachoma can cause it.

 
 

SCLEROSING KERATITIS - is the result of repeated attacks of inflammation around the limbus, leading to Fibrosis of Cornea.

 

IRIS

LEPROMAS can appear like white 'pearls' anywhere on the iris. Their shape can be easily seen if the iris is moving. (Don't confuse them with small colourless points which can sometimes be seen around the pupil, and are senile de generation).

 
 

IRITIS - inflammation of the iris.

 
 

IRIDOCYCLITIS - inflammation of the iris and ciliary body.

 
 

Symptoms:

Pain inside of the eye, and around orbit

   

Redness of Sclera (N. B. Circumcorneal injection is an ominous sign in acute Irido cyclitis)

   

Sluggish light reflex

   

Irregular and small pupil

   

Photophobia

   

Dimness of vision

   

Watering

   

Inside pressure decreased

 

N. B. Iridocyclitis may lead to:

 
 

SECONDARY GLAUCOMA, by different ways:

 
 

(1) When healing, the Iris may produce scars sticking it on the Lens, all around the pupil. This may cut the communications between anterior and posterior chambers, and lead to a secondary Glaucoma.

 
 

(2) Inflammatory cells, exuded in the anterior chamber, may settle in the angles of anterior chamber and block the outlet of aqueous. This also causes a secondary Glaucoma.

 
 

(3) When Atropine is used for treatment of IRITIS and when the pupil is much dilated, the angles of anterior chamber may be shut by the thickness of Iris (at its root) and the outlet of aqueous may be blocked, This also leads to secondary Glaucoma.

 
 

Symptoms of Secondary Glaucoma:

 
   

Sudden increase of pain

   

Misty aspect of the cornea (due to oedema)

   

Increase of tension in the eye

   

N. B. The dilated pupil, which is a symptom of Primary Glaucoma cannot be retained as a secondary Glaucoma because:

   

a) The use of Atropine is producing this effect.

   

b) If there are Synechiae all around the Pupil, sticking it on the Lens, the Pupil cannot dilate anymore.

LENS

CONTRACT - Opacity of Lens

 
 

Normally, the Lens being transparent, the Vitreous can be seen behind it, and this makes the pupil appear black.

 
 

When there is a Cataract, the white lens can be seen and makes the Pupils appear white.

 
 

The Cataract can only be cured by operation. It can be caused by old age (abaft 50), by Glaucoma by traumas or by secondary eye infection, like Iritis.

 

EYEBALL

PANOPHTALMIA or PLEGMON - Total infection of eyeball.

 
 

Causes:

Traumas

   

Infectious illness of eye

   

General infectious illness like

   

Smallpox or meningitis

   

Exoptalmia

   

Red, shining and swollen eyelids

   

Acute pain

   

Fever

   

Suppuration after a certain time

 

N. B. The eye is practically always lost.

 
 

GLAUCOMA - Illness of eye characterized by increase of intra ocular tension and which can rapidly lead to blindness.

 
 

Symptoms:

Start suddenly

   

Acute pain

   

Dilated and oval pupil (not constant but most of the time)

   

Light reflex: sluggish or suppressed

   

Headache

   

Dimness of vision

   

Circumcorneal redness

   

Increase in tension of eyeball

   

Sometimes: vomitions or nausea

 

CRONIC GLAUCOMA - The symptoms are the same as above, by much more slow. The evolution can take years.

 
 

SECONDARY GLAUCOMA - See above, about IRITIS and IRIDOCYCLITIS.

 

OPTIC NERVE

NEURITIS

 
 

Symptoms:

Pain

   

Dimness of vision

   

Sometimes: dilated Pupil

 

Causes:

Meningitis

   

Syphilis (in this case, the pupil is dilated)

   

Intoxication

 

ATROPHY

 
 

Symptoms:

Dimness of vision, or sudden blindness

   

Dilated Pupil

   

Normal tension

   

No pain

 

Causes:

Traumas

   

Cerebral illness

   

Intoxication (for instance, with methylic alcohol)

   

Medicinal intoxication (especially with arsenical drugs)

   

Dangerous illness of eye, like Glaucoma

 

 

DIFFERENTIAL DIAGNOSIS OF "RED EYE" due to:

Symptoms and signs

Conjunctivitis

Scleritis/ Episclevtis

Corneal ulcer kerstitis

lritis-Iriocyclitis

Acute closed - Angle glaucoma

1. History of trauma or irritation

Common

No

Frequent

No

No

2. Blurring of vision

No

No

Yes

Yes

Severe; with haloes around lights

3. Photophobia

No

No

Yes

Yes

No

4. Type of pain

No real pain.

May have itch or 'gritty' sensation

Pain on moving eyeball or touching eye

Both superficial pricking and a deep pain.

Deep pain and circumorbital aching

Severe; deep pain with headache and nausea

5. Exudate

Usually some; may be copious

No

Usually some especially if ulcerated

No

No

6. Position of maximum redness

Generalized; including lid conjunctiva

Localized to affected area

All around cornea but maximal nearest the ulcer or injury

Encircling cornea

Encircling cornea

7. Tint of redness

Bright red

Mixed. Some bright; some a dusky pink

Usually bright

Mixed

Bright

8. Tender to palpation

No

Yes, especially over red area

a little

Yes, often marked

To light touch, none

9. Pressure of eyeball

Normal

Normal

Normal

Sometimes very low; occasionally a little raised

Markedly raised (usually over 50 mm)

10. Pupil size and response

Normal

Normal

May be small

Small; reaction to light sluggish

Dilated, fixed

11. Appearance of cornea

Normal

Normal

Cloudy or even opaque in affected part

Slightly cloudy

Slightly cloudy

12. Cornea with fluorescein

No staining

No staining

Stains gree with fluorescein if ulcerated

No staining with fluorescein

No staining