ICO International Clinical Guidelines:

Eye Disease in Leprosy (Initial Evaluation and Management)

(Download this Guideline as a PDF file - 91 KB)

On this page:

• Initial exam history
  
  
• Initial physical exam
  
  
• Care management
  
  
• Patient education

Initial Exam History

• Ocular symptoms (decreased vision, epiphora, symptoms of irritation) (A:III)
  
  
• Duration of lagophthalmos (< or > 6 months) (A: III)
  
  
• Duration of leprosy  (usually from date of diagnosis) (B: III)
  
  
• Type of leprosy (A:III)
  
  
• MDT treatment; what drugs and for how long (A:III)
  
  
• History of leprosy reactions (B:III)

Initial Physical Exam

• Visual acuity (A:III)
• Eyelids and lid closure (A:III)
• Corneal sensation (A:III)
• Conjunctiva (A:IIII)
• Sclera (A:III)
• Pupil  (A:III)
• Nasolacrimal apparatus (A:III)
• Slit lamp biomicroscopy
  • Corneal epithelial integrity (A:III)
  • Corneal nerve beading, stromal opacity (B:III)
  • Anterior chamber (A:III)
  • Iris atrophy (A:III)
  • Iris "pearls" (B:III)
  • Posterior synechiae (A:III)
  • Cataract (A:III)

Care Management

The main important conditions (cataract, lagophthalmos, anterior uveitis) are managed as for any patient, and people with leprosy should be integrated into the normal eye care service, specifically:

• Cataract should be removed when it adversely affects patient’s visual function (A:III)
  
  
• IOL is not contraindicated as long as quality of surgery is good and eye is quiet. (A:III )
  
  
• Chronic lagophthalmos should be treated surgically if cornea is compromised or cosmesis is a problem, regardless of severity of lagophthalmos, by whatever procedure the surgeon does best.  (A:III)
  
  
• Special considerations in a person afflicted with leprosy include:
  
  
  • New onset lagophthalmos (duration <6 months) should be treated with oral prednisolone 25-30 mg per day tapered over 6 months. (A:III)
    
    
  • Acute uveitis should be treated with intensive topical steroid; associated systemic leprosy reaction must be ruled out or treated if present with systemic steroid give dose) (A:III)

Patient Education

• At the end of MDT all patients should be warned that lagophthalmos could develop and understand the risks associated with this. (A:III)
  
  
• Patients with residual lagophthalmos must be told about the risk from exposure and specifically warned about development of red eye and decreased vision. (A:III)
  
  
• Patients should understand risks to eye during reaction and given explicit instructions on where to report if reaction develops. (A:III)
  
  
• All patients should be informed of significance of decreased vision and told to report this to case worker for referral to higher level. (A:III)

(Download this Guideline as a PDF file - 91 KB)

Next: Posterior Vitreous Detachment, Retinal Breaks and Lattice Degeneration (Initial and follow-up evaluation)

Also see:

• International Clinical Guidelines (Preface)
  
  
• Introduction to the Guidelines
  
  
• List of Guidelines