Evaluation of ocular involvement in patients with Hansen's disease

Hansen’s disease (HD) belongs to the group of neglected diseases and can cause physical deformities and disabilities, in addition to leading to social discrimination. Ocular involvement in HD is estimated at 70–75% worldwide. About 10–50% suffer from severe ocular symptoms and loss of vision occurs in approximately 5% of cases. Ocular changes may persist or worsen even after patients are considered cured and it is necessary to better understand these conditions in order to determine the need for additional public policies. The objective of this study was to identify the prevalence of ocular involvement in patients with HD at two specialist referral centers for treatment of the disease. A cross-sectional study was conducted with ophthalmological evaluations of patients with HD from June 2017 to June 2018. Diagnostic ocular findings, corrected visual acuity, and refractive error were described. Findings were correlated with patients’ clinical and epidemiological variables. A total of 86 patients were evaluated, with a mean age of 50.1 years, predominantly males (59.3%), and with multibacillary HD (92%). The prevalence of ophthalmologic changes was 100% and the most common were dysfunction of the Meibomian glands (89.5%) and dry eye syndrome (81.4%). Cataracts were observed in 22 patients (25.6%), but best corrected visual acuity was normal or near normal in 84 patients (97.7%) and there were no cases of bilateral blindness. Patients with some degree of physical disability had more ophthalmological alterations, involving both the ocular adnexa (p = 0.03) and the ocular globe (p = 0.04). Ocular involvement is common in patients with Hansen’s disease, reinforcing the importance of ophthalmologic examination in the evaluation and follow-up of these patients.
Author summary Leprosy–although use of this term is not recommended because of the negative stigma attached to it–also known as Hansen’s disease is one of the oldest diseases in the world. In modern times, we have identified the agent that causes it, we know how to diagnose it, and we know how to treat it. Nevertheless, thousands of people are still diagnosed late and even though they receive the treatment recommended, they suffer from sequelae that can be highly incapacitating. When discussing its clinical presentation, what springs to mind, even among the public, are the notorious, whitened, discolored patches of skin with sensory dysfunction, but ocular involvement caused by the Mycobacterium leprae bacteria is often ignored by patients and even health professionals. Few studies have been published worldwide reporting the true incidence of eye damage caused by Hansen’s disease and identifying which patients need special care for the eyes. It is extremely important to raise awareness and increase knowledge about these conditions, so that public policies on treatment and prevention can be established. This study found that 100% of the sample of patients with Hansen’s disease had some type of abnormality of the eyes or adnexa and that patients over the age of 50 and those with some degree of physical incapacity secondary to Hansen’s disease were at greatest risk. Another important finding was the high rate of Meibomian gland dysfunction (89.5%) and dry eye syndrome.