Avaliação das manifestações oculares no diagnóstico e durante o tratamento de pacientes com hanseníase

Abstract

Introduction: Leprosy is the disease that mostly frequently gives rise to disorders of the eye, so it is important that all professionals who treat leprosy patients have a basic understanding about these. Eye complications in leprosy have decreased, but they still happen. The ocular features most frenquently seen in leprosy patients are: madarosis, keratitis (due to a combination of trichiasis, lagophthalmos, loss of corneal sensation, and secondary infection), conjunctivitis, scleritis, episcleritis and uveitis. Objectives: To find out the presence of ocular manifestations in patients with leprosy before and during treatment. Methods: A cross-sectional prevalence survey was carried out with leprosy patients at University Hospital Cassiano Antônio de Morais in Vitória, Brazil. Forty two newly diagnosed, untreated leprosy patients were recruited from December 2007 to July 2009, and subjected to eye examination, in accordance with pre established protocol.They were examined before the beginning the leprosy treatment and followed up for 6 months. The data were crossed and analyzed statistically Results The visual acuity ranged from 0.1 to 1.0 at each eye (Mean 0.7); ocular manifestations occurred in 39 patients (92.9%), however considered due to leprosy in 10 (23.8%). Over all, reduction in tear film break-up time and in production of tear film were the most prevalent ocular complication (92.9% and 42.9 % respectively). The most prevalent ocular complication often related to leprosy was madarosis of superclia (14.3%), corneal sensitivity diminished and madarosis of cilia (11.7%). Punctate keratitis was presented in 2 patients (4.8%). During the follow up, 9,5% of patients had increased IOP, 2,4% íris atrophy and 9,5% puctata keratitis. Conclusions: There was a greater prevalence of ocular involvement in the multibacillary forms compared to the paucibacillary forms. Madarosis of the cilia, supercilia, diminished cornea sensitivity, involvement of the cornea and iris were all found at levels below those previously described. These results suggest that ocular involvement at the moment of diagnosis of leprosy was still in the initial stage. The prevalence of ocular complications and the fact that they can occur even during treatment, reassert the necessity of these patients be assessed by an ophthalmologist.