Leprosy keratopathy

Introduction to leprosy keratopathy Leprosy is an extremely chronic and less contagious disease caused by M. leprae, which mainly affects the skin and peripheral nerves. In severe cases, it can cause damage and limb disability. In addition to invasive skin and peripheral nerves causing leprosy nodular lesions, leprosy can also invade various organs and tissues in the body, and the eye is also the most commonly involved organ. 25% of patients can cause leprotickeratitis. The patient not only loses the feeling of touch but also loses sight. It is an irreversible double tragedy, which brings great pain to patients and their families. basic knowledge Sickness ratio: 0.0007%-0.0009% Susceptible people: no special people Mode of infection: blood transmission Complications: Neurosis

Causes of leprosy keratopathy

(1) Causes of the disease

Mycobacterium leprae is a pathogen of leprosy. Its morphology and staining are similar to those of Mycobacterium tuberculosis. It is a typical intracellular bacteria. A large number of cells of leprosy present in the patient's exudate specimens are called leprosy. cell.

(two) pathogenesis

1. Primary keratopathy Mycobacterium leprae directly invades the cornea through epithelial or corneal vessels, localized onset or through antigen-antibody allergy, mainly manifested as corneal stroma.

2. Secondary keratopathy Mycobacterium leprae infects the eyes and face through the blood, causing damage to the facial branch of the facial nerve and the surface branch of the trigeminal nerve, causing abnormal position of the eyelid, and the normal blinking reaction disappears, leading to exposed keratitis. Paralytic keratitis and dry eye syndrome occur.

Leprosy keratopathy prevention

Eat low-lying low-energy diet, maintain a reasonable weight, stop drinking, drink plenty of water, daily drinking water 2000ml or more. Avoid overeating, alcohol, cold and dampness, excessive fatigue and mental stress, wear comfortable shoes, prevent joint damage, and use drugs that affect uric acid excretion such as certain diuretics and low-dose aspirin. Prevention and treatment of associated diseases such as hypertension, diabetes and coronary heart disease.

Complications of leprosy keratopathy Complications

Corneal degeneration, hard cornea and typical skin lesions with neurological symptoms.

Leprosy keratopathy symptoms common symptoms sensory disorder keratitis trichiasis corneal opacity uveitis

Eye lesion

Mainly invading the anterior part of the eye, the structure of the posterior part of the eye rarely occurs, showing bald eyebrows, bald eyelashes, trichiasis, rabbit eyes, keratitis, upper scleritis, scleritis, iridocyclitis and uveitis.

2. Corneal lesions

(1) Rosary keratopathy: It is an important early nerve-related keratopathy. The nerve has localized swelling and beading. There are piles of leprosy cells and a small amount of lymphocytes and pulp in the diseased nerve. Cell infiltration, the lesion can resolve itself, or it can persist for several years due to calcification.

(2) Shallow punctate keratitis: It is the most common type of corneal disease in the first 10 years of leprosy. The symptoms are mild. At the beginning, the lesion often appears in the proximal margin of the supraorbital quadrant. Small and scattered gray-white punctate turbidity, often missed diagnosis due to the small lesions. As the disease progresses, the punctate opacity can be extended to other quadrants and merged into deeper invasion. When the pupil area is affected, it affects vision.

(3) vasospasm corneal opacity: within 20 years after the onset of leprosy, with the development of keratitis, blood vessels grow to the center of the cornea, causing vasospasm opacity, and more leprosy enters the cornea through the blood, producing new Invasive lesions sometimes form "pearl"-like small leprosy in the neovascular network and, in severe cases, extend to adjacent conjunctiva.

(4) corneal leprosy or nodules: early onset of nodular lesions is rare, such as occurs, occasionally seen in the upper sclera near the lateral limbus, this lesion occurs in advanced patients (20 or more years), nodules It can occur frequently, even around the limbus, but the most common, the largest nodules occur in the lateral corneal margin. If the nodule invades the full-thickness cornea, sclerosing keratitis, corneal degeneration or various chronic keratopathy can occur. .

When leprosy patients have typical skin lesions with neurological symptoms, combined with a clear history of the disease, the diagnosis is easier. When the early symptoms are atypical and light, they are often misdiagnosed or missed. The main basis for leprosy diagnosis is:

1. Special clinical rash, peripheral nerve swelling and sensory disturbance.

2. Skin scrapings to find acid-fast bacteria.

3. Biopsy histopathological examination.

4. The exact data on the history of leprosy exposure, etc., after comprehensive analysis and judgment.

Examination of leprosy keratopathy

Anti-acid bacteria can be found on the skin scraper.

Pathological examination revealed characteristic epithelioid cells, Langhans cell granuloma, or leprosy cells, which have important diagnostic value.

Diagnosis and diagnosis of leprosy keratopathy

When collecting medical history, the patient may conceal the condition because of fear. The doctor should fully obtain the trust and cooperation of the patient, focus on the history of the symptoms and the history of family contact, and pay attention to the local sensory impairment with diagnostic value when examining the body. Large nerves, such as sensory disturbances appear in the lesions and numbness and sweat area, it is more diagnostic value. Checking leprosy from the skin tissue is important for diagnosis, but leprosy cannot be ruled out when the bacteria is negative. When tuberculosis-type leprosy is mostly negative, when the bacteria are positive, attention should also be paid to the identification of other acid-fast bacilli. The clinically used bacterial index (BI) and morphological index (MI) are used to indicate the presence of leprosy in tissues, bacteria. The index or bacterial density index is the sum of the bacterial densities of each part according to the Ridely logarithmic classification method, and divided by the number of parts examined. The Ridely counting method is 10 times difference between each level, and the shape index is complete. The proportion of M. leprae (living bacteria) in the total bacterial amount is difficult to standardize in practical application, so only the description of the morphology of the bacteria is reported. In addition to reflecting the content and morphology of M. leprae, it can also be used as an indicator for evaluating the efficacy of drugs. In addition, it should be diagnosed with the type of leprosy, the degree of activity of the lesion, the degree of dysfunction caused, and the presence or absence of residual disability. Help clinical correct treatment.

Leprosy should be distinguished from various skin diseases and various types of neuritis. Important confusing skin diseases include various skin diseases, psoriasis, drug eruptions and various erythematous skin diseases. Infectious and toxic neuritis, neurological symptoms caused by compression of nerve channels, etc. Although leprosy has various forms of skin lesions, most of them have simultaneous peripheral nerve involvement symptoms, which is related to simple skin diseases. More characteristic and discriminating value, such as the results of skin scraping and pathological examination, can generally make a correct diagnosis.

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