Leprosy : $b in its clinical & pathological aspectsHansen, G. Armauer (Gerhard Armauer)
Science
Leprosy : $b in its clinical & pathological aspects
Hansen, G. Armauer (Gerhard Armauer)
Leprosy
The eyes are, in the nodular form, almost always affected; nodules are
frequently present in the eyelids, the upper as well as the lower, and
are usually situated close to their margin. The earliest affection of
the eye itself, which we have observed, is a faint clouding of the
upper part of the cornea, which often appears as a very fine dotting
of the corneal surface, only noticeable when one can compare the upper
part of the cornea with the black pupil, and often requiring for its
recognition the use of a lens. A slight infiltration of the limbus
conjunctivæ is always combined with this clouding of the cornea, but it
is at this early stage so slight that it cannot be noted clinically.
Later on it increases, and gradually attacks the whole of the
outer margin of the cornea. When this infiltration becomes greater it
appears yellow, as seen through the conjunctiva running intact over
it, and this gives to the eye a peculiar woe-begone aspect. It is
quite exceptional for this infiltration to extend completely round
the cornea, for that part of the limbus directed towards the nose
is almost always free. As time goes on the infiltration increases,
and a low rampart is formed around the cornea. Sooner or later the
infiltration and nodule formation attack the cornea itself, in one of
three different ways: first, quite superficially, immediately under the
epithelium. The nodule in this case is always elevated, usually grows
very rapidly till it finally covers the whole cornea, and may by its
height prevent the closure of the lids. That part of the cornea lying
below or behind the nodule is quite clear. Secondly, the infiltration
may attack the cornea in the form of a wedge, and form a node which
is not so much elevated as in the previous instance; and thirdly, the
infiltration may penetrate the cornea close in front of Descemet’s
membrane. The result, complete blindness, is the same in all cases
when the nodule covers the pupil. A frequent accompaniment of this
form of the disease is iritis, or, as anatomical investigation shows,
irido-cyclitis. These forms of iritis run a chronic or sub-acute
course, sometimes so stealthy and painless that it is observed by
neither doctor nor patient, until adhesions have formed between the
pupillary border and the capsule of the lens. Blindness may sometimes
be caused by exudation into the pupil. _Plate II_ shows a typical case
of tuberous leprosy of six years’ duration. The hairs have completely
disappeared from the eyebrows; on the chin a few can still be seen
between the tuberosities. In the right eye is a nodule, growing from
the _Limbus conjunctivæ_ into the cornea. Nodules may also be present
in the iris, and usually arise in the outer and under margin, in the
angle between the cornea and the iris; they may completely fill the
corresponding part of the anterior chamber, are of a yellow colour,
and sometimes look exactly like an obliquely-placed hypopion, as they
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