Research

Leprosy without Borders: Ocular and Cutaneous Manifestations beyond Endemic Areas

AAO Journal4d ago1 min read

A patient from Congo traveled to Paris to undergo cataract surgery. One month after an uneventful procedure, the patient was referred to our department due to the appearance of multiple firm scleral nodules (A). Clinical examination revealed asymptomatic distal ulcerations on the fingers (B) and multiple subcutaneous nodules. Slit-lamp examination revealed complete corneal anesthesia with markedly hypertrophied nerves (arrowheads, C) that appeared moniliform on in vivo confocal microscopy (arrowheads, D).

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AI Summary

Quick Take

A patient from Congo who traveled to Paris for cataract surgery was diagnosed with leprosy after presenting post-operatively with firm scleral nodules and complete corneal anesthesia. Diagnostic imaging via in vivo confocal microscopy revealed markedly hypertrophied, moniliform corneal nerves, a classic but rare clinical sign of Hansen’s disease.

Why It Matters

This case serves as a critical reminder that leprosy remains a relevant clinical entity in a globalized world, even in non-endemic regions. Ocular manifestations can be the primary reason a patient seeks care, and the combination of corneal anesthesia and thickened nerves is a pathognomonic red flag that clinicians must recognize to prevent permanent disability. Understanding these signs is essential for differentiating infectious neurotrophic conditions from more common ocular surface diseases.

Key Findings

Appearance of multiple firm scleral nodules one month following an uneventful cataract surgery.
Complete corneal anesthesia detected during clinical examination, indicating significant trigeminal nerve involvement.
Slit-lamp examination and in vivo confocal microscopy (IVCM) confirmed markedly hypertrophied corneal nerves with a moniliform (bead-like) appearance.
Presence of systemic symptoms including asymptomatic distal finger ulcerations and multiple subcutaneous nodules.

Practice Implications

Clinicians should maintain a high index of suspicion for leprosy when encountering patients with unexplained corneal anesthesia and thickened corneal nerves, particularly those with a history of residence in endemic areas. In vivo confocal microscopy can be a valuable, non-invasive diagnostic aid in visualizing the specific nerve morphology associated with this condition.

Who's Affected

OphthalmologistsCornea SpecialistsOptometristsInfectious Disease Specialists

Evidence StrengthPreliminary

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