Alterações oculares em pacientes com hanseníase em um centro de referência nacional no Brasil

Abstract

Background: Leprosy is an infectious disease in which eye impairment is frequent. Recent decades have provided few studies on eye damage in leprosy. This study aimed to evaluate the ocular alterations in leprosy patients. Methods: These patients were diagnosed according to the clinical forms: indeterminate (I), tuberculoid (T), borderline-tuberculoid (BT), mid-borderline (BB), borderline-lepromatous (BL) and lepromatous (L); for treatment purposes in paucibacillary (PB) and multibacillary (MB). They were evaluated by a multidisciplinary team to determine the World Health Organization (WHO) disability grade (DG) in both eyes, hands and feet, using disability grading scale, ranging 0-2: DG=0 had no impairment due to leprosy; DG=1 presented mild sensory and/or motor changes in the hands, feet and/or eyes; DG=2 had visible deficiencies/disability. The patients were then evaluated by the ophthalmologist, who completed a clinical protocol for ocular evaluation, according to the guidelines of the International Council of Ophthalmology. This evaluation occurred at diagnosis (197 patients) and after discharge (52 patients). Results: Of 249 patients, the mean age was 50.2 (SD 16.5) years; 52.2% (130/249) were women; 79.9% (199/249) MB. The prevalence of clinical forms was: BT 67.0% (167/249), LL 12.4% (31/249), BL 9.6% (24/249), BB 7.6% (19/249), TT 2.0% (5/249) and I 1.2% (3/249). A majority of 63.5% (158/249) presented DG=0, 16.4% (41/249) DG=1 and 20.1% (50/249) DG=2. The most affected disability sites were the feet, followed by hands and eyes. The disability degree in eyes was 87.2% (217/249) DG=0; 4.4% (11/249) DG=1 and 8.4% (21/249) with DG=2. The ocular involvement occurred in 49.4% (123/249) of the patients; there was 207 alterations, a mean of 0.83 per patient. The main ones were: pterygium (12.9%), dry eye (11.2%), dermatochalasis (9.2%), keratitis (6.8%), cataract (6.8%), retinal disorders (6.8%), glaucoma (5.6%) and madarosis (4.4%). Conclusion: Leprosy patients have more disabilities in their feet and hands, and require a specialized ophthalmological assessment of ocular damage, which still prevails in almost 50% of leprosy patients, regardless of presenting leprosy lesions or not. Maintaining vision is not only a protective factor against new impairments in these patients but also a right that must be ensured in caring for people affected by leprosy.