LEPROSY
Leprosy Review
0305-7518
British Leprosy Relief Association
Colchester, UK
31-6321
0305-7518/13/064053+06
10.47276/lr.84.4.316
Case Report
Optic nerve involvement in a borderline lepromatous leprosy patient on multidrug therapy
PrabhaNeel
aSharmaSurinder K.
bSharmaVikas
aChauhanPushpinder S.
bMehtaKaraninder S.
aAbhinavC.
aKhatriGaytri
aChanderBal
cTuliRajiv
ba
Departments of Dermatology, Venereology & Leprosy, Dr. R.P. Govt. Medical College, Kangra (Tanda) 176 001, Himachal Pradesh, India
b
Department of Opthalmology, Dr. R.P. Govt. Medical College, Kangra (Tanda) 176 001, Himachal Pradesh, India
c
Department of Pathology, Dr. R.P. Govt. Medical College, Kangra (Tanda) 176 001, Himachal Pradesh, India
Correspondence to: Vikram K. Mahajan, Department of Dermatology, Venereology & Leprosy, Dr. R.P. Govt. Medical College, Kangra (Tanda) 176 001, Himachal Pradesh, India (Tel: +91 1892 287161; Fax: +91 1892 267115; e-mail: vkm1@rediffmail.com)
01122013
84
4
316
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24102013
© Lepra
2013
Amidst the plethora of ocular complications of leprosy, involvement of the posterior segment or optic nerve is extremely rare. The mechanism of optic neuritis in leprosy is poorly understood. A 47 year-old man presented with a single lesion suggestive of mid-borderline (BB) leprosy over left periorbital region; the histology showed borderline lepromatous (BL) leprosy with a BI of 3+. After initial improvement with WHO MDT-MB and prednisolone (40 mg/d) he developed sudden and painless diminished vision in the left eye, about 3 weeks later. His visual acuity was 6/9 in the left and 6/6 in the right eye, and there was left optic disc edema, hyperemia and blurred disc margins. Treatment with prednisolone (60 mg/d) along with WHO MDT-MB continued. A month later he returned with painless diminished vision in the other eye as well. Visual acuity was 6/6 in the right and 6/12 in the left eye, and there was right optic disc edema and left optic disc atrophy. CT of the head and MRI of the brain were normal. Inflammatory edema of the orbital connective tissue or other surrounding structures, or direct infiltration of vasa nervosa with resultant vascular occlusion leading to optic nerve ischemia, seems the most plausible explanation of optic nerve involvement in this case.