eMedicine Specialties > Ophthalmology > Lid

Hansen Disease: Follow-up

Author: Eva C Kim, MD, Fellow in Ocular Inflammation/Uveitis, Francis I Proctor Foundation for Research in Ophthalmology, Department of Ophthalmology, University of California at San Francisco
Contributor Information and Disclosures

Updated: Jun 22, 2006

Follow-up

Further Outpatient Care

  • After patients are on rifampin for practical purposes they are no longer contagious to other people. However, they should not be lost to follow up to ensure they are complying with their medical regimen. Also, patients should receive follow-up care to see if they have developed sequelae and if they could benefit to changes in their therapy (eg, corneal exposure keratitis, secondary glaucoma, cataracts and recurrent uveitis, iridocyclitis).
  • Household contacts should be checked for the disease; this is defined as anyone who has lived with the patient for at least 1 month since the onset of symptoms. It has been established that 20-50% of leprosy cases may be traced to household contacts. Family members are said to be 8 times more likely to develop lepromatous leprosy and 4 times more likely to develop tuberculoid leprosy. It is recommended that all family members be screened annually for at least 5 years.

Inpatient & Outpatient Medications

Complications

Prognosis

  • Frequently tuberculoid forms are self-healing and may not have symptoms but may have resultant deformities. Lepromatous Hansen disease is progressive and if untreated, can produce blindness and be fatal. Because the response to therapy may vary with medications used, prognosis is variable. When chemotherapy is started early there will be fewer complications.

Miscellaneous

Medicolegal Pitfalls

  • The socioeconomic results of this diagnosis make it essential that histologic sections confirm the diagnosis.
  • Be careful about the publication in the lay press of photos that could identify the patient or the family.
  • Attempting to diagnosis this disease when the symptoms could be confused for others as in the differential diagnosis above.
  • Concerns for other family members should not be neglected by failure to screen them for this disease.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors, Joseph B Michelson, MD, FACS, and James M Arrington, MD †, to the development and writing of this article.



More on Hansen Disease

Overview: Hansen Disease
Differential Diagnoses & Workup: Hansen Disease
Treatment & Medication: Hansen Disease
Follow-up: Hansen Disease
Multimedia: Hansen Disease
References
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References

  1. Allen JH, Beyers JL. The pathology of ocular leprosy I. Cornea Arch Ophth. 1960;64:216.

  2. American Medical Association (AMA). AMA Drug Evaluations. 6th ed. Littleton, Mass: Publishing Sciences Group Inc; 1986:1548.

  3. Centers for Disease Control and Prevention. Hansen disease. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/hansens_t.htm. Accessed 2000.

  4. Elliott DC. An interpretation of the ocular manifestations of leprosy. Ann N Y Acad Sci. 1951;54:84-100.

  5. Fasal P. A primer of leprosy. Cutis. 1971;7:525-534.

  6. Fasal P. But it was not leprosy. Cutis. 1975;15:499-509.

  7. Fasal P. Histopathology of leprosy: a tribute to Kensuke Mitsuda (1876-1964). Cutis. Jul 1976;18(1):66-72. [Medline].

  8. Gelber RH. Leprosy. In: The Merck Manual. 17th ed. Merck & Company; 1999:1206-1209.

  9. Hendrick SS, Wilkin JK. Leprosy. Am Fam Physician. Nov 1982;26(5):161-6. [Medline].

  10. Holmes WJ. Leprosy of the eye. Tr Am Ophth Soc. 1957;55:145-187.

  11. Johnson HA. A modification of the gilles, temporalis transfer for the surgical treatment of the lagophthalmos of leprosy. Plast Reconst Surg. 1962;30:378.

  12. Masters FW, Robinson DW, Simons JN. Temporalis transfer for lagophthalmos due to seventh nerve palsy. Am J Surg. Oct 1965;110(4):607-11. [Medline].

  13. Michelson JB, Roth AM, Waring GO 3rd. Lepromatous iridocyclitis diagnosed by anterior chamber paracentesis. Am J Ophthalmol. Oct 1979;88(4):674-9. [Medline].

  14. Richards WW, Arrington JM. Unsuspected ocular leprosy. Am J Ophthalmol. Sep 1969;68(3):492-9. [Medline].

  15. Shepard CC. The experimental disease that follows the injection of human leprosy bacilli into footpads of mice. Jour Exp Med. 1960;112:445.

  16. Veterans Administration. Medical Bulletin MB-10: Hansen Disease. Veterans Administration; 1965.

  17. World Health Organization (WHO). WHO Expert Committee on Leprosy. 7th Report. World Health Organization (WHO). Available at http://www.who.int/en/. Accessed 1998.

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Further Reading

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Keywords

leprosy, Hansen's disease, Mycobacterium leprae, M leprae

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Contributor Information and Disclosures

Author

Eva C Kim, MD, Fellow in Ocular Inflammation/Uveitis, Francis I Proctor Foundation for Research in Ophthalmology, Department of Ophthalmology, University of California at San Francisco
Disclosure: Nothing to disclose.

Medical Editor

Jack L Wilson, PhD, Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis
Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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