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Dermatology

Moth-Eaten Appearance of the Iris in Hansen Disease

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JAMA Ophthalmology

Published Online: November 16, 2023

Ophthalmic Images

Article Information and Disclosures

Padmamalini Mahendradas, DO, DNB¹;

Jananee Rajendran, MBBS¹;

Radhika Sriram, MBBS, DNB¹

Author Affiliations

¹Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India

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A woman in her early 60s treated for Hansen disease 20 years ago presented with diminution of vision in both eyes for the past year. Her best-corrected visual acuity was 6/24 OU. A moth-eaten pattern of iris atrophy was noted bilaterally (Figure). Iris atrophy has been reported¹ to be the most common ocular lesion in chronic multibacillary leprosy (25% of patients), persisting despite adequate treatment (3% of patients). The patient’s lens showed cataractous changes in both eyes with a normal posterior segment as evidenced on B-scan ultrasonography. Corneal sensation measured with a Cochet-Bonne esthesiometer was 55 mm OD and 50 mm OS (mean [SD] normal sensation, 57.50 [3.41] mm).² Clinical images (slitlamp and near-infrared autofluorescence photographs) showed a moth-eaten appearance of the iris in a case of resolved chronic bilateral anterior uveitis with decreased corneal sensation, which is probably a sequela of Hansen disease.³

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Article Information

Corresponding Author: Padmamalini Mahendradas, DO, DNB, Department of Uveitis and Ocular Immunology, Narayana Nethralaya, 121/C Chord Rd, 1st R Block, Rajajinagar, Bangalore 560010, India (m.padmamalini@gmail.com).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Grzybowski A , Nita M , Virmond M . Ocular leprosy. Clin Dermatol. 2015;33(1):79-89. doi:10.1016/j.clindermatol.2014.07.003 PubMed Google Scholar Crossref

Kotak S , Christina M , Selvin SS . Establishing the normal range of corneal sensitivity in an Indian Population using the Cochet-Bonnet esthesiometer. Curr Med Issues. 2020;18(3):170. doi:10.4103/cmi.cmi_24_20 Google Scholar Crossref

Bala Murugan S , Mahendradas P , Dutta Majumder P , Kamath Y . Ocular leprosy: from bench to bedside. Curr Opin Ophthalmol. 2020;31(6):514-520. doi:10.1097/ICU.0000000000000715 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.