Efficacy of Steroid and Physiotherapy in Early Reported Lagophthalmos of Patient Affected with Leprosy. A Report from Trbal Dominated Leprosy Endemic State of India.

Abstract

Lagophthalmos is one of the well-known complications of leprosy due to involvement of the facial nerve. In the present study an attempt has been made to elucidate the role of early intervention with steroids and adjunct physiotherapy in early reported lagophthalmos in patients affected with leprosy at a tertiary referral institute under the Disability Prevention and Medical rehabilitation (DPMR) programme. During April 2008 to March 2014, 62 patients affected with leprosy reported to Regional leprosy Training and Research Institute with lagophthalmos. Cases reporting within six months of difficulty in closure were categorized as early reporting group. These were either referred from a peripheral health centre (63%) or self-reported (37%). These patients were examined clinically and details were noted in a pretested Performa. The standard dosages of the steroids were given to patients as per NLEP guidelines. Lid gaps on direct gaze and with both gentle and forced closure were assessed using standard measuring technique by a physiotherapist. During the follow-up period the patients were imparted active and passive physiotherapy and any change in the lid gap was recorded. The data was analysed and appropriate test of significance was applied. Out of 62 lagophthalmos patients, 49(79.1%) were males and 13 (20.9%) were females. 56 (90.3%) cases were from MB category and 6 (9.7%) cases were from PB category. 53(85.4%) patients presented with unilateral eye involvement, while 9 (14.6%) had bilateral lagophthalmos. 53 (74.6%) of the eyes achieved complete lid closure, while the remaining 18 (25.4%) eyes had gap on gentle closure. During six month follow-up the amount of recession of lid gap among the early reported lagophthalmos was 4.15 mm with standard steroid regimen and physiotherapy. With the use of the steroid and regular physiotherapy lagophthalmos diagnosed and treated in initial stages shows significant improvement in the lid gap reduction.